United HealthCare StudentResources (UHCSR) is the “third party claims administrator,” the company responsible for reviewing claims and “cutting checks” according to the plan design. If you have questions about the status of your claim, contact StudentResources or go to the StudentResources website, log into UHCSR’s “My Account”, and access your online claims information.
Below are important claim processing features:
PPO Provider Billing & EOB’s
PPO Providers submit claims directly to UHCSR and then bill you for the remainder of the unpaid balance. UHCSR posts the bills (claims) they receive from providers and how they processed (adjudicated) them on their website. The document UHCSR posts is called an Explanation of Benefits (EOB). EOB’s are not bills. However, the patient amount due listed on the EOB should coincide with the amount due on a bill sent to you from the provider.
Reimbursement After Paying For Treatment
If your provider is not a PPO provider, you may be required to pay for health care services when the service is rendered and then request reimbursement from StudentResources.
StudentResources does not require medical claim forms; however, a claim form is on the Forms web page for your convenience. To request reimbursement for a medical claim rendered outside of the PPO network, mail the original invoice, proof of payment, and copy of insurance ID card to StudentResources.
Please retain a copy of all mailed documentation for your records. Approximately 30 business days are required to process a medical claim.
Claims Due to An Injury
If your claim is due to an injury, expect to receive a letter from StudentResources requesting information about how you were injured. You must respond to the inquiry in order for your claims to be paid. To avoid a delay in claims payment, access StudentResources “My Account” online tool to respond electronically.
Cumulative Claims Paid In Excess of $5,000
If your cumulative claims exceed $5,000, expect a letter from StudentResources requesting information about other insurance coverage you may have. You must respond to the inquiry in order for your claims to be paid. To avoid a delay in claims payment, access the StudentResources “My Account” online tool to respond electronically.
If you believe, after you filed a claim appeal with United HealthCare StudentResources, that StudentResources did not pay for the benefits according to the plan design, contact GU Student Health Insurance in writing, to have your appeal reviewed for appropriateness.