BU Health Insurance Claims
Frequently Asked Questions
Student Medical Insurance Plan
1. What does the Student Medical Insurance Plan cover?
There are two Plans offered- Basic and Plus. Depending on your course of study, you may only be eligible for the Plus Plan (see Plan brochure). The Plans do not offer dental benefits for cleanings or filings. It does not cover routine exams or preventative care except as specifically provided for in the Description of Benefits found on the Plan brochure found at www.aetnastudenthealth.com\bu.
2. Can I insure my dependents?
Yes. You may enroll dependent children and lawful spouses. Dependent coverage will be enrolled online directly with Aetna at www.aetnastudenthealth.com\bu. Dependents are only eligible for the Basic Plan benefits.
3. What is my identification number?
Aetna will assign you an identification number. This number will be on the identification card that Aetna will mail directly to you.
4. Does this plan cover my pre-existing condition?
Pre-existing conditions are covered by the BU SMIP.
5. How do I get a prescription filled?
You may go to any pharmacy and purchase your prescription. Participating Preferred pharmacies will charge you only for the applicable copay, with no claim forms to submit. You are required to pay in full for all prescriptions dispensed at a Non-Participating Pharmacy and then submit a claim to Aetna Pharmacy Management. You may obtain a claim form from www.aetnastudenthealth.com\bu for submitting claims from Non-Preferred pharmacies.
6. How do I file a medical claim?
Most providers will bill the insurance company from the information provided on your identification card. If you are required to pay up front, you may fill out a claim form and mail this to Aetna Student Health with your itemized billing. This must include procedure and diagnosis codes, as well as your name and student identification number.
Once Aetna considers your claim, they will send you and the provider an Explanation of Benefits (EOB). The EOB will show you how Aetna has applied your benefits, and it will tell you how much you may owe the provider. If there is a balance owed to your provider, your provider will send you a bill. If after receiving the bill from your provider you have questions about the amount you owe, you should contact Aetna Student Health Customer Service at 800-966-7772.
7. Do we have to pay our percentage amount (co-insurance) at the time of service providers?
Not necessarily. Most providers will file your claim with the insurance company first and then send you a bill with what you owe after the insurance company responds.
8. Are there are certain doctors that I must see?
Charles River Campus student enrollees frequently need to get referrals from Student Health for services to be covered. This plan uses Aetna Preferred Providers. Preferred providers can be found at www.aetnastudenthealth.com\bu
The plan does not require you to see a Preferred Provider, but if you do, you may lower your out of pocket costs. Generally, the Plan reimburses care from Preferred Providers at a higher level than those not part of the Aetna network.
9. Am I able to check claim status online?
Yes, Aetna Navigator is an interactive “self-service” system, which provides registered Aetna members with access to personalized benefit and health information 24-hours a day, 7 days a week.
§ Review who is covered under the plan;
§ Order an ID card for student and/or dependent;
§ Check the status of a claim and view claim Explanation of Benefits (EOB) statements;
§ Check if a provider participates in the Aetna network;
§ Research the price of a drug and learn if there are less costly alternatives;
§ Estimate the cost of a medical procedure or service to plan expenses.
10. Do prescription co-pays apply to the deductible or out-of-pocket maximum?
The prescription co-pays DO NOT apply to the deductible or out-of-pocket maximum.
11, Who do I call if I have any questions about the Student Medical Insurance Plan or my claims?
Contact Aetna Student Health Customer Service at 800-966-7772.
12. Do I need file a claim with Aetna for services I receive at the Health Services?
No. The Student Health Service will bill Aetna directly.
13. Is any other information needed in order to pay a claim?
If the treatment you received was a result of an accident, you will receive a letter from Aetna asking for information about the accident, i.e. was it the result of a car accident, from playing sports, etc. Your claim cannot be processed without this information, so please respond to the letter promptly. You may also receive a letter asking you if you are covered by any other health insurance plan. It is important to respond promptly to this as well.
Common insurance terms:
The amount you pay for a covered service or treatment after the health plan’s deductible has been met. Coinsurance is usually based on a percentage.
For example, you might pay 20 percent of hospital charges. If you use network
providers, you are responsible for 20 percent of the eligible charges. Network providers have agreed not to bill for anything over the approved amount.
However, if you use non-network providers, the plan would pay its share up to the approved amount only (this may be called “usual, customary, reasonable” or UCR).
You are responsible for your coinsurance percentage plus the difference between the approved amount and the billed amount. The difference can be significant.
A flat fee you pay for a covered health care service or treatment. Certain types of plans require a copayment for each office visit to a doctor and often a larger copayment for emergency care.
The amount you pay for medical bills before your plan begins to pay.
Explanation of Benefits (EOB)
A statement from your health insurer that shows amounts it has paid and amounts it has not paid for a claim. If you want to challenge the company’s payments, it’s important to make sure you get all the EOBs that apply to the claim and keep them organized.
The maximum amount your health insurance will pay for a type of covered services.
The maximum amount your health insurance will pay for covered services during your lifetime.
The amount of coinsurance you must pay yourself before your health plan starts paying 100 percent of your covered medical bills. This amount does not include the deductible, copayments, penalties and benefits not covered by your plan.