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Claims, Billing & Coordination of Benefits

Claims for medical or counseling and psychological services
For UC SHIP members, most services at the SHC are provided at no cost.

For services received outside of the SHC with a written referral, either you or your provider will need to submit itemized bills to Anthem Blue Cross, the UC SHIP Claims administrator. Claims must be received no later than 11 months after the date the health care service is rendered.

Here is how it typically works: Most health care providers require your copayment at the time of service. Network providers will submit a claim for you directly to Anthem for the remaining portion of the bill. Out-of-network providers usually require you to pay up front and then submit your own claim to Anthem.

If you receive a bill for the full cost of services, complete an Anthem claim form, attach all bills for services and submit documents to Anthem. You can check the status of your claim on the Anthem site. Within six weeks after submitting a bill, you can expect to receive an Explanation of Benefits (EOB) by mail from Anthem, showing what was paid on your claim. See more about EOBs below. If you need assistance, contact Anthem or get help at the SHC.

What if your payment is denied?
Anthem can deny payment if you do not follow the plan guidelines. For example, if you don’t get a referral from the SHC, Anthem can deny payment of your bill. There are other reasons why payment may be denied, but not getting a referral is the most common. Contact the SHC or Anthem Customer Service at (866) 940-8306 if you have questions about denied services.

Claims for prescriptions
You don’t typically need to file a claim when you fill prescriptions at network pharmacies. If you fill a prescription at an out-of-network pharmacy, use OptumRx's claim form to request reimbursement. Contact the SHC or OptumRx at (844) 265-1879 if you have questions.

Claims for dental services
If you receive dental care in the Delta Dental network, Delta Dental dentists file claim forms for you and accept payment directly from Delta Dental. After the claim has been processed, Delta Dental will send a dental benefits statement to you that will list the costs of the services provided and the amount of any fees you owe your dentist.

If you visit a non-Delta Dental dentist, you may need to file the claim yourself. Contact the SHC or Delta Dental Customer Service at (800) 765-6003 if you have questions about filing a claim.

Claims for vision services
Network providers will submit claims on your behalf. If you visit an out-of-network provider, you will need to file an Anthem claim form to receive reimbursement for your expenses. Contact the SHC or Anthem Blue Vision at (800) 940-8306 if you have questions about filing a claim.

If you are covered by UC SHIP and a second insurance plan
Coordination of benefits (COB) applies to UC SHIP members who are covered by more than one health care plan. COB helps to ensure that students covered by more than one plan will receive the benefits they are entitled to while preventing overpayment by either plan. Coordinating benefits is one of the ways to keep premiums at a minimum.

If you have other coverage, please complete the COB questionnaire and submit it to Anthem.

To get the most out of your coverage, you need to become familiar with how the two plans work together.

Determining the primary plan for payment
If you are covered by more than one health plan (for example, if you are covered under the UC SHIP plan as well as a spouse’s or parent’s health plan), one plan is the primary carrier, and the other is the secondary carrier.

The primary carrier’s benefits are applied to the claim first. The unpaid balance is usually paid by the secondary plan to the limit of its responsibility. Therefore, benefits are "coordinated" between both health plans to make sure payments do not exceed 100% of charges for the covered services.

  • For care at the SHC: The SHC will submit claims to Anthem for SHC services. After you pay the copayment or coinsurance amount — if any — that UC SHIP considers your responsibility, you must submit the claim for that amount to your other insurance carrier for reimbursement. The SHC does not submit claims to other health plans.
  • For care outside of the SHC: Your other medical plan will be considered the primary plan, which means it must pay claims first. After the primary plan processes and pays a claim, any remaining charges may be submitted to UC SHIP (the secondary plan).
  • This holds true for all medical plans except Medi-Cal, MRMIP and TriCare. If you are covered by any of these plans, UC SHIP will be the primary plan, and Medi-Cal/MRMIP/TriCare will be the secondary plan.

For questions about coordination between plans, call Anthem Customer Service at (866) 940-8306.

Explanation of Benefits (EOB)

The EOB is meant to show you exactly how your benefits work for every doctor visit and service, how much the UC SHIP pays and how much you still owe. It also shows how much of your annual deductible is already paid for the year.

The EOB is not a bill, so you don’t need to make any payments when you receive it. Keep your EOB handy, because it can help you keep track of (and make sense of) bills and payments you may receive after you get health care services.

Register on the Anthem site for more details about EOBs and your option to go paperless.