How to use your insurance

Whether you schedule online or by phone, you’ll be asked to share your health insurance information. When using the online scheduler you will upload a photo of your insurance card. Information needed includes:

• Insurance Company name
• Member/Subscriber/Policyholder name
• Member/Subscriber Date of Birth
• Member ID
• Group number

At your first visit, you’ll need to go to the cashier to verify your insurance, make a copy of your insurance card, and to generally make sure we have everything we need to file any claims. If your insurance changes, then please be sure to update your information with a cashier.

During your visit with your medical provider, CAPS counselor, physical therapist, etc., a lot of information is collected that is used to submit a claim to your health insurer. This health information is securely documented in our electronic health record and securely transmitted to your insurer. If we don’t accept your insurance, you can get a copy of your bill containing this information and submit it to your insurer.

• A claim is basically a record of what was done during your visit, why it was done, and how much it cost. Alpha-numeric codes are used to provide a standardized method of communicating this information with your insurance company.

As listed above, a lot of information is used during your visit to file a claim.  Typically, a person may either experience a counseling session, or an office visit, a lab test, and maybe an x-ray. The Student Health Center uses one fee schedule to charge for these services. If you have insurance, your insurer may have a contract with the Student Health Center to reimburse it for these services at a rate established by them. 

This is determined by not just the health insurance company, but also by the type of health plan.

1. First, your health insurance agrees to pay a contracted rate for any covered services, such as an office visit, counseling session, lab test, medical procedure, etc. In some cases, it may pay 100% of the charge, but in most cases, you will pay a portion and the health insurance company pays the rest.
2. The amount for which you may be responsible either a co-pay, a portion of the total cost (i.e., co-insurance), or the entire amount. Sometimes, if you’re enrolled in a “high deductible plan,” you will pay the full amount until that high deductible is met. The Student Health Center will submit your claim to your health insurance, let it process, and await payment. If you owe a balance, then that amount will be billed to your student account.
3. If you do have to pay something, then your payment options are cash, check, credit/debit, health savings account (HSA), or your IU student account. If you don’t know if you have an HSA card, or some other form of flexible spending account, then be sure to check with the policy holder for your insurance. 

Once your visit is completed, staff from the Financial Operations office at the Student Health Center will file your claim and await payment. The Student Health Center will receive payment and any balance owed by you will be billed to your student account.

Remember, a claim includes a lot of confidential health information, such as the types of lab tests ordered, types of procedures, and your diagnosis. For your claim to be paid by your health insurance, the sharing of this information is necessary and legal.

What you may not know is that once this claim is paid, the holder of the health insurance policy (i.e., you, your partner, your parents, etc.) will receive what’s called an Explanation of Benefits (EOB). This document will be mailed to the policy holder, and it will outline the services listed on the claim and amounts paid by each party. 

Special note about privacy
You may need to visit the Student Health Center, but you may not want your parents, partner, etc. to know why you came to the Student Health Center and what services you received. If this happens, then you must tell a cashier to not bill your insurance. We won’t know this, so you must speak up and protect yourself. We will work with you to protect your privacy and to pay your bill.