Seeking Medical Help
Medical attention to sick individuals is prioritized in the United States, generally based on the kind of illness and physical condition of the patient. There are basically three ways to seek help in the event of a medical problem.
- Emergency & 911
- Urgent Care
- Doctor's appointment
Emergency & 911:
Life-threatening health conditions, such as cardiac arrest, respiratory problem, or accident, which require immediate medical attention, are attended to by an emergency unit.
You can also call 911 if you feel helpless, unable to move, or just vulnerable. Once the call is made, help arrives at your doorstep within no time. The paramedics will then check your vitals and try to gather information for the doctors while transporting you to the nearest emergency facility.
Emergency facilities are open 24 hrs a day for all days of a week, and service is provided for any individual, irrespective of the kind of insurance plan. There is a 48-hour cushion time to inform the insurance company about the event. If the insured person is not in a position to do so, anybody on his or her behalf can call and inform the company.
As per the terms defined in the policy, all emergency medical services are paid for, even if the facility visited is not enlisted in the network.
When a patient needs urgent medical attention, but does not face a life threat, the situation calls for urgent care. For instance, allergies, flu, sprains are conditions that fall under urgent care. Visit the nearest medical service registered under the insurance company's network or covered under the support network. Either call the number given on your card or check the provider's directory online to select a facility within the insurance company's network or support network. Avoid availing medical aid from a provider outside the network to prevent ending up with a huge bill.
Chronic problems, physicals, periodic checkups etc. require a prior appointment at the doctors' office. Call the number on your insurance card or go online to check out the provider's directory. Make a list of the medical offices registered under the insurance company's network or covered under the support group.
Secure all bills, receipts and any other documentation that may be of reference to your Visitor Insurance. Inform the insurance company about your completed visits and appointments. This will help later in speeding up your claim process.
When you visit the physician/hospital, show your insurance card to the reception/billing dept. They may make a photo-copy of your insurance card, and call insurance company to verify your policy, and thereafter, bill the insurance company directly. In this case, you will just have to pay the deductible amount.
There may, however, be some cases where the hospital/physician office does not accept an insurance card. They may insist that you directly pay the bill to them. In this case, get detailed bill/receipts and file a claim with insurance company.
A claim form can be obtained from the insurance company. File the claim within the specified period/date, generally within 90 days from the day the service was obtained. Follow up the process from time to time with the insurance company.
The time taken for evaluating a claim is subjective to each case, it may take few weeks to several months depending on several factors, however, the insured needs to be careful and must maintain all the transcripts (bills & receipts) to ensure there is no delay on his/her behalf.
Case I: (Plan Type: Comprehensive Coverage Plan)
Mr. X buys a comprehensive coverage policy of maximum coverage $50,000, with $50 deductible and 80-20% co-insurance.
One day Mr. X falls sick with flu; the condition is not serious, but he needs to make an appointment at the doctor's office. Mr. X goes through the list of physicians/facilities covered under the insurance network and schedules an appointment.
After attending the appointment, Mr. X calls the insurance company help line to inform them about the appointment. Mr. X visits the doctor, presents the insurance card, and completes the necessary paperwork. The doctor prescribes certain medicines after a checkup. Mr. X goes to nearest pharmacy, buys the medicine and makes a full payment to the pharmacy for the medicines.
Mr. X then obtains a claim application form, fills it and then submits it to the insurance company's claim department. The insurance company evaluates the claim, gathers all necessary information and begins to process the claiming accordance with the policy norms and coverage.
Mr. X will still be responsible for any deductible/co-insurance as stated in the policy.
Assume the total charges are 450$ (Physician charges 300$ and Pharmacy charges 150$). Mr X will be liable to pay $50(deductible) and 20% of the rest 400$, rest of it will be the paid by policy/insurance company.
Note: Most of the comprehensive travel insurance coverage plans have 80-20% co-insurance clause for the first $5,000 expenses. This means that after the insured has paid the deductible, the insurance company pays 80% and the insured pays 20% of the total amount remaining. Any expense beyond $5,000 is paid by the insurance company, after the deductible has been paid off.
Case II (Plan Type: Limited Coverage Plan)
Mr. Y purchases a limited coverage plan with a $50 deductible option. Mr. Y is at liberty to go to any facility/doctor. Mr. Y later files the claim, the insurance company makes payments as stated in the policy plan.
It does not matter how much the doctor charges as consulting fee; the plan will only pay the charge according to the fixed clause stated in the policy. For example, the doctor charges $300 for a visit, but the policy determines only $100 per visit. After the deductible is paid, the insurance company will only pay the rest, that is, $50.
Visitors Insurance Tips
- Keep a copy of the insurance card in your wallet at all times.
- Be sure to read the fine print and policy details to understand the available benefits and limitations.
- Always keep certain phone numbers and driving directions to neighboring emergency facilities close at hand.
Visitors Insurance FAQ
In case of a non-emergency situation, is it necessary to go to a provider? Can I visit any physician of my choice?
You may choose to visit any physician of your choice. However, the advantage of taking service from physicians who operate within the insurance company's network, is that they recognize and accept insurance plans without any hassle. Their charges are also reasonable, which makes it all the more easy to settle an insurance claim.
Which Doctor Or Hospital I can visit with visitors coverage insurance?
Note: This information provided is very generic in nature, one must review the policy and its details for exact coverage.