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 (In-network) Providers submit claims directly to UHCSR and then bill you for the remainder of the unpaid balance. UHCSR posts on their secure web based claims system information about the bills (claims) they receive from providers and how they processed (adjudicated) them. The document UHCSR posts is called an Explanation of Benefits (EOB). EOB’s are not bills. However, the patient amount due on the EOB should coincide with the balance due on a bill sent to you from the provider.
UHCSR has an EOB video on their website. Although, the video uses a more basic plan design compared to the Premier Plan’s, e.g., the company’s share of the in-network coinsurance is 80% instead of 90%, viewing it will help you to understand an EOB.
Reimbursement After Paying For Treatment
If your provider is not a PPO provider (out-of-network), you may be required to pay for health care services when the service is rendered and then request reimbursement from StudentResources.
To request reimbursement for an out-of-network medical claim, upload the payment information listed below.
- Copy of your ID Card
- Make sure all bills indicate a diagnostic code, procedure code, date of service and cost.
- If payment was made by check, provide a copy of the front and back of the cancelled check.
- For card or electronic payment documents, the institutions official statement that includes the account holder’s name full name, the institution’s name, and payment information for each date of service is required.
- UHCSR will call the provider of services to verify all cash payments.
- Follow the UHCSR’s instructions for securely uploading your payment documentation for reimbursement.
- If you would rather mail the information, instead, use this claim form for instructions.
Retain a copy of all documentation for your records. Approximately 30 business days are required to process a 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 injury claims payment, access StudentResources “My Account” online tool to respond electronically. You may link here to view UHCSR’s injury form.
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. Also, if you would like help with the appeal, contact us. Appeal instructions and deadlines are in the Certificate of Coverage.