Patriot Platinum America has a network all over the world. Outside the USA, some of the providers
are contracted with IMG for direct billing but there is no network negotiated fee arrangement.
You are free to visit any hospital, doctor or provider
and 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.
Patriot Platinum America from IMG participates in
First Health PPO Network.
First Health PPO Network is
a separately-organized network of approximately 500,000 physicians and 4,700 privately owned and operated hospitals.
There are numerous doctors and hospitals that participate in this network in every major city in the U.S. When you go to the doctors in the network,
please mention that you have First Health PPO Network plan, as the doctor
sometimes
may not be aware of IMG or Patriot Platinum America.
When you go to the doctors and hospitals in the network, they can
take the insurance card and contact IMG to verify the benefits.
IMG can pay directly to the
provider if it is determined that it is an eligible expense(covered expense in the policy).
They 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
doctor's office will need to bill the insurance company directly such as the certificate
number, claims filing address in US, 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 web site.
IMG will reimburse you usually within 4 weeks after receiving the claim.
However, when there is hospitalization/surgery involved and the costs
are quite high to pay first, IMG can make necessary arrangements to pay the provider
directly.
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 insurance company,
insurance company would need to request medical records from the provider
which provider 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 IMG in USA. You never have to contact
the carrier, Sirius International, for any purpose whatsoever.
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