After a student seeks treatment, they are required to submit an insurance claim for their visit. As an administrator, students may come to you with questions about the claims process or a denied bill, leaving you wondering how you can best assist. Typically, when done correctly, the claims process is easy and straightforward. However, when students receive a medical bill or a denied claim, they can panic. Just because a student gets the bill in their mailbox doesn’t mean it’s necessarily their responsibility to pay it. They shouldn’t fear but rather check back to ensure all steps of the claims process are completed.
If a student comes to you with a medical bill or questions about their claim, here’s how you can best assist them.
Advise students to check their online account:
Every student has access to an online claims account with the insurance carrier for their plan. This is a location in which they can submit their claims, check up on the status of pending claims, or download claims decisions for review. When in doubt, this is the first place to look. Steps for registering their online account, along with necessary links, are included on their Student Zone for easy access.
Advise students to call the insurance carrier:
After a student has logged into their account and looked at the information presented, they may still have questions. The next place to go for assistance is the insurance carrier. They can be contacted by email or phone, often 24 hours a day, with language assistance. All the contact information for the student’s insurance carrier will be listed on the Student Zone or the back of their ID card.
Whenever a bill is received, a student’s first step should be to contact the insurance company to see why the bill has yet to be paid. The carrier will be able to outline the rationale behind any delays and clearly explain what documents may be pending to finalize the claim. If the carrier lets the student know that the claim is not on file, it’s important that the student calls the phone number listed on the bill they’ve received to make sure the provider has the correct insurance details on file and that they submit the claim as quickly as possible.
Advise students to submit any missing information:
If additional information is pending, it is the student’s responsibility to ensure the insurance company receives it.
Often, students may forget to present their ID cards during their visit. In these situations, the member needs to contact the hospital or clinic directly and ask that they submit an itemized bill to their insurance. It’s important that the participant has their insurance ID card handy when placing the call, as the provider will likely need to ask a few questions about the information listed on the card.
If the student needs to submit their portion of the claim, direct them to their Student Zone where they can download the claim form as well as the accident form if the visit was due to an accident. After filling this out, they can submit it to the insurance company via email, fax, regular mail, or right on their online account. Depending on the method it was submitted, it will take a few days for this to be received and then reflected back on their account.
If medical records have not yet been received by the insurance company, the student should contact the facility where they sought treatment as soon as possible. They will need to authorize them to send the requested records to the insurance carrier for review.
Once received, new information will reopen the claims process, likely putting the final determination back another 30-45 business days. You can advise your students to be patient and continue checking their account for updates.
If a claim is denied, students have the right to appeal any denied bills directly with the insurance company. If the student chooses not to appeal, they can try to negotiate the balance directly with the provider. The provider has the ability to lower the balance or even write it off completely, but this is at their discretion.
Contact your account manager:
When in doubt, contact your dedicated Account Manager at ISI. They are well equipped to assist you with any questions or concerns regarding a student’s claim. In the unfortunate event that a claim is denied, your account manager will offer their experience and knowledge to help members file an appeal to have the claim reconsidered. They are regularly assisting with making sure claims are processed correctly, so don’t hesitate to reach out so they can help you and your members navigate through each of the points listed above.
Tags: Account Manager, claim form, claims process, denied claim, insurance carrier, Insurance Claims, insurance details, insurance ID card, itemized bill, medical bill, medical records, online claims account, pending claims, Student Zone