Student Health Center Billing
Since 2003, MSHC has been able to bill health insurance plans for reimbursement for services provided by the physician assistant (PA) or pediatric nurse practitioner (PNP). As many of you know, the Center is part of a pilot study with the Maine Association of Health Plans. Through this pilot study, the Center will learn what level of financial support this reimbursement can provide to overall health center operations. Over 60% of our families have consistently signed up for "expanded" medical services for the past four years. Having acute care available at school saved parents time away from work and students from missing time at school.
How does billing work?
The billing for visits with the physician assistant or nurse practitioner works just like it does when you take your child to see your primary care provider. When the PA or PNP sees your child, a billing encounter form is completed. The form is then sent to MaineGeneral Health Associates (MGHA) who is doing the billing for our health center. Penny Sargent, our contact person at MGHA, submits a bill to your health insurance plan.
Will I get a bill for services provided at the Student Health Center?
One of the unique aspects of this pilot project is that you will not be charged a co-pay for visits to the student health center. But, you may receive a bill for part of the cost of the visit if your health plan doesn’t provide 100% coverage outside of the co-pay (e.g. your health plan has a deductible or you pay a small percentage for covered services over and above a co-pay).
How do you determine the cost of each visit?
The cost per visit is based on time spent with your child and the complexity of the visit. The student health center uses the same fee scale as Maine General Health Associates uses in their practices (e.g. Kennebec Pediatrics, Winthrop Family Pediatrics, and the Winthrop Health Center ).
Don’t I need prior authorization from my primary care provider in order for my child to be seen at the Student Health Center?
No, another unique aspect of the pilot project with the health plans is that prior authorization from your primary care provider (PCP) is not required for your child to be seen at the MSHC. This aspect reduces one of the barriers for young people seeking health care. Health Center staff will continue to communicate with your child’s PCP to enhance continuity of care – especially if a new diagnosis is made, a new prescription is written, or there is a need for further care.
If you have other questions about health center billing or other operations, please call Cindy Flye at 685-4923, x318.
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