| SHIP services provided by Anthem
Blue Cross Prudent Buyer Providers |
The Student Health Insurance Plan was created solely for the
benefit of UC Berkeley students. It is a non-profit plan administered
by the University. In order to keep the cost of the plan low,
the University has contracted with Anthem Blue Cross to provide
medical and mental health services through Anthem Blue Cross'
extensive network of providers and hospitals. These providers,
called Prudent Buyer Providers, have agreed to charge lower
fees to Anthem Blue Cross patients.
|
| The SHIP Office will help
you selelct a Prudent Buyer Provider |
When you visit the Student Health Insurance Office
to obtain authorization for off-campus services, a Benefits Representative
will (a) determine if the provider to whom you have been referred
by your clinician is a Prudent Buyer Provider, or (b) help you select
an appropriate Prudent Buyer Provider if one is not specified on
your referral. You may also visit the Anthem
Blue Cross website at http://www.anthem.com/
for a complete list of Prudent Buyer Providers. |
| If you go to a non-Prudent Buyer
Provider |
If you receive care from a provider who is not a Prudent
Buyer Provider, you will pay more. Providers who are not contracted
with Anthem Blue Cross may charge patients more, and Anthem Blue
Cross will pay up to a certain amount, known as the "limited fee
schedule." You are responsible for the amount of charges above the
limited fee schedule. |
| Anthem Blue Cross processes
all claims |
Anthem Blue Cross provides SHIP with another service:
claims processing. Whenever a SHIP member receives a service covered
by the plan, a claim is generated to pay the provider of the service.
For example, when a SHIP member is seen at UHS and incurs fees,
the patient pays only 20% of those fees, and UHS sends a claim to
Anthem Blue Cross. Anthem Blue Cross processes the claim and reimburses
UHS for the remaining 80% of the charges. Claims for services outside
of UHS are handled in a similar way. Non-UHS providers may request
payment of the patient's portion of fees at the time of the visit,
or may send a bill later. For more on claims submission and payment,
see How to Use SHIP. |
| The Anthem Blue Cross Card |
See How
do I obtain a Anthem Blue Cross insurance card? |
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