Outside USA:
For your convenience, The CMN/EA International Provider Network spans approximately 200 countries and territories
worldwide with over 2000 hospitals and clinics and over 6000 physicians.
A listing of providers participating in our international network is located in
Client Zone,
which is easily accessible with your Certificate number and date of birth once coverage has been approved.
Anyway, you are free to visit any provider you like. You may have to first pay and then get reimbursed from the insurance company by
filing a claim form. The doctor's office or local hospital has a choice to be paid by the patient or by the insurance company. However, for larger eligible expenses like hospitalization/surgery etc,
the insurance company can make arrangements for direct payment
to the provider.
Inside USA:
Atlas America from HCC Medical Insurance Services (HCCMIS)
participates in a PPO network administered by CMN.
CMN is a culmination of several networks across the country including
PHCS, FirstHealth, Coventry, Beach Street and several regional networks.
The CMN network is for major medical, foreign travel and other expatriate benefit plans offering service at Centers of Excellence with over 400,000 physicians. The CMN network offers nationwide coverage across the U.S. with concentrations in metropolitan and urban cities, traditional travel states, and many rural areas.
This PPO Network is
a separately-organized network of
a large number of physicians and privately owned and operated hospitals.
As it is a well known network in every major
area of the U.S., there are a good number of doctors and hospitals.
When you go to the doctors in the network,
please mention that you have a particular PPO Network plan (such as First Health, PHCS etc.), as the doctor
sometimes
may not be aware of HCCMIS or Atlas America.
When you go to the doctors and hospitals in the network, they can
take the insurance card and contact HCCMIS to verify the benefits.
HCCMIS can pay directly to the
provider if it is determined that it is an eligible expense (covered expense in the policy).
Providers will also charge only the Network Negotiated Fee (NNF) which is a discounted
fee in many cases.
When you go to the providers outside the network, you can
present the insurance card. The insurance card has all the information
the doctor'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 first pay, you can
get reimbursement by filing a
Claim Form.
You can either use the claim form you receive in the mail along with the insurance
card or you can download the
Claim Form from this website.
HCCMIS will reimburse you usually within 2 weeks after receiving the claim.
However, when there is hospitalization/surgery involved and the costs
are quite high to pay first, HCCMIS can make neccessary arrangements to pay the provider
directly.
If you go to the providers in the network and when they bill directly to the insurance company,
after the annual deductible, the insurance company will pay 100% up to policy maximum. Otherwise,
it will pay 80%/20%
for the first $5000 in expenses and after that 100% up to the policy maximum.
There is no network of providers for prescription drugs (medicines).
Even if the provider agrees to bill the insurance company directly,
you should 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 providers can't give until they have authorization from you to release
the records. Filing a claim form provides such authorization.
All your claims will be handled by HCCMIS in USA. You never have to contact
the carrier, Lloyds, for any purpose whatsoever.
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