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Visitors Insurance - Getting Healthcare FAQ

Visitors Insurance - Getting Healthcare FAQ

Irrespective of the health insurance plan you have (domestic or visitors), irrespective of whether you are U.S. citizen or tourist, getting healthcare in the U.S. can be quite frustrating at times. It is just the unfortunate system of healthcare in the U.S. and not the fault of any particular insurance company or the patient.

What does PPO network mean?

PPO stands for Preferred Provider Organization. That is a directory of doctors, hospitals, labs and other medical facilities (collectively called providers) that have agreed to participate in a specific PPO network. Some insurance companies have their own PPO network while others use a common PPO network that various insurance companies share.

Are the providers in the PPO network required to accept the insurance?

Yes. The PPO network is not simply a yellow pages or internet search. It lists the providers that have specifically signed a contract to accept the patients from a particular PPO network. Not accepting the patients that have a particular insurance that participates in a particular PPO network when the provider is participating in that PPO network is a breach of contract.

When I called a provider from the PPO network directory, they said that they will not accept the insurance or they have never heard about this insurance. Why is that?

Make sure that you provided the name of the PPO network and not the name of the insurance product, insurance company or even the insurance agent/broker.

If you gave the PPO network name and if they still don't recognize, it is most likely due to the ignorance of the front desk staff. It is possible that they only know or remember the names of 2 or 3 PPO networks that they deal with every day and not all the PPO networks that the doctor is participating and signed the contracts with. Obviously, that is beyond the control of any insurance company.

If a provider in the PPO network refuses to accept the insurance, what should I do?

This does not happen often. However, in case it happens to you, you have several options:

  • You pay out of your pocket and file a claim for reimbursement.

  • You contact another provider.

  • You contact us and we will contact the appropriate person in the PPO network who will contact and properly educate the provider staff. In most cases, after such interventions, providers agree to accept the insurance and bill the insurance company to avoid a breach of contract and risking their contract with the PPO network be cancelled.

    In some cases, a particular provider may have stopped participating in a particular PPO network without providing any notice to anyone. Even in that case, it is necessary that the PPO network becomes aware of it so that such provider can be taken off the directory.

I would really like to visit a specific doctor but his name does not come up in the provider directory. Can I visit that doctor?

Yes, you can certainly visit that doctor. These plans do not require you to go only to a in-network provider. Some times, a group of doctors work together and only one of the doctors signed a contract with the particular PPO network but any of the doctors in that group would see the patients and charge as in-network provider. (This is to avoid excessive paperwork for each doctor for each insurance company and PPO network). Some times, the doctor you want to see is really out of network. Of course, the exact situation can be figured out only when you call that doctor's office.

When I called a doctor in the PPO network, they said that they don't accept new patients. How is that possible?

Providers participating in a particular PPO network are not employees of the PPO network. Each provider runs his/her independent practice, decides work hours and decides whether to accept new patients or not. If their practice is too busy to accept new patients, that is beyond the control of any insurance company.

When I called a doctor in the PPO network, they said that the earliest available appointment is after one week. Why is that?

Each doctor makes his/her own schedule and availability. The insurance company has no control over it. Just because a doctor participates in the PPO network, it does not mean he/she would be available immediately. Just like you have the insurance, millions of others have the same insurance with the same PPO network. In addition to the insurance you have, the same doctor has signed up to accept patients from many other insurance companies. That adds up many more millions of insured people. You can see another provider or wait for that provider to be available according to his/her own schedule. Of course, please use your best judgment in selecting what kind of provider or facility is appropriate for your situation. More information at Choosing the Right Medical Provider.

It is very common that earlier available appointment to be able to see a doctor is after few days. The wait for a specialist may even be few months.

That is just the sad status of the healthcare in the U.S. and it is beyond any insurance company's control.

I called many doctors in the PPO network and all of them are saying either they don't accept new patients or they don't have any immediate appointments. What is going on? What good is this insurance if I can't use it when I need it?

That is the general problem with U.S. healthcare irrespective of the insurance you have.

This is beyond any insurance company's control.

Did you know?

Prices are regulated by law.

You cannot find a lower price anywhere for the same product.

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Why purchase insurance from Insubuy®?

Same Price. Better Service.®

There are many advantages in purchasing from Insubuy® and no disadvantages.

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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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Traveling abroad?

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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New immigrant to USA?

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

Purchase new immigrant medical insurance to bridge the gap.

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Going on a vacation?

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

Buy a trip cancellation insurance package plan and be worry-free.

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Are you an exchange visitor to USA?

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

Buy J visa medical insurance to meet your requirements.

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Traveling to Europe?

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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International student in the U.S.?

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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