For Student Health Center Services
Revised: April 15, 2023

Charges, Insurance, and Payment Information

The Student Health Center is financed by Student Service Fees and fees for services. A fee is charged for professional services (office visits). An additional fee is charged for medications, laboratory services, procedures, supplies, injections, etc. based on the plan of treatment and the type of services provided. You may request a cost estimate once a plan of treatment or type of service has been determined by the medical staff.

The Student Health Center will file a claim with the UH System-endorsed Student Health Insurance Plan and university departments or transfer charges to a student's university financial account.

The Student Health Center accepts commercial third-party insurance for pharmacy and eligible laboratory services. All other services are billed directly to patients at a self-pay rate and a statement suitable for insurance claim submission is available through the Healthy Coog Patient Portal.

Payments for charges transferred to a student's university financial account are processed by the Office of Student Business Services. It is the student's responsibility to maintain current payment information with the Student Health Center

• I understand and agree that I am financially responsible for the payment of all balances transferred to my university financial account.
• I understand and agree that it is my responsibility to notify the Student Health Center of my initial payment selection and any future changes by submitting a Support Ticket through the Student Health HELP HUB.
• If you are Enrolled in the UH System-endorsed Student Health Insurance Plan for the current coverage period. Once your insurance plan is active for the current coverage period, allow 24-48 hours for Academic HealthPlans to upload your insurance enrollment information to your Student Health Center records. The Student Health Center will file a claim of all eligible charges with the UH System-endorsed Student Health Insurance Plan.
  • I understand and agree that it is my responsibility to renew my coverage in the UH System-endorsed Student Health Insurance Plan each coverage period.
  • I understand and agree that I will be responsible for the self-pay cost of any services provided at the Student Health Center should I allow my coverage in the UH System-endorsed Student Health Insurance Plan to lapse.
  • I consent to the release of my medical records for the purpose of Student Health Insurance Billing (if applicable).
• If you DO NOT have health insurance. You will be charged at our self-pay rate for services rendered and the amount owed will be transferred to your university financial account.
• If you WILL NOT USE your commercial third-party insurance plan for eligible laboratory services that are sent to Quest. You will be charged at our self-pay rate for services rendered and the amount owed will be transferred to your university financial account.
• If you WILL USE your commercial third-party insurance for eligible laboratory services that are sent to Quest Diagnostics. You will be charged at our self-pay rate for services rendered (with the exception of lab sent to Quest Diagnostics) and the amount owed will be transferred to your university financial account. Quest Diagnostics will file a claim with your insurance carrier for the labs sent to their facility.
  • I understand and agree that it is my responsibility to upload a copy of my health insurance card through the Healthy Coog Patient Portal and inform the Student Health Center of any changes.
  • I understand and agree it is my responsibility and not the responsibility of the Student Health Center medical staff to know the limitations of my insurance plan and if it will pay for laboratory services provided by Quest Diagnostics.
  • I understand and agree that I am financially responsible to Quest Diagnostics for all claims submitted to my insurance carrier on my behalf whether or not it is a covered benefit.
  • I understand and agree that a claim submission is not a guarantee of payment. I will check with my insurance company for benefits and eligibility.

Athletics Billing with Authorization

The Student Health Center will bill Athletics upon receipt of acceptable authorization from the University of Houston Sports Medicine Department.

• I understand and agree that it is my responsibility to request that a payment authorization be submitted to the Student Health Center prior to my appointment and that I am fully responsible for all charges regardless of my department’s authorization or if a payment authorization is not submitted prior to my appointment.
• I consent to a release of my medical records to the University of Houston Sports Medicine Staff for purpose of billing and/or determination of sports eligibility.

UH Department Billing with Authorization

The Student Health Center will bill a UH Department for limited services upon receipt of an authorized UH DEPARTMENT REQUEST FOR STUDENT HEALTH CENTER SERVICES form.

• I understand and agree that I am fully responsible for all charges regardless of my department’s authorization.
• I understand it is my responsibility to inform the front desk at check-in that I have an authorization on file prior to each visit.
• I hereby consent to the release of my medical records for the purpose of UH departmental billing (if applicable).

Eligibility for Services

All currently enrolled students at the University of Houston are eligible for all services at the Student Health Center. Term eligibility dates are based on the university’s Academic Calendar, not college-specific dates.

FALL TERM ELIGIBILITY FOR SERVICES:

Students enrolled in the Fall term are eligible for all services beginning the Monday prior to the first class day through the day prior to the first class day of the Spring term.

SPRING TERM ELIGIBILITY FOR SERVICES:

Students enrolled in the Spring term are eligible for all services beginning the Monday prior to the first class day of the Spring term through the day prior to the first class day of the Summer term.

SUMMER ELIGIBILITY FOR SERVICES AND SUMMER ELIGIBILITY EXTENSION FEE:

Students currently enrolled in any Summer sessions are eligible for all Student Health Center services during the Summer term beginning the first class day of the Regular Summer session through the day prior to the first class day of the Fall term.

The Summer Eligibility Extension Fee is a non-refundable charge to students who are not currently enrolled in a Summer session, meet the following criteria, and choose to use the Student Health Center during the summer. This non-refundable fee cannot be prorated or credited, meaning the fee amounts remain the same even if paid after the summer eligibility period begins or scheduled appointments during the summer period are canceled.

This is an access fee, not health insurance, and allows individuals to use Student Health Center services during the summer through the day prior to the first class day of the upcoming Fall term if they meet the eligibility criteria.

• Students who graduate in May can receive services at the Student Health Center for the subsequent summer period through the day prior to the first class day of the Fall term. A non-refundable Summer Eligibility Extension Fee will be posted to the student's university financial account at the time the first summer appointment is scheduled.
• Students who are not currently enrolled in a Summer session, but who were enrolled for the previous Spring term may receive services at the Student Health Center subsequent summer period through the day prior to the first class day of the Fall term. A non-refundable Summer Eligibility Extension Fee will be posted to the student's university financial account at the time the first summer appointment is scheduled.
• Students who are not currently enrolled in a Summer session or the previous Spring term, but are pre-registered for the upcoming Fall term, may receive services at the Student Health Center beginning July 15th (July 1st for College of Medicine students) through the day prior to the first class day of the Fall term. A non-refundable Summer Eligibility Extension Fee will be posted to the student's university financial account at the time the first summer appointment is scheduled.

Missed Appointments

Appointment No Shows, Late Arrivals, and Late Cancellations penalize patients who have to wait for an appointment with one of our clinics. It could even force a patient to seek care outside the Student Health Center costing them more than our services in-house.

• IN-PERSON APPOINTMENTS: We request that you plan to arrive at the Student Health Center at least 15 minutes prior to your scheduled appointment to allow enough time to complete the check-in process.
• TELEHEALTH APPOINTMENTS: We request that you check in for your telehealth appointment at least 15 minutes prior to your scheduled appointment to allow enough time to complete the check-in process and resolve any technical issues.
• If you arrive after your scheduled in-person or telehealth appointment time, you will be asked to reschedule your appointment. A No Show fee will be posted to your university account if you fail to arrive at your scheduled appointment without appropriate notice. Please take into account the time to travel to our destination which includes traffic and finding a parking space as well as the check-in process so as not to risk a late arrival or no-show.
• I understand and agree that I have read and understand the Student Health Center policy regarding missed appointments.
• I also understand and agree that I am financially responsible for any “No Show” charge that is posted to my university account due to missing an appointment without notice.

Acknowledgment of this agreement is obtained electronically or on a separate form.