귀하께서 네트워크 의사/병원에서 진료를 받으신 경우, 본인의 PSI의료 아이디카드를 보여주시고 보상청구서를 가져가시면 병원 측에서 PSI로 요금을 청구하게 됩니다. 만약, 귀하가 담당자에게 청구서를 받으시면 “정보 통지만을 위한” 것인지 아닌지를 확인하시고 청구서를 잘 검토해주십시오. 대부분의 병원은 귀하께 PSI에게 청구할 총 금액과 귀하의 정보 등을 보낼 것입니다. 만약 담당자가 청구서를 보냈다면 First Student (본사 보상청구 부서)에 청구서를 제출했는지를 물어보십시오.
네트워크 의사/병원이 아닌 곳에서 진료를 받으셨다면 일단 의사/병원에 비용을 지불하시고 기본 의료 요금청구서와 영수증을 보상청구서와 함께 본사 보상 청구부서에 이 메일로 보내 주십시오. First Student (본사 보상청구부서)는 귀하의 보험정책 책자에 나온 대로 비용을 배상할 것입니다.
You need to download and print your ID Card & Claim Form from your PSI online account then submit Medical Claims by Mail or Electronically:
BY MAIL - Send this Claim Form & All Itemized Bills to:
First Student P.O. Box 809025 Dallas, TX 75380-9025
Please fill out the entire first page and be sure to indicate your current address when you submit this. Your doctor will need to fill out the second page of the form
ELECTRONICALLY - Doctors/Hospitals can also submit a claim electronically, using Emedeon (formerly WebMD). This gives a faster turn-around time than submitting a claim by mail. Check with your doctor to see if they are a participant. If they are, show them your ID Card. Electronic Data interchange (EDI) Payor ID: 74227
You can check your claim status by calling First Student at 1-800-505-4160 or email customerservice@uhcsr.com.
1. Always bring your PSI ID Card & Claim Form when you visit the hospital. You can download this from your PSI online account.
2. If you pay for your medical bills upfront, please complete a Claim Form and attached all itemized bills, statements, and receipts attached, and send it to our claims division by Mail. For details on how to file claims, please click here
3. If a Preferred Provider is not available in the Network Area, benefits will be paid at the level of benefits shown as Preferred Provider benefits. Please keep in mind, although the website is updated frequently, it does not always reflect the most up to date information. Prior to being seen, you should always confirm the Preferred Provider is part of the network, as this can change without notice by calling 1-800-505-4160 and/or by asking the Doctor/Hospital. Network Area is 50 mile radius around your school campus.
4. If the Covered Medical Expense is incurred due to a Medical Emergency, benefits will be paid at the Preferred Provider level of benefits.
If you would like to submit a paper claim for reimbursement for a prescription that you paid for out of pocket, please print a copy of this Prescription Claim Form. After filling
out the necessary information, please read the acknowledgement carefully (located at the bottom of page) and sign and date in the space provided. To submit a Generic
Reimbursement Claim Form, please be sure your receipts are complete. In order for your request to be processed, all receipts must contain the information listed below:
Date prescription filled
Name and address of pharmacy
Doctor name or ID number
NDC number (drug number)
Name of drug and strength
Quantity and days’ supply
Prescription number (Rx number)
DAW (Dispense As Written)
Amount paid
This information can usually be found on the receipt which is stapled on the outside of the packaging or in some cases located inside. Your pharmacist can provide
the necessary information as well.
Please mail completed form and receipt(s) to:
FIRST STUDENT
P.O. Box 809025
Dallas, TX 75380-9025
보험보상 청구는 본사가 보험, 또는 의사나 병원에 취한 조치에 대한 보험수당의 설명(보험수당의 설명-EOB)에 따라 진행됩니다. 거기에 따르는 자료들로 고객이 보상을 청구한 수많은 지불 비용을 결정짓습니다. 요금 보상이 부당했거나, 청구가 보류 혹은 거절되었다면 보험수당의 설명(보험수당의 설명-EOB)에 따른 결정임을 알려드립니다:
대부분의 담당자들은 요금을 청구할 때, 자동적으로 요금이 청구되는 컴퓨터 시스템을 사용하고 있습니다. 담당자가 다양한 건강보험 플랜에 속해있고 그런 이유로 직접적으로 본사로 계산서를 보내는 것이 어렵습니다. 보험보상청구서는 이하의 회사 -First Student (보상청구 부서)에서 담당하고 있습니다:
First Student
P.O. Box 809025
Dallas, TX 75380-9025
1-800-505-4160
