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Using Private Insurance

What about Health Insurance?

Health Services strongly recommends it. Cal Poly cannot pay for off-campus care; therefore, for medical and surgical problems beyond the scope of Health Services, each student is encouraged to have their own coverage for major medical, surgical and emergency expenses. A low-cost, limited-benefit policy written for CSU students is available through a private company.

What kind of insurance do I have? How does it work?

It is important that you know what kind of insurance you have: HMO, PPO, or regular indemnity insurance. What follows is a description of the usual characteristics of each type of insurance. The most critical bit of information you need to know about your insurance is whether or not you need preapproval for a medical service in order to be reimbursed for your expenses by your insurance company. Call the number on your insurance card to fi nd out.

Health Maintenance Organizations (HMOs)

If your insurance requires a per visit co-pay, then you probably are covered by an HMO. An important consideration for HMO customers is that any medical service other than care from your primary care provider or emergency medical services will require pre-approval by your HMO. Without pre-approval, most claims will be refused payment and you will be required to pay the entire
bill. Your membership card will have the number you need to call for preapproval. In general, your care under an HMO is managed by a Primary Care Provider. If you plan on living in San Luis Obispo County for the Academic Year or longer, you may want to consider changing to a primary care provider in this County, since his/her approval will be needed for specialty care referrals. This
will save you from having to drive home for that approval. This will not affect your ability to use the Health Services’ providers for your routine health needs.

Out -of-County HMOs (Kaiser)

Some HMOs, like Kaiser, do not operate in San Luis Obispo County. If your HMO does not operate in San Luis Obispo County, you are still covered for medical emergencies. Whenever possible, you should call your HMO for prior approval before seeking care. However, in a true medical emergency, go directly to the nearest emergency room.

Indemnity Insurance Plans

Indemnity insurance plans simply pay a percentage of your medical expenses after your deductible is met. In most instances you will not have to submit bills for medical care, but you will probably have to submit bills for pharmacy items and medical supplies in order to be reimbursed. If you have a $500 deductible plan, the insurance will not pay for the fi rst $500 of expenses you
incur.

Preferred Provider Organizations (PPOs)

Preferred Provider Organizations insurance plans work very similarly to indemnity insurance, except that PPOs create groups of providers that you can see at a discount. For example, they may pay 80% of your bill if you see someone from their provider list, but only 60% if you see someone who is not on the list. Frequently there is a deductible. If you have a $500 deductible plan, the
insurance will not pay for the first $500 of expenses you incur.

Inpatient Hospital Care

Hospital care is extremely expensive. If you are going into the hospital, it is critical that you follow the correct procedures set by your insurance company. If you are covered by an HMO, your hospital stay must be pre-approved by the HMO or you stand a high probability that they will not pay for your care. The hospital admitting offi ce should help with pre-authorization, but in order for them to do that effectively they need your insurance card. Be sure to carry it with you at all times.

When You Need to Use Private Insurance

Italics items may require pre-approval from your health insurer.

  1. For emergency services
  2. For hospitalization
  3. For urgent services that occur after Health Center hours [see urgent care facilities in San Luis Obispo]
  4. For the services of medical specialists not seen at the Health Center
  5. For basic health services away from campus [note that you can receive basic health services from any Cal State University campus if you are a currently enrolled Cal Poly student.

Supplemental Insurance is available online or pick up an application at the Health Center.

 

Supplemental Insurance Checklist

  • IF YOU HAVE A MEDICAL EMERGENCY CALL 911 OR GET TO THE NEAREST ROOM REGARDLESS OF INSURANCE CONSIDERATIONS.
  • CARRY YOUR HEALTH INSURANCE CARD AT ALL TIMES
  • If you have HMO coverage, call for pre-approval of all non-emergency services.
  • If you have PPO coverage, find the appropriate provider from your provider list for this area.
  • If you have indemnity insurance, contact the provider of your choice.
  • Keep all receipts for services, doctor’s costs, pharmacy items, and medical equipment. It may be necessary to submit these to your insurance company at a later date.
  • Know which pharmacies accept your health plan. If there is no pharmacy in this area (as is the case with Kaiser), check to see if the Health Center Pharmacy has the medication. Our prescription prices are generally the best in town.