Helpful Insurance Information and Tips
When you need to seek medical treatment, try Health Services First!
Stetson Health Service is conveniently located on campus and accepts a wide variety of health plans. For a general list of plans they accept, please check this website link.
When seeing a doctor or other medical staff at Health Services, you are responsible for the co-pay and or deductible at the time services are rendered. If the treatment needed is beyond the care of Stetson Health Service, you will be referred to an external doctor*.
*Please make sure you use a doctor who is in your insurance plan's network (see below regarding using preferred or In-network doctors and services).
If you have an emergency (e.g., life-threatening issue or injury), you should go to the emergency room and/or call 911 if you need an ambulance. If the issue is not a medical emergency, and Stetson Health Service is closed, please see Stetson Health Service as soon as the office reopens, or schedule an appointment with an in-network doctor from your plan (see below on In-Network providers).
Helpful Insurance Tips:
No matter what health plan you choose, it is recommended that you review your plan very carefully to understand the following important items and terms of your insurance plan.
In-Network/Preferred medical providers and doctors in your area
Most insurance companies cover more of the cost if you use their 'In-Network' or "Preferred" doctors and medical providers. And some will not provide coverage if you go to a medical provider or doctor 'outside' of their provider network.
- Check the plan to see what the rule is for this.
- Most Plans will have an In-Network/Preferred Provider Link
Check out their Preferred 'Provider Network' to see what hospitals, urgent care, radiologists, labs, and specialists (such as Orthos, ENT's, etc) are in the area you will be accessing them. This is usually done by zip code.
- Stetson University's Zip code to search for providers is: 32720
Many plans have medical providers nationwide, so you may want to check the listing in your home area as well.
- Deductibles: The amount you will pay out of pocket before the insurance company will begin paying their share of medical bills. (often it is an annual deductible, but some medical services may have a 'per-visit' or 'per illness/accident' deductible.
- Co-Insurance Coverage: The amount or percentage of your medical bills that the insurance company will pay for. (Example: 80%/20% Co-Ins = Insurance Co-pays 80%; You pay 20%)
Usually, they start paying this % after you have met the deductible (that is, once you've paid for your medical bills up to the amount of your deductible)
- Exclusions: Read through the insurance company's exclusions to find out what is not covered.
Using the ER vs. Urgent Care/ Walk-In Clinics
Many insurance companies will not pay for medical costs at the Emergency Room if you seek treatment there that is not considered as a "Medical Emergency." It is often better to go to an Urgent Care/Walk-In clinic if your issue is not a true emergency.
- Check your plan to see what their definition is of a "Medical Emergency."
- Although it differs from plan to plan, generally speaking, the definition of a "Medical Emergency" is often described as:
A sudden, serious, and unexpected sickness or injury, that in the absence of immediate medical attention, a reasonable person could believe this condition would result in any of the following: death; placement of the person's health in jeopardy; serious impairment of bodily functions; serious and permanent dysfunction of any body organ or part; or serious jeopardy to the health of a fetus.
- Find out what Urgent Care/Walk-In Clinics are available in your plan's Medical Provider Network for your area.
Insurance Payments/Filing Insurance Claims
When you set an appointment with a doctor or other medical provider they will need to see your insurance card which will provide them with your insurance company's name and billing address, and also with your insurance policy number.
Depending upon your plan design, the medical provider will either ask you for payment at the time of your appointment and/or they will bill your insurance company.
Once your insurance company gets a bill from a medical provider, they will pay their portion of the bill (per your plan coverage) and then will send you a statement showing how much they paid and (if applicable) how much your cost is. The medical provider will then send you a bill for your portion of the cost.
Customer Service: Your insurance company should have a toll-free 800 number to call to Customer Service for any claims or insurance payment questions. Sometimes this number is on your insurance card, and/or can be found on your insurance company's website.
If you are not sure if something is covered or have billing questions or issues, you should contact your insurance company's Customer Service for assistance.
If you get a prescription from a medical provider, it can usually be filled at most local pharmacies.
Walmart, CVS, Publix and Walgreens are in the Stetson University area in DeLand.
Costs of prescriptions differ with each plan. Sometimes a plan requires a set copay cost for each prescription, and some plans will pay a percentage of the cost, or you may need to pay for the whole cost of the prescription and send in a claim form to your insurance company for reimbursement.
Check your plan benefits to see how prescriptions are covered and paid.