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Q:claims process with HCCMIS Hi , thanks insubuy for creating this forum. This is very insightful - unfortunately I had not read this forum until I bought Atlas America insurance - otherwise I could have purchased it through insubuy. Having said that- this is regarding a claim for my FIL who was visiting us . He is 63 years- known hypertensive with a history of COPD. He had severe chest pain and was taken to emergency and was in the hospital for three days. Various test were performed including angiogram. At the end everything was normal and he was discharged. The insurance was charged more than 50k for the admission. I understand from the beginning the pre certification requirement. Hence I made numerous calls to HCCMIS , made the hospital call and got the authorization code. Now after 45 days they get back saying pre certification is incomplete without the clinical packet which the hospital utilization department had to send. Now I contact the UR and they did send the packet but to a wrong fax number. I did request them to send it to the right number. So is there a way to make hccmis understand that as a patient I had done all that is required. I had no idea on this clinical packet. Although I got the authorization code - will I be penalized for what the hospital did not do ? How can this claim process be more efficient . Any help and guidance will be appreciated . Thanks

A:
I am sorry to hear that you are having difficulties with your claim. As you didn't buy from Insubuy, we are legally not allowed to interfere in this matter. If you had bought through us, we would definitely help you personally. Read /why-purchase-from-insubuy/ Why buy from Insubuy. In any case, I would be glad to provide you with general help. I suggest that you contact the hospital and have them write a letter explaining what happened. If they can provide a proof that they had sent it to a wrong fax number (may be fax transmission report or something), you can attach that. After that, you can follow up with HCCMIS and explain basically what you are explaining here that you did everything you could as a layman customer. You would have no idea about this clinical packet. I don't see any mention of that patient responsibility anywhere in the certificate wording. I hope this suggestion is helpful to you and it works out for you. Thanks so much for the reply and suggestion Even though it is a little late, I got the following reply from HCCMIS. "Clinical packet is what we send to the provider to be completed as part of the pre certification process. It is basically the precert forms where provider fills in needed info for imas to review for med necessity. After reading the thread please advise no penalty will be assessed due to a delay of the needed information. Assure our valued member I will personally notate his file as such and follow up with our pre certification department asap. This is not an approval for payment. The decision for payment will be made after we receive and review all necessary documentation." Therefore, according to the above, you should not be penalized. Please let me know how it goes. If you need to get in touch with the person who sent me the above reply, please contact me privately. Hi thanks so much for following up. I would appreciate if you could provide me the details of the person you contacted at HCCMIS . My email is ashu9_in@yahoo.com At present my claims is in ' in processing' stage. I have not yet received a final explanation of benefits. Thanks so much for following up. Hopefully this thread and informations will be useful I future for other customers as well . I have emailed you the details.
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Q:Question on the insurance for my 71 Year old mom She will be coming to US on Friday. Good health but has arthritis issue. Planning to get her the Patriot USA insurance (Not platinum). I know the coverage is extremely limited and almost everything could be a preexisting condition. But in case of a pre-existing condition claim will the billing be for the negotiated rate or the premium rate if it is not covered by insurance? Thank you for your reply

A:
Network negotiated fees are only for the covered expenses. Please let us know if you have any other questions. Thank you for your reply!
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Q:Visitor's Insurance in state of Washington Hi there, I read thru the details on different insurances and now i would like to go ahead with Atlas America for my in-laws who are already here with us in Washington. According to the rules, i cannot purchase the insurance when they are physically in state of Washington. So my question is, can I drive them to Portland, OR and purchase the insurance while we are there? Technically they wouldnt be in Washington when i purchased the insurance. Will that work? Thanks

A:
Yes, that would definitely work. In fact, it is described at /guide/ Yes, that would definitely work. In fact, it is described at /guide/ Cool, so will there be any requirements in terms of providing the proof that they were physically not in WA when insurance was purchased? No
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Q:Coverage for a Procedure Hi, My MIL went to a PCP today as she was having chest pain while climbing stairs. The doctor did an ECG and advised angioplasty. She had this procedure done 8 yrs back. Now she is 49 years old. She has Atlas America insurance with 50000 dollar max limit for acute onset of preexisting conditions. Will that procedure be covered by Atlas America. Please advise as we need to take some important decisions on the treatment based on the coverage and out of pocket expenses. Thanks Kala

A:
Kala, From what you have described, there is no way to tell in advance like this whether something would be covered or not. In fact, nobody can tell that. Please read /visitor-insurance-acute-onset-of-pre-existing-conditions/ for further information. In short, it will be determined by the claim department AFTER the providers submit all the medical records and physician report to them, and NOT BEFORE that. I am sorry that I could not be any more specific. If there is anything else that we can help you with, please feel free to contact us at any time.
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Q:International Major Medical Insurance for 74 yo Hi! Does the 'International Major Medical Insurance' provide coverage for pre-existing conditions? Like a heart attack if the person has high blood pressure? Also, what does it mean that there is no PPO network? Does it mean that there are no negotiated fees with the hospital/providers, and that we'd have to pay out of pocket and then get reimbursed? Can you direct me to a site that offers more info on this insurance? I found the brochure, but it has only limited info on how this works. Thanks!

A:
1. International Major Medical Plan (IMMP) does not provide any coverage for pre-existing conditions. 2. As it does not have any PPO network, it will not have any network negotiated fees with providers. It would be up to the provider whether to bill directly or not. If they do, good. Otherwise, you will have to first pay and file for reimbursement. Read /international-travel-insurance/ for more information on that. Thank you! So what would you recommend for insurance for a 74 yo with high blood pressure but nothing else? The way I see it, the most likely scenario is a heart attack or stroke, so I would need an insurance that offers the max coverage for pre-existing conditions. Unfortunately, at that age, it is really difficult to find insurance that covers even the new medical conditions. Please look at /patriot-america-lite-insurance/ or /patriot-america-platinum-insurance/ which will cover either $50,000 or $100,000 in new medical conditions respectively, but will cover up to $2,500 for sudden recurrence of a pre-existing condition. I understand that $2,500 is not much but that is the most available.
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Q:health insurance for Texas A&M University Hi, I am a Chinese student, and I am going to Texas A&M University as a visiting scholar. I am informed with that the health insurance is necessary to obtain J1 visa. The following is the fundamental requirement. I am not sure if your company meets the last item. Could you tell me that? In addition, does the Plan A meets all items? Thanks! · Medical benefits of at least $50,000 per person, per accident or illness · Repatriation of remains in the amount of $7,500 · Expenses associated with medical evacuation of the exchange visitor to his or her home country in the amount of $10,000 · Deductible not to exceed $500 per accident or illness · The policy must be backed by: the full faith and credit of your home country government OR the company providing the insurance must meet minimum rating requirements established by the US Department of State (an A. M. Best rating of “A-“or above, an Insurance Solvency International, Ltd. (ISI) rating of “A-I� or above, a Standard & Poor’s Claims-paying Ability rating of “A-“ or above, or a Weiss Research, Inc. rating of B+ or above).

A:
You can purchase /patriot-exchange-program-insurance/ It will meet the requirements including the last one.
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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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