Okay…so I am enrolled in my school health care and I recently went to the health center twice.
I just looked up the health care claims in my account, and one of them says denied., and the patient balance is 105 bucks! It was just a simple visit and some medicine prescription…
What should I do in this case? Should I call the company? There isn’t anyone around that can help me because I am a foreigner ;-(
Have you met the deductible for this year?
You should call the insurance company to see why the claim was denied. It’s possible that there was a mistake on a form.
it says: Deductible Preferred Providers $250 (Per Insured Person, Per Policy Year). I went there twice.
Wish I had different health care but this one was what I could afford
first one was:
Amount: 79$. Discount: 30.44. Total covered: 48.56 Copay 20. Total Benefit: 28.56. Copay 20.
Second one was:
Denied. Claimed 105$. Inelligible. 105$
Nothing about co pay or any health center fee haven’t showed up yet in my student account, though
Seeing a patient balance is NOT a bill.
Don’t do anything until you get an actual bill. Then you will have a phone number and an invoice number, and you can call and find out why the claim was denied.
Thanks…will keep updated when I get into problems 
You are going to want to know why it was ineligible. Was it the diagnosis that wasn’t covered? Are you limited to a certain # of visits? When you get the bill from the health center, see what they say on the invoice. Call and ask questions. Be sure you completely understand why it wasn’t covered. You may want to fight it or at least know what to do next time.
Insurance makes mistakes all the time. I spend my life on the phone on these things.Call the health services (billing) to see what the denial was for, then call the insurance company. They may send you back and forth like a ping pong ball but you will get answers along the way.
^^^ Oh yes - ALL the time. As others have said, wait for the bill as it may be worked out by then. Good luck to you!
Thanks
Just for more detail, my first visit diagnosed me with abscess on my wisdom tooth and a cold. That one was the inelligible one. I got my prescription antibiotic drug and naproxen
My second one was just to see my dry throat.
It may be that the health center bills everything to insurance to see if it is covered and reimbursable. If not, the health center eats it. Most university health centers will see you for free (as part of your student health fees), but they’d still like to keep their operating costs down so bill everything to the insurance to see what is covered. The $48 of the first visit wasn’t paid by the insurance either, as you haven’t meet your deductible.
The $105 may have been denied because it was billed wrong (as a dental matter?). I bet the health center will resubmit, but it’s still going to be under your deductible.
Update:
I am looking at my student account now and it charged me 105$…what should I do? It seems like exactly what @twoinanddone said. Maybe it was because of dental stuff.
But all they did was to see inside my mouth, take a swab of my tooth, and tell me I have an abscess. And charging 105$ just for that sounds kinda ridiculous(or am I naive??)
Should I call SHC or the company?
Call the health insurance company first. It does look like it was denied because it’s dental, and medical insurance almost never covers dental matters. But call them, and ask why it was denied. Ask if you can appeal the claim.
Appeals are not usually successful. The next thing to do is THEN speak to the billing office at SHC and put your payments on a schedule. At my students’ school, health center visits go directly onto their student account, and can be paid down a bit at a time. Your school is likely to have a similar plan, where you pay a little bit each month.
Health care is extremely expensive, and can be a lot of work to figure out, so don’t be discouraged.
Billing questions aside, a tooth abscess never just goes away. It might get better with the antibiotic, but unless the underlying cause is treated it will flare up again and then you are right back where you started.
Do you have dental coverage at all? I don’t think the health center should have diagnosed you. Usually if there is pain, swelling the dentist will take an xray. Ae your wisdom teeth all the way erupted? Are they trying to grow in and maybe there is infection around the tooth? Is there a dental school around the area that might offer care at reduced fee? Alot of teens and young adults have problems with their wisdom teeth and you need to see a dentist to find out what the problem is. This is very important.
@mommdc Luckily, I am one of the people who have little to no problem with wisdom tooth. My wisdom tooth emerged long long time ago and I had no problem until I got an abscess. Actually, I thought it was weird to have one because most of time you get that when your tooth hasn’t emerged yet. The nurse said that it could happen if your tooth brush doesn’t reach your tooth well so some food speckles could remain there. YUCK! So I took antibiotic, and has put extra attention on my wisdom tooth whenever I brush my teeth since. I feel just fine now.
How complicated is an appeal process? By the way, my health insurance is 1200$/academic year, which seems quite cheap. 250$ deductible, no max dollar policy.
Here is the link, just in case anyone of you is curious
http://sas.ua.edu/files/2014/07/2014-328-1-4-Summary-Brochure-Revised-7-16-2014.pdf
That health insurance amount is not really “extremely cheap”; it’s what one of my kids would pay if he weren’t covered on ours; for my other kid it would be more like $1800. College kids are cheap to cover because they are generally pretty healthy Dental problems can be expensive, believe me; if that is the reason you were denied, and you’re ok now, thank your lucky stars that it’s only $105. Go ahead and question it, though.
Yes, it depends, usually if a tooth is abscessed it means that the pulp inside is infected, in that case you might need a root canal or extraction. But it sounds like in your case the food particles caused the gum around the tooth to get inflamed or something. Hopefully it is not the tooth itself. Yes, make sure you clean that area very well.
Did you go to the appointment for your cold or tooth pain? You could put that in the appeal.
Cold one was covered. Thank God!
Tooth one… I have to appeal that one just for the heck of it.
Just for an update,
I called the billing office and explained that I got a wrong information that everything other than 20$ visit fee would be covered but got charged 105$. And today, my student accounts has just been updated and shows that 70$ out of 105$ has been dropped! YEY
Sometimes dental issues that are handled as medical can be covered with some effort. If the problem wasn’t in the tooth you could get your MD to get some kind of after the fact authorization if the fact that it was “dental” caused the denial. Talk to someone at customer service at your insurance, and if the person on the phone cannot help then politely ask for a supervisor.