How to Use Your Health Insurance

Understanding How Health Insurance Works in America

Insurance plans usually have specific doctors and/or hospitals that you have to go to for medical cared. These places and people are called your "network" or "provider group."

  • The "network" or "provider group" have a business contract with your insurance company to provide you with healthcare when you are sick.
  • Ask your insurance company about how to find a doctor or hospital that is in your plan. There is usually a toll-free (1-800) phone number to call or an online directory to listing the names, addresses and phone numbers of doctors and hospitals in your plan.

 

Find out if your insurance company will let you go outside their "network" for medical care.

 

Learn what the process is before you have a medical emergency.

  • Certain insurance companies ask that you get permission to go to an "outside of network" hospital.
  • Some ask that you call them before you go to an emergency room at a hospital.
  • It is important to know what your insurance company's rules are because going outside the "network" can be very expensive.

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How to Get the Most From Your Health Insurance

  • Carry your insurance ID card with you.
  • Know the name and location of the network hospitals in your insurance plan that are near where you live and where you are permitted to go.
  • Write down the emergency information (doctor, hospital, insurance details) so housemates and friends know how to get help for you.
  • Find and register with your own primary care (general) doctor before you are seriously sick or injured.

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What to Do When You Are Sick or Injured

  • Make an appointment at Student Health Services at SF State during business hours if you can.
  • If you have a doctor, call your doctor. They will return your call if it is after business hours and tell you what to do.
  • In an emergency, go to the nearest hospital Emergency Room or call 911.
  • Show your insurance ID card to the doctor or at the hospital before you receive medical care. Be prepared to pay your "co-pay" or your share of the expense.
  • Send in the completed claim forms to your insurance company with the required documentation. Answer later requests for more information quickly.

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When Do I Use Student Health Services?

  • Check with your insurance company to see if you are required to use the Student Health Services before you go to a private doctor off-campus.
  • Ask them if you need a "referral" (written permission to receive medical treatment from a different doctor).
  • Check with your insurance company to see if you will be paid for the medicine and services that you receive and pay for at Student Health Services
  • If Student Health Services is closed, contact your insurance company's provider network for help finding a doctor or hospital via phone or online.

 

Student Health Services Hours

Student Health Services Appointments

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To have your bills paid or to receive repayment for bills that you have already paid, you must file a "claim" with your insurance company. This claim tells your insurance company that you have received medical care and the cost of care.

  • Find out whether you need to mail a completed claim form or if you can file the claim electronically. Insurance companies usually have claim forms on their websites.
  • A claim lists specific medical and payment details. It is your responsibility to make sure a claim has been filed properly. Know the rules of your company.
  • After a few weeks, ask questions! Call the claims department and ask for a status report on your claim.

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