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Cashless Visitors Insurance
A: The exact phrase 'cashless insurance' is used in India by Indian insurance companies and people in India. Such exact wording is not used in the United States.
In any case, 'cashless insurance' is the insurance where you don't have to first pay upfront to the provider (hospital or doctor), but the provider can bill the insurance company directly and the plan pays the provider directly. Therefore, the insured does not have to pay upfront and file for reimbursement later.
A: Yes. Many visitors insurance plans that we offer participate in the PPO (Preferred Provider Organization) network which is a network of hospitals and doctors all across the United States. When you visit the providers in the PPO network, they can bill the insurance company directly instead of you having to pay first and file for reimbursement later.
Therefore, the right question to ask would be 'Do you offer visitors insurance that participates in PPO network?'. And the answer is, yes.
A: That is not true. Other than the provider billing the insurance company directly, all terms and conditions of the insurance policy still apply. For eligible expenses, you still have to pay the deductible before plan pays anything (unless the deductible is specifically waived for some expenses in some policies). After that, in comprehensive coverage plans, you will have to pay the coinsurance (typically 10% or 20% for the first $5,000 in eligible expenses) and then it will pay 100% up to the policy maximum. In fixed coverage plans, the insurance company will pay according to the schedule of benefits (sub-limits) and you will have to pay the difference yourself. In any case, the insurance company will not pay anything beyond the policy maximum or for ineligible or excluded medical expenses.
A: Many people typically associate the claim form with having to pay first and then file for reimbursement. But that is not the only purpose. In order to determine the eligibility for a particular claim, the insurance company needs the medical records from the provider which they can't release until they get the written authorization from the insured. Filling out the form gives such authorization and also gives additional information to the insurance company regarding what happened, where you got treated etc.
A: No. Pre-certification is not the determination of eligible expenses but it is more like a notification where you are letting the insurance company know what happened, where you are getting treated etc. Eligibility for a given expense can only be made after the fact when the insurance company gets the medical records from the treating provider and not before that.
A: There are providers that participate in the PPO network which are hospitals, doctors, labs, urgent cares and so on. Therefore, the cashless facility is available for all kinds of medical treatment. However, please note that some time some doctor's office may still refuse to accept the insurance card in spite of participating in the PPO network. But that is an exception and not a general rule. If that happens, please inform us and we will pass that information to the insurance company who will try to educate that provider. Such possibility is a lot higher in the fixed coverage plans compared to the comprehensive coverage plans.
A: Providers in the PPO network should bill the insurance company directly. That is exactly why they are in the PPO network. However, for the providers outside the PPO network, it really depends upon the provider. As a practical matter, we are yet to see a U.S. hospital who refused to bill the insurance company directly. But in case of doctor's visit, you may end up paying out of your pocket and filing for reimbursement later.
A: Prescription drugs is a good example.
A: Please look at the 'Claims Process' section in our guide.
Disclaimer: The information within this article is intended as a broad summary of benefits and services and is meant for informational purposes only. The information does not describe all scenarios, coverages or exclusions of any insurance plan. The benefits and services of an insurance plan are subject to change. This is not your policy/certificate of insurance. If there is any discrepancy between the information in this article and the language of your policy/certificate wording, the language of the policy/certificate wording will prevail.