Billing & Insurance Information

Student Health Service will submit claims to most insurance companies. Some exclusions of when we are unable to bill insurance includes Canadian insurance, Sanford True or out of state Medicaid plans (we can only bill ND and MN Medicaid). Students are responsible to contact their insurance company prior to receiving care to verify coverage including, but not limited to, determining network status (in-network versus out of network), coverage for services, and referral requirements. It is important to verify this information with the insurance company as some policies state that if a student is further than 50 miles from home, or if utilizing a Student Health Center, that they will recognize that facility as in-network. If a referral is required, please provide this to Student Health Service so visits can be covered as in-network. All questions regarding a specific insurance policy should be directed to the insurance company.

Some insurance companies may ask for our specific NPI number. This information can be provided upon request by calling 701-231-7331.

Please see our Billing & Insurance Information Sheet for a printable version of our billing process, insurance information and frequently asked questions.

See Enrolling in Health Insurance.

Health insurance can be very complicated and confusing, and some people do not know where to start or what questions to even ask. United Healthcare provides information called Health Insurance 101 to help those individuals better understand the basics of how it all works and provides definition to the following terms.

• Coinsurance: Your share of the costs of a covered health care service, calculated as a percent (for example, 20%) of the allowed amount for the service. You pay co-insurance plus any deductibles you owe. For example, if the health insurance or plan's allowed amount for an office visit is $100 and you've met your deductible, your co-insurance payment of 20% would be $20. The health insurance or plan pays the rest of the allowed amount.
• Coordination of benefits: This process is applied by individuals who have two or more existing policies to ensure that their beneficiaries do not receive more than the combined maximum payout for the plans.
• Co-pay: A fixed amount (for example, $30) you pay for a covered health care service, usually when you receive the service. The amount can vary by the type of covered health care service.
• Deductible: The amount of money you must pay out-of-pocket before coverage kicks in. Deductibles are usually set at rounded amounts (such as $500 or $1,000). Typically, the lower the premium, the higher the deductible.
• Dual coverage: The act of maintaining a health plan with more than one insurer. For example, many married people receive coverage from both their employers and their spouse’s employer. Others may opt to receive individual coverage from more than one insurer.
• Enrollment period / open enrollment: The window of time during which you can apply for health insurance or modify a plan to include your spouse and/or children. Policyholders are unable to adjust their plan until the next open enrollment unless they experience a qualifying life event. These include a marriage, divorce, birth of a child, changes to individual/household income, or interstate residence relocation.
• Network Coverage:
  • In-network: This term refers to physicians and medical establishments that deliver patient services covered under the insurance plan. In-network providers are generally the cheapest option for policyholders. Insurance companies typically have negotiated lower rates with in-network providers.
  • Out-of-network: This term refers to physicians and medical establishments not covered under your insurance plan. Services from out-of-network providers are usually more expensive than those rendered by in-network providers. This is because out-of-network providers have not negotiated lower rates with your insurer.
• Out-of-pocket maximum: The amount of money you pay for deductibles and coinsurance charges within a given year before the insurance company starts paying for all covered expenses.
• Pre-existing condition: Any chronic disease, disability, or other condition you have at the time of application. In some cases, symptoms or ongoing treatments related to pre-existing conditions cause premiums to be higher than usual.
• Premium: The amount you pay your insurance company for health coverage each month or year.
• Referral: An official notice from a qualified physician to an insurer that recommends specialist treatment for a current policyholder.
• Waiting period: Many employer-sponsored insurance plans mandate a period of 90 days before employees can enroll in their insurance plans.