West Texas A&M University Student Medical Services is excited to announce that our facility will begin billing the student’s health insurance plans in the Fall 2014 semester. WTAMU Student Medical Services will utilize a third party billing company. The student health fee which is paid by the student with each semester’s academic charges will cover the co-payment. Students may opt to have their primary insurance company billed for services (lab tests, x-rays, medical procedures, medications, etc) or they may choose to self pay. This service will be specifically for fees incurred within Student Medical Services.
· Who is required to have insurance and why?
All United States citizens and all international students are required to have health insurance. On March 23, 2010, President Obama signed the Affordable Care Act. The law puts in place comprehensive health insurance reforms. https://www.healthcare.gov/
· What documents or information will the student need for SMS to bill their health insurance company (ies)?
Please provide SMS with the most current health insurance card. This will include the insurance carrier, policy number and group number of the insured.
o If you would like to e-mail a PDF copy of health insurance cards to firstname.lastname@example.org or fax 806-651-3287. Please be sure that the copy of the insurance card is legible and includes a the name of the student and the student's Buffalo Gold Card number. Please also provide a telephone number in case we have questions.
· Will the student need to pay a co-pay for the visit?
No. Because students pay tuition that includes a health fee, which supports the basic operations of WTAMU Student Medical Services, it will NOT be necessary for us to charge a co-pay for services.
· What is a deductible?
A deductible is the amount of expenses that must be paid out of pocket before an insurer will pay any expenses
· Will the student have to pay the deductible?
Insurance claim denied due to deductible not met
If the student has not met the deductible on the insurance policy, it may be declared as uncollectible. The charges will be adjusted to accommodate the self pay fee schedule.
Insurance does pay but has a deductible for fees
If the insurance company pays for the service, the charges will be adjusted and deductibles will be waived due to the student health fee coverage.
· Is it the student’s responsibility to file a claim?
No. The WTAMU Student Medical Services Department will submit the claim to the billing agency. This billing agency will file the claim with the insurance company(ies).
· Will an academic hold/restriction be placed on the student’s account until the insurance claim is paid?
No. We will not place an academic hold/restriction on the student’s account if the account is being processed by the insurance company (ies). If the claim is denied or deemed as uncollectible, the student will receive a bill by mail and have an additional 14 days to pay the balance before a hold is placed. The student has a right to file an appeal with the insurance company. If an appeal is filed, please notify Student Medical Services so that a hold/restriction is not placed on the student.
· What if my claim is denied or uncollectible by my insurance company?
Your account balance will be returned by the third party biller to WTAMU Student Medical Services. You have the right to file an appeal with your insurance carrier, but must notify Student Medical Services if an appeal is being filed. You will receive a bill in the mail for the basic fees incurred (lab, medications, x-rays and certain procedures). As with all non-insured patients, you will have up to 14 days to pay the balance before an academic hold and a $2.00 processing fee is placed. Once the balance is paid the hold will be removed.
· What will NOT be billed by WTAMU Student Medical Service’s 3rd Party Biller?
o Meningitis Vaccine that has been documented as a tuition payment. (The student can either submit their insurance claim for the vaccine or place the payment on their tuition bill. We cannot do both.)
o Referrals, health care or health expenses incurred outside WTAMU Student Medical Services. The patient or the outside facility must file the claim.
o No shows/non cancellation fees
o Processing fees/late fees
o CPR/AED, First Aid or BLS classes
What if the student doesn’t want a confidential lab, medication or procedure to be submitted to insurance?
The student can self pay for any lab test, medication or procedure that they do not want to have submitted to insurance.
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