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Billable Services

Fees Effective: September 1, 2023

While the majority of services available at the Health Service are free to students who are registered for classes and paying the health access fee, there are some services that have a fee associated with them.  Below is a listing of those services and the associated fee.

Please contact the Patient Accounts Office with any billing or insurance reimbursement questions:

E-mail:  Dicks.House.Patient.Accounts@Dartmouth.edu 

Phone:  (603) 646-9439

Federal Tax Identification Number: 02-0222111

National Provider Identifier:  1205271574

 

Medical Service Fees

Medical service fees include office, telehealth and phone visits with Health Service Physicians, Physician Assistants and Nurse Practitioners.   

  • Registered, Paid Health Access Fee - $0 per visit
  • Leave Term and Part Time Students -  $115.00 per service
  • Athletic Physical - $115.00 per physical
  • DOT, Employment, Peace Corps and Pre-op physicals - $130.00 per physical
  • No Show Fees
    • $10.00 for each missed Primary Care appointment
    • $10.00 for each missed Specialty Clinic appointment
    • $25.00 for each missed employee DOT appointment 

Please Note:

  • No Show Policy, a $10 no show fee will be billed to the student's fees and fines account through the Dartmouth Card Office for each scheduled Primary Care Appointment that is not cancelled prior to the scheduled appointment time, or when a patient arrives more than 5 minutes late for a medical assistant appointment, or more than 10 minutes late to a primary care appointment.
  • Patients will be responsible for any lab or x-ray fees associated with a physical.

Counseling Service Fees

Counseling service fees include office, telehealth and phone visits with Health Service psychologists, psychiatrists, social workers, licensed mental health counselors, psychiatric residents, and psychology interns.

  • Registered, Paid Health Access Fee - $0 per session
  • Leave Term and Part Time Students - Fee for service sessions not available
    • Students not paying the health access fee must enroll into the Health Service Eligibility Program, and pay the associated fee, to be eligible for Counseling services during leave terms or terms when part time.
  • CNS Vital Signs Test - $30.00 per test

Immunizations

  • Chicken Pox (Varivax/Varicella) - $206.00
    • Diagnosis:  Z23  
    • Procedure:  90716  
  • Hepatitis A (Havrix) - $90.00 
    • Diagnosis:  Z23  
    • Procedure:  90632
  • Hepatitis B (Engerix, 3 doses) - $58.00 
    • Diagnosis:  Z23  
    • Procedure:  90746
  • Hepatitis B (Heplisav-B, 2 doses) - $163.00
    • Diagnosis:  Z23  
    • Procedure: 90739
  • HPV (Gardasil 9) - $341.00
    • Diagnosis:  Z23  
    • Procedure: 90651
  • Japanese Encephalitis - $409.00 
    • Diagnosis:  Z23  
    • Procedure: 90738
  • Measles/Mumps/Rubella (MMR) - $112.00 
    • Diagnosis:  Z23  
    • Procedure:  90707
  • Meningococcal (Bexsero) - $206.00
    • Diagnosis:  Z23  
    • Procedure: 90620
  • Meningococcal (Menquadfi) - $194.00
    • Diagnosis:  Z23  
    • Procedure: 90619
  • Pneumonia (Pneumococcal) - $153.00  
    • Diagnosis:  Z23  
    • Procedure: 90732
  • Polio (Poliovax) - $51.00 
    • Diagnosis:  Z23  
    • Procedure: 90713
  • PPD (Tuberculosis) - $24.00 
    • Diagnosis:  Z11.1  
    • Procedure:  86580
  • Rabies (Rabies) - $500.00 
    • Diagnosis:  Z23  
    • Procedure: 90675
  • Tetanus Diphtheria (Tetanus Diphtheria) - $44.00
    • Diagnosis:  Z23  
    • Procedure: 90714
  • Tetanus Diphtheria & Pertussis (Tetanus Diphtheria & Pertussis) - $49.00 
    • Diagnosis:  Z23  
    • Procedure: 90715
  • Typhoid (Typhim) - $159.00  
    • Diagnosis:  Z23  
    • Procedure: 90691
  • Yellow Fever - $235.00
    • Diagnosis:  Z23  
    • Procedure: 90717

Immunization fees are per dose and some require more than one dose. 

Birth Control

  • IUD (Liletta) - $773.00  
  • IUD (Paragard) - $1,223.00
  • IUD (Mirena) - $1,385.00
  • IUD (Kyleena) - $1,374.00
  • IUD (Skyla) - $1,073.00
  • IUD (Insertion Only) - $528.00
    • IUD purchased through prescription plan
  • Etonogestrel Implant (Nexplanon) - $1,584.00

Miscellaneous Services

  • Cane Deposit - $22.00  ($17.00 will be credited when item returned)
  • Crutch Deposit - $29.00  ($24.00 will be credited when item returned)
  • Copy Of Medical Record - $15.00 per copy
  • Copy Of X-Ray - $12.00 per copy
  • Allergy Injection - $10.00 for single injection per visit
  • Allergy Injections - $15.00 for two or more injections per visit

Form Completions

  • Signature only - $0
  • Moderate complexity - $20.00 per form
  • Complex - $50.00 per form

Labs / Testing

Any lab that is not paid for by the Dartmouth College Health Service (Dick's House) will be billed directly to the patient by the Dartmouth-Hitchcock Medical Center who processes the specimens.

 

Making a Payment

All billable service fees will automatically be posted to the student's tuition account if not paid for at the time of service with cash, check or credit card.  Charges posted to a student's tuition account do not state the service or treatment provided as that information is confidential and cannot be released without the patient's written consent. 

We are unable to submit claims to insurance companies; however, upon written request of the patient, an invoice will be provided which may be submitted to his/her health plan for reimbursement -- please send a request to Patient Accounts.

Insurance Reimbursement

If you are a member of the Dartmouth Student Group Health Plan (DSGHP), most of the billable services will be submitted to the Plan directly for you through a secure portal by the Patient Accounts Office.  A few weeks later the DSGHP Office here on campus will post a "DSGHP Reimbursement" payment to your student tuition account where the charge was posted.  DSGHP reimburses 100% of the following charges when received at the College Health Service:

  • Leave term office visits
  • Athletic Physicals
  • DOT Physicals
  • Immunizations
  • Birth Control Devices
  • Inpatient Admissions

 The DSGHP does not cover or reimburse the following charges at the Health Service:

  • Form Completions
  • Cane or Crutch Fees
  • X-ray Copy Fees
  • Medical Record Copy Fees
  • No Show Fees 

 

If you have waived enrollment into the DSGHP, keeping your own health plan, the Health Service will be an out of network provider and unable to submit claims directly to your health plan on your behalf.  However, the Patient Accounts Office can, at the patient's request, provide an invoice that the patient may submit to their health plan for possible reimbursement.  The amount of the reimbursement, if any, will be determined by your plans terms and conditions.  If you have an outside plan and need a billable service, e-mail or call the Patient Accounts Office to go over the billing prior to receiving the service.