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Question:

Would like to know how I am covered if I would need to visit a Physician within the PPO network for minor ailment like cough, cold .. Will the Doctor fees is included in the insurance?Is prescription drugs is also included in the insurance ? Do i need to pay forany lab accessibility of doctor fees is covered?

Answer:

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. 

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DISCLAIMER: Information presented in our Questions and Answers section is generic and was deemed to be accurate at the time of response. Please use the answers as a guide and do not make decisions based on the answers. The answers presented may be outdated and altogether inaccurate currently or not relevant as the details provided such as the insurance terms and conditions, plan benefits, eligibility and coverage may have changed. Insubuy assumes no responsibility for relying on such answers. You should review the latest certificate wording of the insurance policy (available on this website) for the product you are considering for the latest and complete details. If there is any conflict between the answers provided here and the certificate wording, the details of the certificate wording will prevail.

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