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FAQ for PPO network in fixed coverage visitors insurance plans
Q: What PPO network do these fixed coverage visitors insurance plans participate in?
A: Fixed coverage plans like Visitors Care, Visitor Secure, Inbound USA, Inbound Guest, Inbound Immigrant, Inbound Choice etc., no longer participate in PPO networks; you can visit any doctor or hospital you choose to.
Such insurance plans are called indemnity plans.
Note: In the past, the Inbound series of plans and the Visitor Secure plan used to participate in PPO networks; however, participation in the PPO networks was discontinued for the Inbound series of plans May 10, 2013 and for the Visitor Secure plan in the third quarter of 2015.
Q: Do I have to first pay and file for reimbursement or will they bill the insurance company directly?
A: When you go to the provider, you can present the insurance card, either the one you received in the email or by postal mail. The insurance card has all the information the provider's office will need to bill the insurance company directly such as the certificate number, claims filling address in the U.S., 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 pay first, you can get reimbursement by filing a Claim Form.
However, when there is hospitalization/surgery involved and the costs are quite high to pay first, the claims administrator can make necessary arrangements to pay the provider directly, once it is determined that it is an eligible expense.
Even if the provider agrees to bill the insurance company directly, you must still file a Claim Form to expedite the claim process. When the provider sends the bills to the insurance company, the insurance company would need to request medical records from the provider which the provider can't give until they have authorization from you to release the records. Filing a claim form provides such authorization.
All the claims are handled in the U.S.
A: As fixed coverage plans only pay a fixed amount for each procedure and you will have to pay the difference yourself, the insurance companies have no incentives to negotiate the fees on your behalf as they are still going to pay the same fixed amount in either case. Repricing the claims (negotiating the charges) in PPO network costs a good amount of money and as the insurance companies pay fixed amount anyway, they do not negotiate the charges.
Q: When I call the Dr office, do I tell them what insurance plan I have so that they can tell me whether they will accept it or not?
A: Calling them in advance is most likely not going to work as most providers recognize most of the insurance plans by the PPO network and there is no PPO network in fixed coverage plans. Therefore, the best strategy is to visit the provider and present the insurance card to them. As the insurance card has all the information that they will need to bill the insurance company, most of the Doctors and almost all the hospitals will directly. Because the charges are usually smaller at the Dr's office, it depends upon the Dr but it is extremely unlikely that the hospital will not bill the insurance company directly. In around 9 to 10 years, we have never heard from a single customer who complained that the hospital didn't accept the insurance card.
If you would still like to call them in advance, you can provide your insurance plan name, claims administrator name or the insurance underwriter name.
A: Directories of providers who bill the insurance company directly are available only in the PPO plans. As fixed coverage plans do not participate in PPO network, there is no such directory. You can use your favorite doctor, ask your friend for a suggestion or search online or in yellow pages.
Q: But, from your experience, can you tell me the list of providers who have been billing directly in my area?
A: Again, there is no directory because there is no PPO network. In absence of a PPO network, there is no way to keep track of who is doing what, as that is exactly what the PPO network does.
Q: I have seen the link to PPO network for fixed coverage plans (such as Visitors Care etc.) on some other web sites. However, you indicate that there is no PPO network. What is correct?
A: For a given plan, if there is no PPO network, there is no PPO network, no matter which web site you look at or which agent/broker you buy the insurance from. It is the exact same plan.
It is possible that such a web site is outdated and does not have the accurate information or they have simply taken the PPO network link from some other plan that participates in the PPO network and displayed next to the fixed coverage plan which does not participate in the PPO network. If the given plan does not participate in a PPO network, such acts are not going to make the plan participate in a PPO network, just because they are displaying some random links.
You can be assured that we strive to provide you the most accurate and up to date information up front, before you purchase the insurance so you know what exactly you are getting into.
If there were indeed a genuine PPO network directory for a given plan, it would simply be much easier for us to just put a link right next to it, rather than writing this lenghty set of FAQ justifying why there is no such link. Trust us!
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.