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Using GU Student Health Insurance for Local Referrals

This information is for students who are currently enrolled in GU's Student Health Insurance: The MEGA Life and Health Insurance Company.  For any unfamiliar terms, please go to the glossary at the bottom of this page.

Helpful Links

• The GU Student Health Insurance website
• 2007-2008 Information Booklet (PDF)

Regarding psychotherapy expenses, there are three Schedules of services:

1. Schedule 1: CAPS ongoing services (resources and availabilities are limited).  Students pay a $5 copay per office visit for ongoing services (psychotherapy and/or medication management).
2. Schedule 2: Preferred Providers
• Georgetown Univeristy Hospital.  For emergency room visits, students pay $100 and the deductible applies.
• For United Healthcare Options preferred providers (PPOs), visits 1-40 are covered at 75%, and 60% thereafter. There is no deductible, and typically the student only pays the copay, with the provider seeking reimbursement of the remainder directly from the insurance company.
• To find a preferred provider follow this link.
3. Schedule 3: Out-of-Network
   • This refers to all other providers of service.
   • Visits 1-40 are covered at 75%, and 60% thereafter (the percentages apply to U&C).
   • The deductible of $250 per student applies.
   • In most cases, the provider will want all payment (fees for services rendered) up front, with the student seeking and waiting for reimbursement from the insurance company.
   • Bills for reimbursement should be sent to:
     • United Healthcare Student Resources, P.O. Box 809025, Dallas Texas, 75380-9025
     • 800-767-0700 & claims@uhcsr.com
   • No precertification is required for the first 6 sessions. Additional sessions will require precertification.

Glossary of Terms

• Copay: this is the percentage of the fee that you pay for out-of-pocket.  The remainder is covered by the insurance company.  The copay will usually a set dollar amount (e.g. $5, or $21.50), or a percentage of the fee (e.g. 25%; this is also refered to as coinsurance).  If you are seeing a provider out-of-network, you may have to pay the provider the entire fee amount, and seek reimbursement for the percentage the insurance covers (e.g. 75% of U & C).
• Deductible:  This is the monetary amount an individual must pay for health care expenses before the insruance company begins to cover a percentage of any costs thereafter.  In the case of MEGA, the deductible of $250 applies to Schedule 3 services, meaning the student will have to pay $250 for any health care expenses (including medical) before the company will start reimburse for mental health services.  Often, insurance plans are based on yearly deductible amounts.
• Out-of-network providers: this refers to providers who are not "in-network" or part of the PPO.
• PPO: Stands for Preferred Provider Organization, and also known as "In-network" providers.  This is an organization of providers (e.g. therapists and psychiatrists) who provide, for a reduced and set fee, services to insurance company clients.  Additionally, the student will only pay the copay out of pocket, with the provider seeking reimbursement for the rest.  If you use an "out-of-network" provider (i.e. outside the PPO plan), you must pay more for the services.
• U & C: stands for Usual and Customary, which is the average fee charged by a particular type of health care provider within a geographic area.  The term is used by your insurance company as the amount of money they will approve for a specific test or procedure (e.g. psychotherapy).  If the actual fees are higher than the approved amount, the individual receiving the service is responsible for paying the difference to the provider.  For example, based on a typical DC zip code, the insurance company may determine that the Usual and Customary fee for a psychotherapy is $140.  This means that if your out-of-network provider actually charges you $160 per session, insurance will only reimburse 75% of $140, and not $160 (which they have determined is more than U & C).  Sometimes, however, if an individual questions his or her provider about the fee, the provider may reduce the charge to the amount that the insurance company has defined as usual and customary.