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CONTACT US

Insurance Office
209.946.2027
insuranceoffice@pacific.edu
Cowell Wellness Center
Ranai Koch
Student Insurance and Marketing Coordinator
3601 Pacific Ave
Pacific Health Services
Stockton, CA 95211

Student Insurance FAQ

CLAIMS

REFERRALS

COVERAGE

CLAIMS

You are financially responsible for any charges you incur outside of Pacific Health Services, regardless of whether your insurance is expected to pay or not. If you receive any statements from Anthem Blue Cross or from a provider of service, it is your responsibility to follow up and ensure that the charges are paid, either by you or by the insurance plan, and that you respond to all requests from Anthem for additional information in order to process your claim.
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The doctor (or hospital) is billing me, but I have insurance. What should I do?

You should contact the provider of service to discuss the charges further. If they (or you) have already filed the claim with the insurance company, you should contact Anthem Blue Cross to verify the status of the claim. If the claim has already been considered, you should verify the amount you are responsible for paying and then contact the provider of service to discuss payment options. If the charges have not been filed yet, and the provider has agreed to file the claim on your behalf, give them your insurance information.
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I received a statement from the insurance company that says 'THIS IS NOT A BILL". What do I do?

When an insurance company processes a claim, they will send you an Explanation of Benefits (EOB). The EOB will tell you whether charges were denied, applied towards your deductible or co-pays, or how it was paid. The EOB will also reflect the "Patient's Responsibility" which is the amount you will owe the provider of service. That amount does not include any payments you may have already made to the provider. It is important that you follow up with the provider to confirm that their records reflect any payments made by you or the insurance company. You should be able to match up the EOB(s) with any bills you received from the provider. If the totals do not match, you may call the insurance company to discuss the EOB(s) further. You may also call or visit the Insurance Office for assistance qt 209.946.2027.
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Why is Anthem asking for information from me?

Anthem requires a claim form from you in order to consider any charges. The claim form contains important information that they need in order to review your claim and also allows them to request information from providers, if necessary. Sometimes they require additional information such as prior medical history, other insurance coverage or accident details. It is very important to complete the requested form(s) and to supply the requested information so that Anthem can continue the processing of your claim. If you fail to supply the requested information, your claim may be delayed or denied.
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How do I file a claim?

If service is provided at Pacific Health Services, we will file the claim for you. Service rendered outside of Pacific Health Services should be billed by that provider. If you need to submit a claim form because another provider did not do so on your behalf, you can contact the Insurance Office for help or get a claim form from Anthem.
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Can I view my claims online?

Yes, you can view all of your submitted claims online through the Anthem Blue Cross member website. You must first create an account using the member ID on your insurance card. This also allows you to: print out a temporary insurance card and request a permanent one, see cost estimates on various procedures prior to services being rendered, chat online with an Anthem representative regarding claims and coverage, and learn more about various illnesses and how to prevent them.
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REFERRALS

Important referral requirements

When receiving care within a 30-mile radius of Pacific, the SHIP requires that you obtain a written referral from Pacific Health Services prior to receiving any non-emergency services. A referral is not required for Emergency Care, but a written referral from Health Services is required for any follow-up care after your visit to the emergency room. A referral from an Emergency Room doctor is not a valid referral. NO BENEFITS ARE PAYABLE when covered charges are incurred within a 30-mile radius of Pacific in the absence of a Health Services written referral or emergency.

Exclusions: Students do not need a referral in these circumstances-

  • Any student not attending the Stockton campus
  • Health Science majors on clinical rotations or internships
  • Maternity
  • Psychiatric care

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    When do written referrals expire?

    Each written referral for a condition is valid for the number of visits or time period indicated on the referral form. In no case is the referral authorized for more than 365 days or beyond your last day of SHIP coverage.

    It is the student's responsibility to obtain a new referral from Health Services prior to the expiration of the current referral, if on-going services are necessary.
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    Medical services outside a 30 mile radius of Pacific

    When outside 30 miles of Pacific, students may access care directly and no referral is required. Students are encouraged to utilize the PPO network to ensure the highest level of coverage for eligible services. To find an in-network provider you may use the Find a Doctor service through Anthem or call the customer service number listed on the back of your insurance card.
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    Emergency room services

    In the event of a medical emergency, proceed immediately to the nearest medical facility. Using an in-network facility will be most cost-effective.

    Eligible services through an in-network provider would be covered at 100%, after the $50 deductible has been satisfied.
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    If follow-up care is required after the emergency room visit, a written referral from a Health Services provider is required. If a written referral from a Health Services provider is not obtained prior to services being rendered, coverage and payment will be denied and the student will be responsible for all charges. A referral from an emergency room doctor is not a valid referral.

    COVERAGE

    To find out more about what the Anthem Blue Cross plan covers, please read the plan brochure.

    How do I find a Preferred Plan Provider (PPO Provider)?

    To locate a provider, you can access the Find a Doctor service or call the customer service number on the back of your insurance card.

    Please be aware that if you are treated at an in-network hospital, it does not mean that all providers at that hospital are also in-network.
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    Prescription Coverage

    SHIP provides benefits for covered prescriptions. Refer to the SHIP brochure for co-insurance and benefit information.  Prescriptions supplied by Health Services will be a $10 co-pay or the cost of the medication, whichever is less. Prescriptions filled at an in-network pharmacy will result in a $10 co-pay for generics, $20 co-pay for brand name when generic is not available, and $30 co-pay for brand name when generic is available. FDA approved contraceptive medications and devices are covered with no co-pays, meeting Affordable Care Act guidelines.
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    Vision Coverage

    The Anthem Blue Cross Plan has a full vision plan included. To see your benefits, please refer to this plan document.
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    Does SHIP provide benefits for pregnancy?

    Yes. Pregnancy is considered the same as any other medical condition. Maternity care benefits are based on the type of service provided.

    A newborn is covered for any illness or accident for 30 days from birth. To continue coverage for a newborn beyond the first 30 days, you must enroll him/her as a dependent in the plan. This coverage can be purchased over the phone with Wells Fargo. 
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    I just graduated. When will my coverage end?

    Coverage will continue through the last day of the term you are enrolled in the plan. From this day you have 45 days to enroll in the Continuation plan through Wells Fargo. Anthem provides a 3 or 6 month plan with the same benefits as the student plan. Please note this is a one time enrollment so you must choose wisely as you can not enroll in the 3 month plan and then extend it to 6 months at a later date.
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    Does SHIP provide coverage for dental services?

    For the 2012-2013 academic year, SHIP provides very limited coverage for dental services that results from an injury to healthy natural teeth. See the brochure for more information. To purchase a separate dental plan please refer to the Wells Fargo site to get a quote. Please note that these plan are not sponsored or endorsed by the University.

    Beginning in academic year 2013-2014, dental will be included with the student plan. More information will be provided as it becomes available.

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    What are the mental health benefits?

    Anthem Blue Cross covers mental health issues on the same basis as any other sickness. Please refer to the plan brochure for benefit specifics.

    Pacific has also contracted with Anthem to provide students with a Student Assistance Program. There is 24-hour online access to topics that will point you in the right direction for a variety of mental health issues.
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