Insurance for Domestic Students
Make a photocopy of the original itemized bill. Keep this original receipt for your records. On the photocopy, clearly print the following:
- Date of birth
Insured Student Information:
- Current address
- Your social security number or the 10 digit number you register for UT Dallas classes with.
- Policy number: 101464
File claims within 30 days of Injury or 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.
Mail this copy to:
Blue Cross and Blue Shield of Texas
P.O. Box 660044
Dallas, TX 75266-0044
For further 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 the Blue Cross Blue Shield Insurance Company. This is not a bill. Do not pay it. An EOB is an informative statement about your claim (bill) that has been processed. 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, phone the SHI Office at 972-883-2747 to schedule an appointment.
If you have questions regarding a claim and/or EOB, please contact the claims department at 1(800) 521-2227 or call customer service at 1(855) 247-2273.
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. Here is how to submit a reimbursement form:
- Print and complete the Pharmacy Claim Form.
- Attach a copy of your pharmacy receipt to this form
Mail complete form and receipts to:
P.O. Box 14624
Lexington, KY 40512-4624
Visit Prime Therapeutics to find the nearest participating pharmacy. If you have any questions regarding your claim, please call 1(800) 521-2227.
File claims within 30 days of Injury or 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 UT Dallas Student Health Insurance Office does not receive or process claims 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. If you need assistance, please send an email email@example.com.