To be covered by UC SHIP, you need a referral from UCSF Health Primary Care to get medical care anywhere else — except for emergency room care, urgent care clinic visits, obstetrics services, gynecological care, and LiveHealth Online virtual visits.
You’ll pay nothing for preventive care at UCSF Health Primary Care. If needed, UCSF Health Primary Care will authorize a referral for services it does not provide. Without a referral from UCSF Primary Care Health, healthcare services will not be covered by UC SHIP. When necessary, be sure to get a referral so you’re not stuck with an unexpected bill.
The Student Health Insurance office may help you navigate your UC SHIP benefits or assist with claims and billing questions. Log in to the MyHealthRecord Portal and message the Insurance Coordinator.
| Type of Question | Who to contact | Phone | |
|---|---|---|---|
| Benefit & Claim General Questions | SMHW Practice Coordinators | [email protected] | (415) 476-1281, option 1 |
| Benefit & Claim Specific Questions | Send a secure message to the Insurance Coordinator via: https://myhealthrecord.ucsf.edu (SMHW secure medical record system). | (415) 476-1283 | |
Claims for Medical and Behavioral Health Services
For authorized healthcare services received outside the UCSF Health Primary Care, you or your provider must submit itemized bills to Anthem Blue Cross.
Network providers will usually submit a claim directly to Anthem for the remaining part of the bill. You are responsible for the copay at the time of service (if applicable).
When you get care from an out-of-network provider, you may have to pay upfront and submit your own claim to Anthem for reimbursement. Remember: Anthem covers only a percentage of the total allowable charges; you’re responsible for the remaining cost, including anything over the maximum allowable amount.
To submit reimbursement for an out-of-network provider, complete an Anthem claim form [PDF], attach all bills for services, and mail the documents to Anthem at the address on the form. You may also submit claims online; log in to the Anthem website; navigate to “Using Your Anthem Plan”.
Within six weeks of submitting your claim, Anthem will mail you an Explanation of Benefits (EOB) statement. It will show what was paid on your claim. Register on the Anthem website to get more information about EOBs and exercise your option to go paperless. If you need help, contact Anthem or UC SHIP services at (866) 940-8306.
What do I do if I get a bill?
Step 1: Is it a bill? Confirm it is a bill and not an explanation of benefits (EOB). It should be from a provider of care and explicitly state that “you owe” a certain amount or to “please pay this amount.”
Step 2: Did the provider bill your insurance? Confirm that the billing provider (e.g. doctor’s office) has billed your insurance. Did you give the provider your Insurance Card or Member ID number? If you are not sure, contact your provider of service.
Step 3: Was your visit authorized, or did you obtain a referral from UCSF Health Primary Care? Does Anthem have the referral information? If you received a statement that says your insurance claim was “denied,” Anthem may not have received your referral from UCSF Health Primary Care. Contact Anthem at 1-800-888-2108 to see if you have a referral for your visit. If you do not have a referral for your visit, contact your UCSF Health Primary Care provider.
Step 4: Is the amount I owe my deductible, copay, or co-insurance? Review your bill and calculate whether the amount owed is correct. Check if the amount owed is equivalent to your deductible, copay, or co-insurance payment.
Step 5: What do I do with a UCSF bill? If the amount owed is equivalent to your co-insurance for an inpatient stay call Patient Financial Services at 1-866-433-4035 and inform them, you are a UCSF student and per the memorandum of agreement between Student Mental Health and Wellbeing and UCSF Medical Center the inpatient 5% co-insurance is eligible to be waived.
If your billing question is not addressed by following these steps, please call SMHW at (415) 476-1281 for assistance.
Terms to Know
Copay (copayment). The flat fee you pay for covered services is usually due at the time you receive care. For example, you might pay a $15 copay to see a specialist.
Coinsurance. The slice of a medical service you’re responsible for. For example, you might pay 5% of the cost for a particular service, and the insurance company or plan will pick up the tab for the remaining 90%.
Deductible. The amount you must pay toward medical costs before UC SHIP starts paying part of the bill.
Explanation of Benefits (EOB). The explanation sent by the plan that shows how your benefits work for every doctor visit and service you receive. It includes how much UC SHIP pays and how much you owe, as well as how much of your annual deductible you’ve already paid for the year. EOBs are typically mailed to you by Anthem within six weeks after you or a provider submits a claim for payment.
Maximum allowed amount. The total reimbursement payable under your plan for covered services you receive from network and out-of-network providers. It is the claims administrator’s payment toward the services billed by your provider, combined with any deductible or coinsurance you may owe. If you receive services from an out-of-network provider, the provider will bill you the difference, if any, between their charges and the maximum allowed amount.
Network/network providers/in-network providers. A group of health care providers and facilities — including doctors, hospitals, and labs — that contract with your health care plan to provide services at negotiated discount rates. You’ll usually pay less when you use a network healthcare provider. UC SHIP contracts with Anthem Blue Cross to provide access to its extensive network of hospitals and providers, including UC Family facilities and provider groups.
Out-of-network/out-of-network providers. Health care professionals, hospitals, clinics, and labs that do not belong to the Anthem Blue Cross network. You’ll typically pay more, pay upfront, and file your own claim for reimbursement when you use out-of-network services.
Out-of-pocket cost. The expenses for medical care that aren't reimbursed by the insurance including deductibles, coinsurance, and copayments for covered services and non-allowable charges.
Out-of-pocket maximum limit. The maximum amount of money you’ll have to pay for health care in a benefit year. After you meet the maximum, UC SHIP covers 100% of all eligible costs for the rest of the benefit year.