Medical and Mental Health Claims

2019-2020 Plan Year

To estimate your financial responsibility when seeking treatment, refer to the Premier Plan Certificate of Coverage  for the details of applicable deductibles, co-payments, co-insurance, limitations, and exclusions. In addition, refer to the Certificate for details regarding the following features of managing your health care costs:

PRECERTIFICATION

Call Advocare to precertify specific treatment and to help coordinate covered expenses for:

  • Inpatient admissions,
  • Allergy testing when referred by the Student Health Center, and
  • Maternity care expenses within the first thdree months of pregnancy.

EMERGENCY ROOM COVERAGE

To have Emergency Room services reimbursed, the condition must meet the Medical Emergency definition in the Premier Plan Certifcate. Consider urgent care clinics for after hours urgent care needs.

REIMBURSEMENT SCHEDULES 1, 2, AND 3

To reduce your out-of-pocket costs, access providers according to the schedules below.

  1. Schedule 1, first: Student Health Center and the Counseling and Psychiatric Service,
  2. Schedule 2, second: United HealthCare Choice Plus PPO network
  3. Schedule 3, last: Other out-of-network providers, worldwide

Plan reimbursement differs according to provider billing not provider referrals. For example, the Student Health Center may order labs or x-ray from Georgetown Univeristy Hospital. They will be billed by the hospital and paid under Schedule 2.

PPO PROVIDERS

If you obtain care from the United HealthCare Choice Plus PPO network, your provider has agreed to provide treatment at a discount and to bill the claims company directly. Most providers at GUH are United HealthCare Choice Plus PPO providers. 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 United HealthCare StudentResources.

To identify a United HealthCare Choice Plus PPO provider, go to www.UHCSR.com. When you contact the Provider to schedule an appointment, confirm that the Provider continues to be a United HealthCare Choice Plus PPO provider.