UC SHIP Billing Process

What to Expect – Billing from UCSF Health

Billing and Insurance at UCSF Medical Center is specific to each department in which you receive care.  Some offices will collect your specialty copay at the time of the service.  Other offices will not collect a copay at the time of service but rather bill your insurance carrier first (i.e. Ambulatory Care Clinic*).  After the claim has been adjudicated you will receive an explanation of benefits from the insurance carrier reflecting payment.  UCSF will post insurance payments and direct remaining charges to the patient (deductible, copay, and coinsurance). 

UCSF will generate a statement every month until the balance is paid and if payment is not received after 3 statements, the patient will receive automated phone call reminders about the unpaid balance. You may check your outstanding balance within “https://www.ucsfhealth.org/mychart”.

*Visit to the ambulatory care clinic requires a referral from Student Health and Counseling Services

What happens if my account is turned over to a collection agency?

Accounts are assigned to “Collection” when the patient fails to pay the amount due and/or fails to meet payment arrangements. UCSF writes off the account and transfers the entire balance to the collection agency. The collection agency UCSF uses is Transworld Systems, Inc.  The collection agency will pursue the account balance until resolved which may affect your credit rating.

If the collection agency recovers the money (claim reprocessed, private pay, etc.), the UCSF write-off adjustment is reversed, and the payment is posted to your “https://www.ucsfhealth.org/mychart” account. The patient would then be responsible for remaining charges (deductible, copay, and coinsurance). You may check your outstanding balance within “https://www.ucsfhealth.org/mychart”.

If you are seeking care that is not covered by your insurance plan, you are considered a self-pay patient. All self-pay  patients at UCSF are eligible for a discount. For additional information about UCSF’s discount policy, please contact the Financial Counseling office at (415) 353-1966. 

*Visit to the ambulatory care clinic requires a referral from Student Health and Counseling Services

Out-of pocket costs are your expenses for medical care that aren't reimbursed by insurance including deductibles, coinsurance, and copayments for covered services plus all costs for services that aren't covered. For more information about your insurance see Medical Plan.

Q: Why hasn’t my bill been paid?

A: The claims administrator, Anthem Blue Cross, needs authorization from Student Health & Counseling Services before claims are processed. Anthem Blue Cross 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. 

Also make sure the claims administrator received a copy of the bill which includes the necessary CPT codes.  Even if you gave the provider of care your insurance information, sometimes the actual bill doesn't make it to Anthem Blue Cross.  Confirm that the insurance company has a copy of the bill.

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

A: It may be that you are lacking a referral from Student Health & Counseling Services or the service you had received is an insurance exclusion. 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: If the specialist does not bill the insurance company directly, then you will need to get reimbursed by the insurance company by completing the Medical Claim Reimbursement Form. In this case, make a copy of your receipt and itemized bill, complete a claim form, and mail both to Anthem at P.O. Box 60007, Los Angeles, CA 90060-0007. If billing issues arise, please review the Medical Billing Process.

Q: Who do you call for billing questions?