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Get a Referral for Care Outside the SHC

You Need a Referral for Care Outside the SHC
I have my referral. What now?

You Need a Referral for Care Outside the SHC

UC Davis, Hastings, Los Angeles, Merced, Santa Cruz, San Diego and San Francisco students: You must get an SHC referral for care outside the SHC, regardless of the distance from campus, except for the following: emergency room care and visits to urgent care clinics, pediatric care, obstetrics services, gynecological care and LiveHealth Online virtual visits.

UC Irvine, Riverside and Santa Barbara students: You must get an SHC referral for care outside the SHC, regardless of the distance from campus, except for the following: emergency room care and visits to urgent care clinics, pediatric care, obstetrics services, and gynecological care.

If you are out of the area or on a term break and can’t make it to the SHC, contact the SHC insurance office for assistance before you receive non-emergency care. Referrals are made at the sole and absolute discretion of the SHC.

No referral. No coverage. You must get a referral before receiving care outside the SHC, or your claims will not be covered under UC SHIP. You will be responsible for paying for all care you receive without a referral.

I have my referral. What now?
It can feel overwhelming when you find out you need medical care, especially if that involves visiting a specialist. Here are the steps to follow after you receive your referral for care.

  1. Explore the UC Family Network: As a member of UC SHIP, you have access to the UC Family of nationally ranked medical centers — along with their affiliated facilities and professional providers. The UC Family of medical centers, affiliated facilities and professional providers are in Anthem’s Prudent Buyer PPO network. Your clinician at the SHC can help you select a UC Family provider.
  2. Find network providers: You can ask the SHC for assistance finding a provider in the Anthem Blue Cross Prudent Buyer network. You can also use your StudentHealth app or go to Anthem’s online listings to search for network providers, clinics and hospitals in your area. Here's how to search the online listings:
    • Enter your Member ID or Student ID number in "Existing Member Search," or you can click on the "Use your identification number or alpha prefix to search without logging in," then enter "XDP."
    • On the following screen:
      • Select a state: California.
      • Select a plan: UC SHIP
      • Choose "Select" and "Continue"
    • Contact the provider you select to confirm he or she is still an Anthem Blue Cross Prudent Buyer network participating provider, as this can change at any time.
  3. If you must receive out-of-network care: You can also choose to take your referral to an out-of-network provider, but heads up: your costs will be considerably higher. Before you go out-of-network, keep these points in mind:
    • You may be asked to pay up front. Plus, you will have to handle your own claims paperwork because you aren’t using an Anthem provider.
    • You may pay significantly more to see an out-of-network provider than you would to see an Anthem provider. In this case, you will need to pay the difference between the provider’s billed charge and Anthem’s maximum allowed amount. These excess costs don’t count toward the annual limit on out-of-pocket costs. You’ll also pay a higher percentage of your bills out of your own pocket.
    • The annual limit on your out-of-network out-of-pocket costs is two or three times higher than if you receive care in the network.
    As you can see, out-of-network costs can add up quickly. Remember, once your costs hit the out-of-pocket limit, UC SHIP steps in to pay 100% of your costs.

For more information on finding a provider, get in touch with the Insurance Office at your on-campus SHC.

File a claim for reimbursement. For services received outside of the SHC with a written referral, either you or your provider submits the itemized bills to Anthem. To be eligible for reimbursement for your covered costs, claims must be received no later than 11 months after the date that the health care service is rendered. Find out more at “Claims, Billing, and Coordination of Benefits” and submit a claims form.

After receiving services, watch for an Explanation of Benefits (EOB) in the mail within six weeks after receiving care (network) or submitting a claim (out-of-network). The EOB shows how much Anthem will pay toward your care and how much you will pay. While the EOB is not a bill, it helps you keep track of your costs.

At first glance, an EOB may look like it’s written in a foreign language. But it has lots of useful info. Anthem even has a handy how-to guide for reading an EOB, including a tour of the statement.

Heads up: Your EOB may be mailed to your home address or your address at school. Prefer to get your EOBs online? Update your settings on the Anthem site by choosing the green “Profile” tab.