The following are some visitor medical insurance buying tips for you:
Most comprehensive coverage plans in the United States participate in a PPO network.
Many of the comprehensive visitors insurance plans participate in either the First Health PPO Network or the United Healthcare PPO Network; within each network, there are an extensive number of providers (doctors, hospitals, and urgent cares) all throughout the country. These are widely recognized PPO networks in the U.S. and when you go to providers within the PPO network, they are able to bill the insurance company directly and you would receive the Network Negotiated Fees for eligible medical expense(s).
When you are shopping for insurance, you need to ask the agent or insurance company whether there is a provider network. If you are told that, "you can go to any doctor," then ask, "If I can go to any doctor, how do I know if they will accept the insurance?" You can also ask a local hospital or your personal doctor where you should go in case of an incident and how the claim would be processed by saying, "Do you bill the PPO network directly?" If no network is available with the plan then ask, "Do you bill the insurance company directly?" If the provider says, "No, we do not bill directly" then whatever an agent or an insurance company says will have no affect on the provider's decision.
For those familiar with a visit to a hospital or a doctor's office in the U.S., you know that whenever you go to the doctor the first thing the receptionist requests is your insurance ID card. If you buy visitors insurance (fixed or comprehensive) from a company based in the U.S., you will receive an insurance ID card. Be sure to ask any agent or company you speak with if an insurance ID card will be issued. In absence of an insurance ID card, providers are generally not willing to bill an insurance company directly, and rarely are companies located outside of the U.S directly billed.
If purchasing insurance from a country outside of the U.S., regardless of what country the claims are processed in, ask the agent/agency whether the administrator of the plan you are interested in has a reserve of money to pay the eligible medical expense(s) or if they have to wait to receive it from the underwriting insurance company first. The wait will take time, sometimes months for the bill to be paid; meanwhile, collections agencies may already be after you to pay the overdue bills.
Be sure to ask the agent/agency or insurance company about the hours of availability for emergencies (is the number available 24/7 or only during specific hours), and get their administrative (business) hours for non-emergency assistance. Find out what support services are offered before the effective date, during the effective period of coverage and after the coverage has expired. This is especially important if purchasing through an agent/agency as you may need assistance with changes, corrections, claims, etc., after you have purchased. Ask if there is a toll-free phone number, and if you must call the insurance company that is located overseas before going to a doctor in the U.S.
This is very important; make sure you understand whether the coverage is fixed or comprehensive. This is not usually explained well, if at all. Depending on the country that the insurance is purchased in, comprehensive coverage may only be available to a person below a specific age (like 55) and for those aged 55 and above, only fixed coverage is available. Be sure to verify the type of coverage you are considering and that you understand the covered benefits before you purchase a plan (what are the limitations of the plan of interest).
Do not put yourself in the position to find out the hard way that you purchased a limited plan when you assumed it was more comprehensive, know what you are buying before you purchase.
While cost is an important factor, do not make it the only factor you take into consideration before buying a plan. Many times, what you pay for is what you get.
Ask if the plan is renewable, especially if you are not sure how long you or your visitor is going to stay. If the visitor is initially planning to stay for 6 months, and then decides to extend their stay for another 6 months, you should know if the plan can be renewed before making a purchase.
To the best of our knowledge, laws in some countries do not allow an insurance company to insure a person staying/visiting abroad for more than 6 months, renewing is not always an option, and depending on the home country, it is usually not possible to purchase a new plan if a person is already located outside of their home country.
Ask whether a plan can be refunded in case of visitors early departure from the U.S., as not all plans are refundable before the effective period, or during the effective period. Some plans can only be refunded if they are cancelled before the effective date of the policy, and if the request to cancel comes during the active period of coverage, then no premium would be refunded. Other plans can be refunded before the effective date, as well as after the plan is in effect. Refunds are dependent on the plan and sometimes the agent/agency from whom you are purchasing.
If you are told that you need to go to hospital instead of a doctor, check your policy/certificate wording to see whether outpatient benefits (such as a doctor's office visit, outpatient prescription drugs, x-rays, etc.) are covered or if it is just hospitalization coverage.
Whichever agent you are talking to (whether they are in the U.S., India or any other country), ask them whether they are a licensed insurance agent, and what kind of professional experience they have. If you are buying through a travel agent in another country, they may not be aware how the healthcare system works here in the U.S.
Also, from whomever you buy, be sure to ask what kind of mediation, representation or any other support you might need in the future and how they will be able to assist in case of any problems later. If the agent is in a country outside of the U.S., ask how they will provide service to you while you or your visitor is in the U.S.
If you have further questions, please call or email our office and any representative will be happy to help you gain a better understanding of visitors medical insurance. There are also more articles offered in the Guide for your benefit.