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Over 30 Years of Health Insurance Experience
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Here are suggestions to help you get the most from your international health or travel health insurance contract.
Page Contents...
Using Your International Insurance Policy... Some Suggestions
Who's Who in Your International Insurance Contract
Tips on Filing a Health Insurance Claim
Understand the "Pre-Certification" Provision (VERY IMPORTANT!)
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Many international health & travel insurance policies contain a "Pre-Certification" or "Pre-Notification" provision. Simply put, this says that you must notify the insurance company prior to scheduled surgery, inpatient testing, or other large anticipated medical claims. Failure to do so jeopardizes your coverage amount, so we emphasis that you be aware of this provision. |
"Pre-Certification" enables the insurance company to be sure you are receiving adequate and appropriate treatment, to coordinate all care, and to pre-negotiate fees and arrange for payment.
Copy all 24-hour telephone numbers, along with your policy ID number and keep this information handy at all times. As a rule of thumb, with regard to any medical situation -- when in doubt . . . call your plan's 24-hour worldwide assistance service.
From outside the USA, most companies allow you to call "collect." When doing so, we are told it is usually best to use an AT&T operator.
In a medical emergency, seek treatment immediately. Then, you or someone should contact your insurance company as soon as possible.
When Receiving Treatment Outside the USA, Always Request a Fully Itemized Bill
When receiving medical treatment overseas, especially in developing countries, you may not receive a bill in which all charges are fully itemized. This will create a problem when you file the claim with the insurance company. Always request a fully itemized bill, which will help you later in the claims process.
Avoid Using a Hospital Emergency Room for Non-Emergency Treatment
Hospital emergency facilities are sometimes convenient, especially after normal business hours. But typically, your health insurance plan will not pay for expenses incurred during a non-authorized hospital emergency room visit which is not of an emergency nature. (See your plan exclusions.) (In a true medical emergency, seek immediate treatment at the nearest facility.)
Here is a general definition of a medical emergency; a medical condition manifesting itself by acute signs or symptoms which could reasonably result in placing the Insured Person’s life or limb in danger if medical attention is not provided within 24 hours. Usually, the symptoms are sudden and unexpected.
If it is not a medical emergency, but you want treatment ASAP, one option is to call your 24-hour assistance service first. If the assistance service refers you to a medical facility that also happens to be an emergency facility, then you can reasonably expect to be covered without question. (If this occurs, it's a good idea to make note of the time and to whom you spoke.) The assistance company may then call the medical facility on your behalf to arrange for treatment and to pre-negotiate fees.
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For all international insurance obtained here, you enjoy three (3) levels of assistance. Knowing "who's who" can mean better and faster assistance for you, if or when needed. |
1. Your International Insurance Plan "Administrator"
Contact your plan administrator for questions regarding;
When people refer to the "insurance company," they are really referring to the "insurance plan administrator." For all practical purposes, a policy holder will never communicate directly with the insurer or policy "underwriter."
Today, most administrative matters are best handled via the Internet, where you have an e-mail trail. Claim forms and insurance IDs are readily available online or by e-mail. Here are the Websites of the insurance Administrators whose plans are offered here:
Seven Corners, Inc. (SCI) http://www.sevencorners.com (Reside Prime, Reside, Liaison Majestic, Liaison International).
HTH Worldwide (HTH) http://www.hthtravelinsurance.com (Global Citizen, Global Citizen EXP, and TravelGap Excursion).
Global Underwriters Agency (GUA) http://www.globalunderwriters.com (All Diplomat Plans).
HCC Medical Insurance Services (HCCMIS) http://www.hccmis.com (Atlas Series)
2. Your 24-Hour, Worldwide Assistance Company
For pre-certification, medical guidance, or questions regarding any medical situation. Also coordinates emergency medical evacuation, repatriation, etc..
Today, most 24-hour Worldwide Assistance Companies are owned by and operated "in-house" by the larger insurance Administrators. Some companies have a separate telephone number for 24-hour Worldwide Assistance, while others use one telephone number for both the Administrator (usually available 8 hours per day) and the 24-Hour Worldwide Assistance Company.
Your on-line and/or e-mailed Confirmation of Coverage (Insurance ID) will contain your policy number, important telephone numbers and other information. Our advice to you is always "when in doubt, call."
From outside the USA, most companies allow you to call "collect." When doing so, we are told it is usually best to use an ATT operator.
3. Your Independent Insurance Agent (that's us)
For questions while shopping and during the application process. Also, in the event of a possible claims dispute (with the Administrator), we can openly offer guidance.
Per USA Federal and State Laws, as a licensed independent agency, we have a "fiduciary obligation" to you the client. We work for you (Independence Guarantee).
Please note that obtaining your international insurance here does not alter your cost in any manner (Lowest-Rate Guarantee), but it does give you with an extra level of service if needed.
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If you need to file a health insurance claim, complete instructions are contained in your insurance policy. Also in most cases, you will find instructions and forms at your plan administrator's Website. |
Suggestions on Filing a Claim.
Notify the plan administrator of your claim as soon as practical from the date of your illness or injury, or within 90 days. A claim form is normally included with your insurance policy and ID card. You may also obtain a claim form through your insurance plan administrator, by going to their Website calling or e-mailing.
Read your policy for instructions on filing a claim. When completing a claim form, be sure your personal information and policy number are clear and readable. Be sure the form is signed and dated.
Attach your original medical bill. If properly itemized, this bill will usually contain the medical information that your insurance company needs. Keep copies of everything.
Tip: When receiving treatment outside of the USA, always ask for an itemized bill. (Not all doctors or clinics outside the USA will think about this when preparing your bill.)
What to Expect Next.
Upon receiving your claim, the administrator should promptly send you a written notice verifying receipt. You will sometimes be asked for additional information about your health history, such as the full names of all doctors seen during the past year. When this occurs, the company is making sure that your claim is not related to a "pre-existing condition" (see your policy for definitions and exclusions).
Respond promptly and keep copies. Be sure that your name and policy number are clearly printed on all correspondence. (Remember, it is other humans who are reading your handwriting.)
Tip: Sometimes, a doctor's office can be slow to respond to an insurance company's request for medical information. A polite call to your doctor's office may help to speed up this process, and your claim payment.
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