Medical Billing Process

Personal Insurance Administrator (PIA) is the Student Insurance Plan claims administrator. Student Health and Counseling does not pay or process your medical bills.  If you have questions about your bill, call PIA 1-800-468-4343.

To expedite the payment of your bill, make sure to follow these steps:

• Step 1

• Bring a copy of your Student Health referral to your specialty care appointment. Note: All referrals must be authorized by Student Health.

• Step 2

• Give the doctor's office your health insurance ID card (download it now.)

• Step 3

• If you receive a medical bill, and you have followed the steps above, the bill is likely your annual deductible, co-insurance or co-payment. To find out, call PIA 1-800-468-4343. Note: The insurance company also sends you Explanation of Benefits when claims are processed.

What are my out-of-pocket costs?

The annual deductible, co-insurance, and co-payment that apply to services received outside of Student Health and Counseling are as follows:

• • $250 annual deductible per policy year
• • 10% of costs of covered benefits for network providers
• • 30% of costs of covered benefits for non-network providers
• • $20 co-payment for each doctor's office visit
• • $50 ER co-payment

Frequently Asked Questions

Q: Why hasn’t my bill been paid?

A: The claims administrator, PIA, needs authorization from Student Health and Counseling Services before claims are processed. Nationwide Life Insurance Company maintains the right to investigate submitted claims, and sometimes require additional information including claim forms as necessary for the proper adjudication of the claim, at its discretion.

Q: Why was my claim denied? What do I do now?

A: It may be that you are lacking a referral from Student Health and Counseling Services or the service you had received is an insurance exclusion (see page 14 of your insurance brochure for details of exclusions and limitations). It is also possible that the claim is a pre-existing condition (see page 15 of the insurance brochure for more information). You have the right to request an independent medical review if healthcare services have been improperly denied, modified, or delayed based on medical necessity. Always keep a copy for your files of all forms submitted for claims.

Q: How do I get reimbursed for services I paid for?

A: Send in your itemized receipt from your provider. It needs to include a diagnosis code. You also need to attach a proof of payment and sometimes a claim form. Mail your reimbursement request to: Personal Insurance Administrators, P.O. Box 6040, Agoura Hills, CA. 91376-6040.

Q: Who do you call for billing questions?

A: Call PIA, the claims administrators, at 1-800-468-4343.