FAQ: Oxy Student Health Insurance Plan
1. I have insurance through my parents and do not want the Student Health Insurance Plan through Oxy. How do I prove to Emmons that I have insurance and how do I get the charge taken off my Student Account?
Occidental College has implemented a waiver system that allows students to provide their insurance information and, if your current insurance meets the requirements set forth by Occidental College, the Student Health Plan and the fee for the insurance will be waived. Waivers only need to be completed once a year unless the student has a change of insurance between semesters. If you waived in the Fall with an insurance plan that termed before Spring semester, you will need to complete the waiver again in order for Oxy to verify that your insurance still meets the requirements. The waiver system opens during the summer every academic year so that students are afforded enough time to complete their insurance waiver. If, at any time, the student is found to not have active health insurance coverage through an insurance company, the student will be signed up for the Student Health Plan. If you waived the Student Health Plan in the Fall, but decide you would rather be enrolled on the Student Health Plan for the Spring, you can always contact Emmons at (323) 259-2657 to make the switch.
2. I waived the Student Health Insurance. That means I won’t have to pay anything if I go to Emmons, right? Wouldn’t I just owe my co-pay?
Please keep in mind that as a Student Health Center, Emmons cannot be contracted with any insurance companies. Because we are not open to the general public and do not allow non-enrolled students access to our facilities, insurance companies will not allow us to become a contracted provider. If you do not have the Student Health Insurance Plan through Oxy, your visits will often times be applied to your out-of-network health insurance benefits (which might bring extremely high deductibles). If your insurance company does not pay anything towards your visit to Emmons, Emmons gives our students a 50% discount on the billed charges. So, if your $140.00 visit to Emmons is applied to an out of network deductible, we will discount these services by 50% and place a $70.00 charge on your Student Account. Please be aware that while we do attempt to bill every student’s insurance for every visit, this is not a guarantee. If we are unable to bill your insurance for any reason, we will provide you with a letter explaining the reason why and a detailed invoice for your visit; the discounted rate is then applied to your Student Account. With the detailed invoice, you will be able to bill your insurance company for reimbursement. You can contact your insurance company using the Customer Service number on your Insurance ID Card to find out more information on submitting a claim for reimbursement.
3. I paid the fee for my student health insurance. That means I don’t need to pay anything else, right?
Wrong. Except for annual Wellness Visits, you will have a co-pay or co-insurance (think of it as a cost share) due every time you see a medical provider. If you visit Emmons, you will only owe a $10 copay that will be charged to your Student Account. However, if you see a doctor off-campus, you will owe a $25.00 co-pay at the time of visit. Any other services apply to your deductible and co-insurance.
4. What is a deductible and why is it important to know?
A deductible is a set amount of money you must pay for services before your Oxy Student Health Plan will begin paying claims. For the Oxy Student Health Plan, that deductible is $150.00. Many services apply to your deductible, so services like lab work, x-rays, MRIs, ambulance rides, surgeries, and much more all apply to that $150.00 deductible. Please understand, even if lab services are done at Emmons, we do not bill the insurance for that service – the Labs do – so your deductible will still apply to things like bloodwork. Even after you have met your $150.00 deductible, the Oxy Student Health Plan will only pay 80% of your insurance bill when you see an in-network provider. You will have a balance due of 20%.
5. Is STI testing free at Emmons?
YES! STI testing is free for all enrolled students at Occidental College. However, please remember that only the screening is free. If you see a medical provider for STI screening and other health related issues during the same visit, only the screening will be paid for by the college – you will still owe for any unrelated physical symptoms that are treated or labs that are ordered that do not pertain to an STI screening.
6. How does medication work? Do I have to pay for medication?
It depends. If you receive your medication from Emmons, you will not owe a co-pay for that medication; it is covered 100% by the insurance. However, if you are given a prescription to fill at a local pharmacy because Emmons does not have the medication you require, you will owe money for that medication. Depending on the type of medication you have been prescribed, you could owe either $20, $40, or $65 for your medication every time you have it filled. Always ask the Pharmacist how much you will owe if this could become a financial burden. If it is too much, please contact Emmons immediately and notify them of your situation.
Medication such as birth control is covered 100% under the current Oxy Student Health plan. So, you do not need to pick up your birth control at Emmons for it to be free. Any pharmacy can dispense that medication to you for free.
7. I keep getting e-mails from UHCSR that I have a new EOB or claim letter on file. What is an EOB?
An EOB is an Explanation of Benefits. These are extremely important to keep track of when you receive lab services or visit a physician off campus because you will be billed according to these EOBs. An EOB will have all of your personal and insurance information at the top, and at the bottom will describe all the services that were billed to the insurance company during your visit. The most important thing to pay attention to on these EOBs is the “Patient Balance" portion at the very right of the chart. This Patient Balance will clearly explain how much you owe for your visit, lab work, x-ray, etc. If you receive a bill from a physician’s office or hospital that is different than the amount shown in the “Patient Balance" box, please contact Emmons immediately at (323) 259-2657, or by email at kplace@oxy.edu.
8. I don’t understand my claims or any of these bills. Who can I talk to at Emmons?
If you are having trouble understanding your Explanation of Benefits or any bills you may have received from a doctor’s office, please contact Krista Place at Emmons via e-mail at kplace@oxy.edu. If you have copies or PDF files of the bills or EOBs, make sure to attach them with your email as Emmons does not have access to this information; often times we only need to see the EOB to be able to answer your billing questions.
9. I waived the student health insurance, why am I being charged a student health fee?
The health fee is separate from insurance. All students must pay the annual student health fee. This fee serves to cover the operational costs of the health center. Our service - available to all students regardless of insurance - include free mental health counseling and free STI testing, in addition to low cost medical services. We also provide health education and promotion during the academic year and set health policy for the college. The fee supplements our ability to provide all students these free and low cost services, as well as operate toward the goal of positive health outcomes for the whole community.