Which doctor/hospital can I choose? Is there any network?
With all insurances, you are free to choose any doctor you like. Insurance has no restrictions on doctor visits.
Most of the insurances we offer have a health care network (PPO network). PPO stands for Preferred Provider and there is a PPO Provider Directory. Next to the product details, there is also a medical network query link. If you choose an in-network doctor/hospital, there is an In-Network Negotiated Rate (NNC) between them (unless there are exceptions for specific insurance). Therefore, the hospital only charges the fee negotiated with the insurance company.
In other words, there are advantages and no limitations to medical access within the PPO network. Also, with hospitals all over the United States, finding a hospital is not difficult.
If you go to an out-of-network hospital, payouts or reductions.
Currently, all travel insurance participating in the PPO network offers an in-network negotiated fee.
If I get sick, do I need to pay the doctor/hospital first and then submit the claim, or will the doctor/hospital mail the bill directly to the insurance company?
When you buy insurance from an insurance company in the United States, you will receive a medical insurance card with your name, the insurance company’s toll-free consultation number, and claims information. You bring this card to the doctor when you are sick, many times the receptionist will ask for the insurance card and contact the insurance company to verify the insurance. The doctor has all the information needed to bill the insurance company directly, and if you haven’t paid the deductible, you’ll need to pay the deductible first.
In fact, most insurance is PPO and doctors are located all over the United States. When you are in-network, please mention that you have specific PPO network insurance (eg Coventry, First Health, UnitedHealthcare, etc.) as doctors sometimes don’t know the name of the insurance (eg Safe Travels Elite, Atlas America, Patriot America Plus, etc.), or the name of the manager (IMG, WorldTrips, Trawick International, etc.) or insurance underwriter (Sirius Specialty Insurance Corporation, Lloyd’s, Nationwide, etc.).
Also, most of the time, the hospital mails the bill directly to the insurance company. But sometimes individual doctors may not want to mail the bill directly to the insurance company, they may ask you to prepay based on the treatment receipt. In this case, you will receive a bill from your doctor for the item you submit your claim to.
Do I need to file a claim or will the hospital bill the insurance company directly? Why do I have to file a claim form if I go to a hospital in the PPO network?
Claim forms are widely used to reimburse prepaid medical expenses, not just claim forms.
Even if the hospital bills the insurance company directly, the insurance company cannot make any payments until it receives the hospital’s medical records and ensures that it is a qualifying expense. However, because medical records are kept confidential by U.S. federal law, the Health Insurance Portability and Accountability Act, the hospital cannot release them without your written authorization. Claim forms are also used for this purpose.
When American residents use the resident insurance hospital for medical treatment, the insurance company already has a lot of information about the insured. However, in the case of short-term visitors, such information does not apply. Insurance companies need to get information about your illness/injury/accident from you, collect information about your international travel dates, ensure your identity, etc. to ensure that you are indeed eligible for insurance and benefits. The claims form provides all of this information.
In other words, claims forms are used for many purposes.
So, even if the hospital agrees to bill the insurance company directly, you still need to submit a claim form to speed up the claims process. If you do not submit a claim form, the insurance company will also send you a claim form after receiving the bill from the hospital.
When I go to in-network hospitals, they still refuse to accept insurance and direct mail bills. I pay $140 out of pocket first. However, when I filed a claim with the insurance company, I was only covered for $110 and I was told this amount was an in-network negotiated fee. How do I get the $30 difference?
When you visit an in-network hospital, they should bill the insurance company directly. So, this kind of situation may not happen very often. Anyway, if the hospital is in the network, they should charge you $110 for a special visit, and they should charge you $110 at the start. It is your responsibility to take the difference of $30 from the hospital. Please show the payment explanation to the hospital.
How do I find in-network hospitals based on specific travel health insurance plans?
Choose the insurance you are interested in. And select the task as ‘List of Medical Institutions (PPO Network’ and click ‘Submit’).
Click on ‘Search Hospitals’ within the US. Some plans also have a network of hospitals outside the United States.
Enter criteria to search for a specific hospital. You can use different criteria such as zip code, city/state, type of institution (doctor, hospital, urgent care, etc.), hospital department, etc.
Even before you buy insurance, you can search for hospitals in specific plans.
How can I find the list of PPO networks outside the US?
The concept of a PPO network is mainly used in the United States. Many countries have publicly funded health plans (Canada, most of Europe, Australia, etc.) and usually do not have the concept of a PPO network. So, no matter which insurance you buy, the situation is the same. This is because it does not depend on specific insurance but on the overall health care system of a specific country.
When you travel outside the United States, there is no way to know which hospital bills directly or not. However, in either case, insurance companies have always been happy to work with hospitals that bill directly. But ultimately it depends on the hospital.
For the high costs in developed countries, hospitals may be willing to cooperate with insurance companies. But in other cases, you may pay your own expenses and submit a claim.
Although travel medical insurance companies have medical directory listings, it does not mean that doctors in the PPO network work directly with the insurance company. In many cases, listings are simply directories like the Yellow Pages. You can also find the same information anywhere by searching online, asking friends, or others.
In conclusion, by not participating in the medical network, you generally do not need to worry about a reduction in coverage out of the network. Coverage is the same no matter where you seek medical treatment.