Determining Your Benefits for Medical Care

Call the member benefits phone number on your health insurance card.

• Have your insurance card ready as you will need to provide basic demographic information.

In-Network Insurance Plans

The following plans are considered in-network with University Health Services.

If your insurance is not listed as in-network, please confirm your network status before being seen at UHS.

• Ask the customer service representative if University Health Services (UHS) is in-network. They may need to search using our tax ID: 746000203 or our address: 100 W. Dean Keeton St., Austin, TX 78712.
• If UHS is not in-network, the representative can help you find an in-network provider or inform you about out-of-network benefits.

Verifying Benefits for Other Providers

For the following providers, refer to the information listed below:

• Clinical Pathology Laboratories (CPL): Tax ID: 74-2554159
• Austin Radiological Associates (ARA): Tax ID: 74-1597116
• For other medical providers: contact the doctors’ office or healthcare facility directly to obtain their Tax ID or NPI (National Provider Identification) number if you need it to verify benefits for their services.
• When speaking with your insurance’s customer or member services, reference the Tax ID or NPI number you obtained. We recommend confirming whether the provider is in-network with your insurance.
• You can request general benefit information (e.g., laboratory, radiology) or ask about benefits using specific CPT and/or diagnosis information if you’ve already been seen by a UHS provider.
• If you need CPT or diagnosis codes, that are not listed in your medical records viewable in your MyUHS/CMHC portal, contact the Billing office for assistance in obtaining that information.

If You Haven't Visited UHS Yet

• Confirm your member benefits for the medical services you anticipate. Ask about your coverage for specific services, such as:
  • Office sick visits
  • In-office diagnostic labs
  • Physical therapy
  • Contraceptive coverage or family planning benefits

Note that health insurance carriers often need CPT and ICD-10-CM codes to provide precise benefit information. This information is unavailable before your visit, but your insurance should be able to guide you about member benefits related to certain benefit categories. You can also check your insurance plan booklet or online member portal for additional details on excluded services.

If You Have Visited UHS

• Contact Healthyhorns Billing for CPT and ICD-10-CM codes related to the services you received. This information is available after your provider has documented your visit and/or ordered additional services.
• Provide these codes to your insurance representative to understand your financial responsibility, including:
  • Co-payment (fixed amount for the service)
  • Deductible (amount paid before insurance coverage begins)
  • Co-insurance (percentage you owe)
  • Check for Benefit Exclusions
• Ensure you understand if any services are excluded from your plan. Clarify with your insurance provider if you are unsure about any financial responsibilities for "covered benefits."

Document Your Call

• Before ending the call, request a call reference number or note the date, time, and representative's name. Keep this information in a safe place.

Appealing Claim Decisions

• If your claims are processed differently than quoted, you have the right to appeal. Use the call reference number or call details for the appeal process. Your health plan member services can guide you through this.
• By following these steps, you can accurately verify your benefits and understand your financial responsibilities for medical services.