FAQ for PPO network in fixed coverage visitors insurance plans
Q:
What PPO network do these fixed coverage visitors insurance plans participate in?
A:
Fixed coverage plans such as
Inbound USA, Inbound Immigrant, Inbound Guest,
Visitors Care
etc. do not participate in
any PPO network. You can visit any doctor or the hospital.
Such insurance plans are called indemnity plans.
Q:
Which providers can I go to?
A:
You can visit any provider you like. There are no restrictions.
Q:
Do I have to first pay and file for reimbursement or will they bill the insurance company directly?
A:
When you go to the provider, you can
present the insurance card, either the one you received in the email or by postal mail. The insurance card has all the information
the provider's office will need to bill the insurance company directly such as the certificate
number, claims filling address in the U.S., toll-free number to call and verify the coverage.
It still depends upon the doctor whether
to bill the insurance company directly or not. Even if the doctor accepts the card,
there is no network negotiated fee.
If you have to pay first, you can get reimbursement by filing a Claim Form.
However, when there is hospitalization/surgery involved and the costs
are quite high to pay first, the claims administrator can make necessary arrangements to pay the provider
directly, once it is determined that it is an eligible expense.
Even if the provider agrees to bill the insurance company directly,
you must still file a Claim Form to expedite
the claim process. When the provider sends the bills to the insurance company,
the insurance company would need to request medical records from the provider
which the provider can't give until they have authorization from you to release
the records. Filing a claim form provides such authorization.
All the claims are handled in the U.S.
Q:
Are there network negotiated fees in fixed coverage plans?
A:
No. As there is no PPO network, there are no network negotiated fees either.
Q:
Why there is no PPO network in the fixed coverage plans?
A:
As fixed coverage plans only pay a fixed amount for each procedure and you will have to pay the difference yourself, the
insurance companies have no incentives to negotiate the fees on your behalf as they are still going to pay the same fixed
amount in either case. Repricing the claims (negotiating the charges) in PPO network costs a good amount of money and as
the insurance companies pay fixed amount anyway, they do not negotiate the charges.
Q:
When I call the Dr office, do I tell them what insurance plan I have so that they can tell me whether they will accept it or not?
A:
Calling them in advance is most likely not going to work as most providers recognize most of the insurance plans by the PPO network
and there is no PPO network in fixed coverage plans. Therefore, the best strategy is to visit the provider and present the insurance
card to them. As the insurance card has all the information that they will need to bill the insurance company, most of the Doctors
and almost all the hospitals will directly. Because the charges are usually smaller at the Dr's office, it depends upon the Dr but
it is extremely unlikely that the hospital will not bill the insurance company directly. In around 9 to 10 years, we have never heard
from a single customer who complained that the hospital didn't accept the insurance card.
If you would still like to call them in advance, you can provide your insurance plan name, claims administrator name or the insurance
underwriter name.
Q:
Is there a directory of providers that bill the insurance company directly?
A:
Directories of providers who bill the insurance company directly are available only in the PPO plans. As fixed coverage plans
do not participate in PPO network, there is no such directory. You can use your favorite doctor, ask your friend for a suggestion
or search online or in yellow pages.
Q:
But, from your experience, can you tell me the list of providers who have been billing directly in my area?
A:
Again, there is no directory because there is no PPO network. In absence of a PPO network, there is no way to keep track
of who is doing what, as that is exactly what the PPO network does.
Q:
I have seen the link to PPO network for fixed coverage plans
(such as Inbound USA, Inbound Immigrant, Inbound Guest,
Visitors Care etc.) on some
other web sites. However, you indicate that there is no PPO network. What is correct?
A:
For a given plan, if there is no PPO network, there is no PPO network, no matter which web site you look at or which agent/broker
you buy the insurance from. It is the exact same plan.
It is possible that such a web site is outdated and does not have the accurate
information or they have simply taken the PPO network link from some other plan that participates in the PPO network and displayed next to
the fixed coverage plan which does not participate in the PPO network. If the given plan does not participate in a PPO network,
such acts are not going to make the plan participate in a PPO network, just because they are displaying some random links.
You can be assured that we strive to provide you the most accurate and up to date information up front, before you purchase the insurance
so you know what exactly you are getting into.
If there were indeed a genuine PPO network directory for a given plan, it would simply be much easier for us to just put a link right
next to it,
rather than writing this lenghty set of FAQ justifying why there is no such link. Trust us!
Q:
What if I would like to buy the visitors insurance with PPO network?
A:
Buy comprehensive coverage plan.
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