What PPO network do these fixed coverage visitors insurance plans participate in?
Fixed coverage plans like and no longer participate in PPO networks; you can visit any doctor or hospital you choose.
Such insurance plans are called indemnity plans.
Which providers can I go to?
With the fixed coverage visitors insurance plans that do not participate in a PPO network, you can visit any provider you like. There are no restrictions.
In the fixed coverage plans that don't participate in a PPO network, do I have to first pay and file for reimbursement or will they bill the insurance company directly?
When you go to the provider, you can present the insurance card, either the one you received in the email or by postal mail. The insurance card has all the information the provider's office will need to bill the insurance company directly such as the certificate number, claims filing address in the U.S., toll-free number to call and verify the coverage. It still depends upon the doctor whether to bill the insurance company directly or not. Even if the doctor accepts the card, there is no network negotiated fee.
If you have to pay first, you can get reimbursement by filing a Claim Form.
However, when there is hospitalization/surgery involved and the costs are quite high to pay first, the claims administrator can make necessary arrangements to pay the provider directly, once it is determined that it is an eligible expense.
Even if the provider agrees to bill the insurance company directly, you must still file a Claim Form to expedite the claim process. When the provider sends the bills to the insurance company, the insurance company would need to request medical records from the provider which the provider can't give until they have authorization from you to release the records. Filing a claim form provides such authorization.
All the claims are handled in the U.S.
Are there network negotiated fees in such fixed coverage plans?
There are no network negotiated fees in the plans that don't participate in a PPO network. You may hear people call it contracted fees or discounted fees.
Why do most fixed coverage plans not participate in a PPO network?
As fixed coverage insurance plans only pay a fixed amount for each procedure and you will have to pay the difference yourself, the insurance companies have no incentives to negotiate the fees on your behalf as they are still going to pay the same fixed amount in either case. Repricing the claims (negotiating the charges) in PPO network costs a good amount of money and as the insurance companies pay fixed amount anyway, they do not negotiate the charges.
When I call the Dr office, do I tell them what insurance plan I have so that they can tell me whether they will accept it or not?
Providers usually recognize the name of the PPO network and not the name of the insurance plan, so calling ahead won't matter if you buy an insurance plan that doesn't participate in a PPO network. The best strategy is to visit the provider and present your insurance ID card to them as the insurance ID card has all of the information they will need to bill the insurance company. A doctors office may or may not bill directly as they are charging smaller amounts, so it varies and is dependent completely on the doctor you choose to visit. Hospitals typically bill directly because they are charging more for treatments; we haven't heard from a single customer in over a decade declaring that the hospital they used didn't accept their insurance card.
If you would still like to call them in advance, you can provide your insurance plan name, claims administrator name or the insurance underwriter name.
Is there a directory of providers that bill the insurance company directly?
Directories of providers who bill the insurance company directly are available only in the PPO plans. As most fixed coverage plans do not participate in a PPO network, there is no such directory for these plans. You can use your favorite doctor, ask your friend for a suggestion, or search online or in yellow pages.
From your experience, can you tell me the list of providers who have been billing directly in my area?
There is only a directory if the plan participates in a PPO network. In absence of a PPO network, there is no way to keep track of which provider is doing what, as that is exactly what the PPO network does.
I have seen the link to a PPO network for fixed coverage plans on some other web sites. However, you indicate that there is no PPO network. What is correct?
For a given plan, if there is no PPO network, there is no PPO network, no matter which web site you look at or which agent/broker you buy the insurance from. It is the exact same plan.
It is possible that such a web site is outdated and does not have the accurate information or they have simply taken the PPO network link from some other plan that participates in the PPO network and displayed next to the fixed coverage plan which does not participate in the PPO network. If the given plan does not participate in a PPO network, such acts are not going to make the plan participate in a PPO network, just because they are displaying some random links.
You can be assured that we strive to provide you the most accurate and up to date information up front, before you purchase the insurance so you know what exactly you are getting into.
If there were indeed a genuine PPO network directory for a given plan, it would simply be much easier for us to just put a link right next to it, rather than writing this lengthy set of FAQ justifying why there is no such link. Trust us!
What if I would like to buy the visitors insurance with PPO network?
Buy a comprehensive coverage plan.
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