Thank you for contacting Insubuy. The Patriot America plan you have purchased provides coverage for new illnesses, injuries or accidents that manifest after the effective date of the policy. The plan does not cover pre-existing conditions, routine doctors visits, or preventative treatments. The final determination as to whether the medical situation is a covered medical expense or not is determined by the claims department, and they will make their decision based on the medical records, and attending physicians statement. 

If you visit an in-network medical provider for a covered medical condition, the plan will pay 100% up to the policy maximum for any eligible medical expenses such as doctors visits, and diagnostic services. If the treatment is provided at an out of network facility, the plan will pay 80% up to $5,000, then the plan will pay 100% up to the policy maximum for any eligible medical expenses. Since there is no network of pharmacies, prescriptions will be treated as out of network. 

The medical provider you visit can choose to bill you directly or bill the insurance directly. The best practice is to present the insurance information to the provider, and then they will call to verify benefits. You may also call the provider in advance and ask if they particpate in direct billing. If you end up paying from your pocket, you may file a claim for the reimbursement. If you have any additional questions, please feel free to contact our office at +1 (866) INSUBUY 467-8289.