Medical attention for sick individuals is prioritized in the United States, usually based on the kind of illness and the physical condition of the patient. There are three basic ways to seek help in the event of a medical problem:
Emergency & 911:
Life-threatening health conditions such as cardiac arrest, respiratory problems, or major accidents require immediate medical attention. These situations are usually attended to by paramedics and hospitals. You can call 911 in the U.S. to summon the paramedics and be transported to a hospital.
You can also call 911 if you feel helpless, are unable to move, or just feel vulnerable. Once the call is made, help arrives at your location very quickly. The paramedics will check your vitals and try to gather information for the doctors while transporting you to the nearest emergency facility.
Emergency facilities are open 24 hours a day, seven days a week, and service is provided for any individual regardless of his or her insurance plan. There is a 48-hour cushion period to inform the insurance company about the event. If the insured person is not in a position to do so, anybody can call and inform the company on his or her behalf .
As per the terms defined in the policy, all emergency medical services are paid for, even if the facility visited is not in the network.
When a patient needs urgent medical attention but does not face an immediate threat, urgent care facilities are often the best option. Environmental allergies, the flu and ankle sprains are some conditions that fall under urgent care. Visit the nearest medical center registered under your insurance company's network or covered under the support network. Either call the phone number on your card or check the provider's online directory to select a facility in the insurance company's network or support network. Seeking medical aid from a provider outside the network can mean that you end up with a huge bill.
If you are hacing chronic problems, need a physical exam or a periodic checkup. you will require a prior appointment at a doctor's office. Call the number on your insurance card or go online to check out your provider's directory. Choose a doctor from the list of the medical offices registered under the insurance company's network or covered under the support group.
Keep a copy of all bills, receipts and any other documentation that may be important to your visitor insurance. Inform the insurance company about your visits and appointments. This will help you later in speeding up your claim process.
When you visit the physician or hospital, show your insurance card to the reception or billing department. They may make a photocopy of your insurance card and call the insurance company to verify your policy so that they can bill the insurance company directly. In this case, you will only have to pay the deductible amount.
There may be some cases where the hospital or physician's office does not accept an insurance card. They may insist that you directly pay the bill to them. In this case, get detailed bills and receipts so that you can file a claim with your insurance company as soon as possible.
Claim forms can be obtained from the insurance company. File a claim within the specified period, generally within 90 days from the day the service was obtained. Follow up from time to time with the insurance company to make sure everything is going smoothly.
The time taken for evaluating a claim differs between each case. It may take a few weeks or months depending on several factors. The insured needs to be careful and must keep all the transcripts, bills and receipts to ensure that his or her end of the process goes as quickly as possible.
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 the 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 and facilities covered under his insurance network and schedules an appointment.
Mr. X calls the insurance company's helpline to inform them about the appointment. Mr. X visits the doctor, presents his insurance card and completes the necessary paperwork. The doctor prescribes certain medicines after a checkup. Mr. X goes to the nearest pharmacy, buys the medicine and makes a full payment to the pharmacy for the medicines.
Then, Mr. X obtains a claim application form, fills it out and submits it to the insurance company's claim department. The insurance company evaluates the claim, gathers all necessary information and begins to process the claim in accordance with the policy norms and coverage.
Mr. X will still be responsible for any deductible and/or co-insurance as stated in the policy.
Assume the total charges are $450. The physician charges $300 and the pharmacy charges $150. Mr. X will be liable to pay the $50 deductible and 20% of the remaining $400 (which would be $80), the rest will be the paid by the 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 amount remaining. Any expense beyond $5,000 is paid by the insurance company, after the deductible.
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 or 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 covers only $100 per visit. After the deductible is paid, the insurance company will only pay the rest, $50.
Visitors Insurance Tips
- Keep a copy of the insurance card in your wallet at all times
- Read the fine print on your policy so that you understand the benefits and limitations
- Make a note of the importnat phone numbers and driving directions to local emergency facilities
Visitors Insurance FAQ
In 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 choosing a physician who operate within the insurance company's network is that they recognize and accept your insurance plan without any hassle. Also, their charges are often more reasonable, which makes iteasier 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 your exact coverage.