If you have any additional forms of insurance coverage, submit:
- A completed Aetna Claim Form. The online form requires Adobe Acrobat Reader, or you may pick up a form at the Student Health Insurance Office.
- An itemized bill from the provider of the service. Accepted forms are CMS 1500 or HCFA 1500 billing from a physician; UB92 or UB04 billing from a hospital.
- Most patient bills are
not
suitable for insurance and our not accepted unless they contain CPT procedure codes, IDC10 diagnosis codes, modifiers, provider tax identification & NPI numbers, along with billed amounts and dates of service.
- An explanation of benefits from your other insurance carrier(s).
If Student Health Insurance is your only form of insurance coverage, submit:
- A completed Aetna Claim Form. The online form requires Adobe Acrobat Reader, or you may pick up a form at the Student Health Insurance Office.
- An itemized bill from the provider of the service. Accepted forms are CMS 1500 HCFA 1500 billing from a physician; UB92 or UB04 billing from a hospital.
- Most patient bills are
not
suitable for insurance and our not accepted unless they contain CPT procedure codes, IDC10 diagnosis codes, modifiers, provider tax identification & NPI numbers, along with billed amounts and dates of service.