Visitors insurance is short-term international travel medical insurance that generally covers any new medical conditions, injuries or accidents that may occur after the effective date of the policy. Check up coverage in visitors insurance could mean a few different types of appointments depending on where you're from in the world. In the U.S., visits to the doctor are known as preventive checkup visits, sick visits, or routine visits. If you or your family member have visitors insurance, you should know what each type of doctor visit is and whether or not it's covered in your visitors insurance plan.
Check up Coverage
Many people ask the question, "Is a check up covered in visitors insurance?"
It is very important be specific when you ask by stating what exactly you need to have covered. When the question is phrased as written above there can be some confusion because according to US healthcare terminology that question is asking whether a checkup, which could be confused for a preventive visit or as a routine visit, is covered in visitors insurance. By using the above phrasing in the question the answer you would receive is that visitors insurance plans don't cover preventive checkups.
A better way to phrase the question is to ask, "If the visitor becomes ill with a new sickness after the effective date of the policy, can they visit the doctor's office to get checked up so they can find out what is wrong and receive treatment?"
If this were the question asked, then the response would be similar to this answer, "Yes, if a visitor is unwell they would be covered for their sickness under visitors insurance plans because the new sickness occurred after the effective date of the insurance plan."
Preventive checkups are also called annual physicals and are performed by primary care physicians. Annual preventive checkups are designed to prevent certain illnesses and health conditions from occurring, and to detect health issues in the early stages. The extent of a preventive care checkup may vary based on the physician, your age, your gender, your family history and several other factors. These visits normally include screenings such as blood tests, urine tests, ears/eyes/nose/throat examination, or a Pap test. Additionally, it may also include HIV screening, Diabetes (Type 2) screening, or cancer screenings such as, mammography for breast cancer (women) or colorectal cancer (male).
Preventive checkups are not covered by any of the visitors insurance plans from any company anywhere. Insurance companies simply can't afford to give away money like that for such term travel medical insurance. Preventive checkups should be done in home country annually or just before leaving for a foreign trip.
Other correct terminology you could use would be, "If a visitor becomes sick, can they visit the doctor?". The answer is "Yes" as long as it is generally a new medical condition that occurs after the effective date of the policy that would be covered. In short, customers mean to ask if they can use the visitors insurance for an outpatient doctor visit if they suffer from a minor illness such as cold, flu, fever, diarrhea, stomach upset, food poisoning, etc., or if the insurance is only for major things like hospitals or surgery. Visitors insurance plans are both for outpatient services as well as hospitalization.
Please refer to the certificate wording of an insurance plan for the specific details of the insurance plan you are considering.
Routine maintenance of pre-existing conditions, such as periodic checkups of blood pressure or diabetes, can be included in the annual physical, but are not considered preventive because the pre-existing condition is a diagnosed medical condition. Routine maintenance of pre-existing conditions is not covered. Medications and treatments such as blood pressure medicine, insulin for diabetes, dialysis for kidney or anything that you routinely need to treat your pre-existing condition is excluded.
Calling Doctor's Office or Claims Department
When you contact a Dr's office, an Urgent Care and even the insurance claims department you should be careful with the words you choose to use to avoid any confusion. It will save you a lot of frustration if a claim is coded wrong because of the phrasing you used initially. See the following examples of how you should or should not request an appointment:
- When you or your visitor is sick and you would like to visit a doctor's office, you should say something like, "My father is sick. I would like to schedule an appointment for him."
- If you visit an urgent care as a walk-in patient (no appointment) or are scheduling your appointment, you should say something like, "I am sick. I would like the doctor to check it."
- You should NOT say, "I would like to bring my father for a check up." because as you have learned, saying this would be misunderstood as an annual physical or routine maintenance of a pre-existing condition, which are not covered.
You should now understand the different appointment types according to US medical terminology and have samples of language to use when you need to visit a doctor or facility in the U.S. Be sure that you use the appropriate phrasing from the very beginning to prevent trying situations with the insurance company's claims department later and continuing using the correct terminology when communicating with the insurance company's claim department.