Medical Claims

Make a photocopy of the original itemized bill. Keep this original receipt for your records. On the photocopy, clearly print the following:

Patient information:

  1. Name
  2. Date of birth

Insured student information:

  1. Name
  2. Current address
  3. Your social security number or your 10-digit UTD ID.
  4. Policy ID number (begins with ZGP)
  5. Group number/section number: 101464 - 0694

File claims within 30 days of injury, first treatment for a sickness, or as soon as reasonably possible. Bills should be received within 90 days of service. Bills submitted after one year will not be considered for payment except in the absence of legal capacity.

Mail to:

Blue Cross and Blue Shield of Texas
P.O. Box 660044
Dallas, TX 75266-0044

For more information, please visit utdallas.myahpcare.com.

After you have submitted your claim to the insurance company and it has been processed, you will receive an Explanation of Benefits (EOB) from Blue Cross Blue Shield. This is not a bill, do not pay. An EOB is an informative statement about your claim. Keep this EOB for your records.

You will then receive a bill from the provider for your remaining balance. The balance due on the bill from your provider should match your balance due listed on the EOB. If it does not match, call the Student Health Insurance office to schedule an appointment.

If you have questions regarding a claim or the EOB, please contact the claims department.

Prescription Claims

You have two options:

Present your ID card to the network pharmacy when the prescription is filled. You will be responsible for paying the applicable copayments. If you do not use a network pharmacy, you will be responsible for paying the full cost of the prescription.

OR

If you do not present your card, you will need to pay for the prescription and then submit a Prescription Reimbursement Form along with the paid receipt in order to be reimbursed. If you do not use a network pharmacy, you will be responsible for paying the full cost of the prescription. To submit a reimbursement form:

  1. Print and complete the Pharmacy Claim Form.
  2. Attach a copy of your pharmacy receipt to this form.

Mail complete form and receipts to:

Prime Therapeutics
P.O. Box 14624
Lexington, KY 40512-4624

Visit Prime Therapeutics to find the nearest participating pharmacy. If you have questions regarding your claim, please call 1-800-521-2227.

File claims within 30 days of injury, first treatment for a sickness or as soon as reasonably possible. Bills should be received by the company within 90 days of service. Bills submitted after one year will not be considered for payment except in the absence of legal capacity.

 

Please Note: The Student Health Insurance Office does not receive or process claims for services provided outside the Student Health Center and does not have access to insured members’ claims. Our office is able to explain the insurance process to insured members and the steps to take when dealing with the insurance company. Please contact us if you need assistance.

 

picture of the campus mall