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FAQ for PPO Network in Fixed Coverage Visitors Insurance Plans

FAQ for PPO Network in Fixed Coverage Visitors Insurance Plans

What PPO network do these fixed coverage visitors insurance plans participate in?

Fixed coverage plans like Visitors Care, VisitorSecure, Inbound USA, Inbound Guest, Inbound Immigrant, Inbound Choice etc., no longer participate in PPO networks; you can visit any doctor or hospital you choose.

Such insurance plans are called indemnity plans.

Note: In the past, the Inbound series of plans and the VisitorSecure 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 VisitorSecure plan in the third quarter of 2015.

Which providers can I go to?

You can visit any provider you like. There are no restrictions.

Do I have to first pay and file for reimbursement or will they bill the insurance company directly?

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 filing 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.

Are there network negotiated fees in such fixed coverage plans?

No. As there is no PPO network, there are no network negotiated fees either. Some people call it contracted fees or discounted fees.

Why there is no PPO network in the such fixed coverage plans?

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.

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?

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.

Is there a directory of providers that bill the insurance company directly?

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.

But, from your experience, can you tell me the list of providers who have been billing directly in my area?

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.

I have seen the link to a PPO network for fixed coverage plans Visitors Care on some other web sites. However, you indicate that there is no PPO network. What is correct?

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!

What if I would like to buy the visitors insurance with PPO network?

Buy comprehensive coverage plan.

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Visiting USA?

Healthcare costs are very high in the U.S.

Buy U.S. based visitors insurance and enjoy your trip.

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Did you know that your insurance may not cover you abroad or that it may only provide limited coverage?

Purchase travel medical insurance that includes emergency medical evacuation.

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You would not be eligible to enroll in Medicare for the first 5 years.

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You could lose your non-refundable trip costs if you had to cancel your trip.

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The U.S. Department of State requires all J visa holders to purchase compliant insurance.

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Schengen countries require most non-US citizens to purchase Schengen visa insurance.

Make an instant purchase online and get instant visa letter.

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Traveling frequently throughout the year?

You don’t need to purchase travel insurance for every trip.

Purchase annual multi trip travel insurance for your travels.

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Most schools require international students to purchase health insurance.

Purchase international student health insurance that meets most school requirements.

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To continue with the application please scroll down to confirm this notice

CALIFORNIA RESIDENTS SPECIAL NOTICE

1. THE INSURANCE POLICY THAT YOU ARE APPLYING TO PURCHASE IS BEING ISSUED BY AN INSURER THAT IS NOT LICENSED BY THE STATE OF CALIFORNIA. THESE COMPANIES ARE CALLED "NONADMITTED" OR "SURPLUS LINE" INSURERS.

2. THE INSURER IS NOT SUBJECT TO THE FINANCIAL SOLVENCY REGULATION AND ENFORCEMENT THAT APPLY TO CALIFORNIA LICENSED INSURERS.

3. THE INSURER DOES NOT PARTICIPATE IN ANY OF THE INSURANCE GUARANTEE FUNDS CREATED BY CALIFORNIA LAW. THEREFORE, THESE FUNDS WILL NOT PAY YOUR CLAIMS OR PROTECT YOUR ASSETS IF THE INSURER BECOMES INSOLVENT AND IS UNABLE TO MAKE PAYMENTS AS PROMISED.

4. THE INSURER SHOULD BE LICENSED EITHER AS A FOREIGN INSURER IN ANOTHER STATE IN THE UNITED STATES OR AS A NON-UNITED STATES (ALIEN) INSURER. YOU SHOULD ASK QUESTIONS OF YOUR INSURANCE AGENT, BROKER, OR “SURPLUS LINE” BROKER OR CONTACT THE CALIFORNIA DEPARTMENT OF INSURANCE AT THE FOLLOWING TOLL-FREE TELEPHONE NUMBER 1-800-927-4357. ASK WHETHER OR NOT THE INSURER IS LICENSED AS A FOREIGN OR NON-UNITED STATES (ALIEN) INSURER AND FOR ADDITIONAL INFORMATION ABOUT THE INSURER. YOU MAY ALSO CONTACT THE NAIC’S INTERNET WEB SITE AT WWW.NAIC.ORG.

5. FOREIGN INSURERS SHOULD BE LICENSED BY A STATE IN THE UNITED STATES AND YOU MAY CONTACT THAT STATE’S DEPARTMENT OF INSURANCE TO OBTAIN MORE INFORMATION ABOUT THAT INSURER.

6. FOR NON-UNITED STATES (ALIEN) INSURERS, THE INSURER SHOULD BE LICENSED BY A COUNTRY OUTSIDE OF THE UNITED STATES AND SHOULD BE ON THE NAIC’S INTERNATIONAL INSURERS DEPARTMENT (IID) LISTING OF APPROVED NONADMITTED NON-UNITED STATES INSURERS. ASK YOUR AGENT, BROKER, OR “SURPLUS LINE” BROKER TO OBTAIN MORE INFORMATION ABOUT THAT INSURER.

7. CALIFORNIA MAINTAINS A LIST OF APPROVED SURPLUS LINE INSURERS. ASK YOUR AGENT OR BROKER IF THE INSURER IS ON THAT LIST, OR VIEW THAT LIST AT THE INTERNET WEB SITE OF THE CALIFORNIA DEPARTMENT OF INSURANCE: www.insurance.ca.gov.

8. IF YOU, AS THE APPLICANT, REQUIRED THAT THE INSURANCE POLICY YOU HAVE PURCHASED BE BOUND IMMEDIATELY, EITHER BECAUSE EXISTING COVERAGE WAS GOING TO LAPSE WITHIN TWO BUSINESS DAYS OR BECAUSE YOU WERE REQUIRED TO HAVE COVERAGE WITHIN TWO BUSINESS DAYS, AND YOU DID NOT RECEIVE THIS DISCLOSURE FORM AND A REQUEST FOR YOUR SIGNATURE UNTIL AFTER COVERAGE BECAME EFFECTIVE, YOU HAVE THE RIGHT TO CANCEL THIS POLICY WITHIN FIVE DAYS OF RECEIVING THIS DISCLOSURE. IF YOU CANCEL COVERAGE, THE PREMIUM WILL BE PRORATED AND ANY BROKER’S FEE CHARGED FOR THIS INSURANCE WILL BE RETURNED TO YOU.

07/11
LSW1146D

Cuba Notice

Travel to Cuba remains subject to restrictions imposed by U.S. sanctions, administered by the US Treasury. Only those who qualify for travel authorized under US Treasury's regulations and who comply with the terms of such authorization can legally travel to Cuba. Individuals traveling to Cuba must meet the following criteria in order to qualify for travel authorized under one of the general licenses outlined below:

Criteria for travel authorized by the US Treasury

If you have read and agree to the terms of both Notices: California and Cuba, please click the continue button if you wish to complete the application process. Otherwise, please click cancel to abort the application process.

To continue with the application please scroll down to confirm this notice

CALIFORNIA RESIDENTS SPECIAL NOTICE

1. THE INSURANCE POLICY THAT YOU ARE APPLYING TO PURCHASE IS BEING ISSUED BY AN INSURER THAT IS NOT LICENSED BY THE STATE OF CALIFORNIA. THESE COMPANIES ARE CALLED "NONADMITTED" OR "SURPLUS LINE" INSURERS.

2. THE INSURER IS NOT SUBJECT TO THE FINANCIAL SOLVENCY REGULATION AND ENFORCEMENT THAT APPLY TO CALIFORNIA LICENSED INSURERS.

3. THE INSURER DOES NOT PARTICIPATE IN ANY OF THE INSURANCE GUARANTEE FUNDS CREATED BY CALIFORNIA LAW. THEREFORE, THESE FUNDS WILL NOT PAY YOUR CLAIMS OR PROTECT YOUR ASSETS IF THE INSURER BECOMES INSOLVENT AND IS UNABLE TO MAKE PAYMENTS AS PROMISED.

4. THE INSURER SHOULD BE LICENSED EITHER AS A FOREIGN INSURER IN ANOTHER STATE IN THE UNITED STATES OR AS A NON-UNITED STATES (ALIEN) INSURER. YOU SHOULD ASK QUESTIONS OF YOUR INSURANCE AGENT, BROKER, OR “SURPLUS LINE” BROKER OR CONTACT THE CALIFORNIA DEPARTMENT OF INSURANCE AT THE FOLLOWING TOLL-FREE TELEPHONE NUMBER 1-800-927-4357. ASK WHETHER OR NOT THE INSURER IS LICENSED AS A FOREIGN OR NON-UNITED STATES (ALIEN) INSURER AND FOR ADDITIONAL INFORMATION ABOUT THE INSURER. YOU MAY ALSO CONTACT THE NAIC’S INTERNET WEB SITE AT WWW.NAIC.ORG.

5. FOREIGN INSURERS SHOULD BE LICENSED BY A STATE IN THE UNITED STATES AND YOU MAY CONTACT THAT STATE’S DEPARTMENT OF INSURANCE TO OBTAIN MORE INFORMATION ABOUT THAT INSURER.

6. FOR NON-UNITED STATES (ALIEN) INSURERS, THE INSURER SHOULD BE LICENSED BY A COUNTRY OUTSIDE OF THE UNITED STATES AND SHOULD BE ON THE NAIC’S INTERNATIONAL INSURERS DEPARTMENT (IID) LISTING OF APPROVED NONADMITTED NON-UNITED STATES INSURERS. ASK YOUR AGENT, BROKER, OR “SURPLUS LINE” BROKER TO OBTAIN MORE INFORMATION ABOUT THAT INSURER.

7. CALIFORNIA MAINTAINS A LIST OF APPROVED SURPLUS LINE INSURERS. ASK YOUR AGENT OR BROKER IF THE INSURER IS ON THAT LIST, OR VIEW THAT LIST AT THE INTERNET WEB SITE OF THE CALIFORNIA DEPARTMENT OF INSURANCE: www.insurance.ca.gov.

8. IF YOU, AS THE APPLICANT, REQUIRED THAT THE INSURANCE POLICY YOU HAVE PURCHASED BE BOUND IMMEDIATELY, EITHER BECAUSE EXISTING COVERAGE WAS GOING TO LAPSE WITHIN TWO BUSINESS DAYS OR BECAUSE YOU WERE REQUIRED TO HAVE COVERAGE WITHIN TWO BUSINESS DAYS, AND YOU DID NOT RECEIVE THIS DISCLOSURE FORM AND A REQUEST FOR YOUR SIGNATURE UNTIL AFTER COVERAGE BECAME EFFECTIVE, YOU HAVE THE RIGHT TO CANCEL THIS POLICY WITHIN FIVE DAYS OF RECEIVING THIS DISCLOSURE. IF YOU CANCEL COVERAGE, THE PREMIUM WILL BE PRORATED AND ANY BROKER’S FEE CHARGED FOR THIS INSURANCE WILL BE RETURNED TO YOU.

07/11
LSW1146D

If you have read and agreed to the terms of this notice and wish to continue, please click the continue button. Otherwise, please click cancel to abort the application process.

Cuba Notice

Travel to Cuba remains subject to restrictions imposed by U.S. sanctions, administered by the US Treasury. Only those who qualify for travel authorized under US Treasury's regulations and who comply with the terms of such authorization can legally travel to Cuba. Individuals traveling to Cuba must meet the following criteria in order to qualify for travel authorized under one of the general licenses outlined below:

Criteria for travel authorized by the US Treasury

I certify that I have read the above and that all individuals applying for coverage qualify for travel authorized under one of the general licenses per US Treasury regulations.

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