What You Need to Know
Many services at the student health services (SHS) are provided at no cost to UC SHIP members. When you receive care outside the SHS, you — or your provider — may be required to submit a claim directly to the claims administrator.
Claims for Medical or Counseling and Psychological Services
For services received outside the SHS with a written referral, either you or your provider will need to submit itemized bills to Anthem Blue Cross — the UC SHIP claims administrator — within 11 months of the date you receive care.
How billing typically works:
- You pay a copay at the time of service.
- Network providers will usually submit a claim directly to Anthem for the remaining part of the bill.
- When you get care from an out-of-network provider, you may have to pay upfront and then submit your own claim to Anthem for reimbursement. Remember: Anthem covers only a percentage of the total allowable charges; you’re responsible for the remaining cost, including anything over the maximum allowable amount.
If you receive a bill for the full cost of services, complete an Anthem claim form [PDF], attach all bills for services, and mail the documents to Anthem at the address on the form. Alternately, to submit claims online or check the status of your claim, log in to the Anthem website. Navigate to Using Your Anthem Plan > Submit or Track A Claim.
Within six weeks of submitting your claim, Anthem will mail you an Explanation of Benefits (EOB) statement. It will show what was paid on your claim. Register on the Anthem website to get more information about EOBs and exercise your option to go paperless. If you need help, contact Anthem or get help at your SHS.
Note: Anthem can deny payment of your bill if you do not follow the plan guidelines, including that you get a referral from the SHS before you get care elsewhere. If you have questions about denied services, contact your SHS or Anthem Blue Cross Member Services at (866) 940-8306.
Receive EOBs Electronically
Opt in to get paperless EOBs by logging in to your Anthem account.
Claims for Prescription Drugs
When you fill your prescription at a network pharmacy, you won’t need to file a claim.
If you use a pharmacy that isn’t in the OptumRx network, you’ll typically pay the full cost upfront and then submit your claim to OptumRx for reimbursement. Complete the OptumRx claim form and mail it to the address on the form. If you have questions, contact your SHS or OptumRx at (844) 265-1879.
Claims for Dental Services
Delta Dental network dentists will file claim forms for you and accept payment directly from Delta Dental. After Delta Dental processes the claim, you’ll receive a dental benefits statement that lists the costs of the services you received and the amount you owe your dentist.
When you use a dentist who isn’t part of the Delta Dental network, you may be asked to pay at the time of service and then submit your own claim to Delta Dental for reimbursement. Complete the Delta Dental claim form [PDF] and mail it to Delta Dental of California, PO Box 997330, Sacramento, CA 95899. If you have questions, contact your SHS or Delta Dental at (800) 765-6003.
Claims for Vision Services
Anthem Blue View Vision providers will submit claims on your behalf.
When you visit an out-of-network provider, you will need to submit your own claim to Anthem Blue View Vision for reimbursement. Complete the Blue View Vision claim form [PDF] and mail it to the address on the form. If you have questions, contact your SHS or Anthem Blue View Vision at (866) 940-8306.