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Health care is extremely expensive in US and without proper Health insurance you are in deep soup. There are broadly two categories of immigrants researching on Health insurance --- Visitors (or those who are inviting Visitors), long term workers (mostly those who are working with small consulting companies).

I would divide this in two areas – one for Visitor’s Insurance and another for Insurance for Long term workers. This page is for Visitor’s Insurance

Visitor’s Insurance

Tons of companies advertise for Visitor’s insurance but all the advertisements focus on how easy it is to purchase the insurance not on how easy the claim process is. There are broadly two types of companies selling such products – some based on overseas and some based in US; each has their own share of pros and cons:

Overseas Company

• Costs usually less • Limits on individual coverage (example room, surgeon etc.) Though some insurance provide unlimited coverage • In some cases, no cashless service or negotiated payment with provider ; you need to pay first and get reimbursed • Most companies cover (or rather they claim that they cover) Emergency situation for pre-existing conditions. • It is much easier to fight for non-payment of claim. In India , filing a complaint with Insurance Ombudsman usually resolves the matter

US Company

• Higher Premium • Option of unlimited coverage (no limit on room, surgeon etc.) • In some cases, no negotiated payment with provider ; you need to pay first and get reimbursed • Emergency Pre-existing rider available but the coverage is very limited ; usually around 15 to 25 K • The companies are generally not licensed by Department of Insurance and so DOI will not accept any complaint. The only option is to hire an Attorney and sue the company

As you will see from above, there are some differences. However, the big common factor is they tend to deny even valid claims on one pretext or other. I read a joke in another forum – if your hand has a fracture, they will say “Oh! You had a hand; and that too with bone in it; that is pre-existing , we will not pay” Every person will decide on their own which one to buy but here are a few factors (in order of importance) which you should consider when buying a Visitor’s Insurance:

• What recourse you have if the insurance does not pay your claim. This should be No. 1 consideration. • Is the underwriter licensed by Department of Insurance of ANY state . Verify this with DOI. Most of these insurance companies are not required to be licensed because they are selling a surplus line insurance • Does the insurance company (or its tie-up in US) provide Cashless service and/or have a negotiated payment with most US providers. • Do you need unlimited coverage or limited coverage? If you are young , limited coverage should be OK but for elderly , unlimited coverage is preferred • Do they allow to extend/cancel coverage if the return date is rescheduled. • Read the policy carefully. Get all answers in writing Cost should be the last consideration.

What to do before Travelling

• Have a comprehensive health checkup . It will cost some amount but significantly cheaper in comparison to the cost in US. Don’t forget the Dental work ! • Carry ALL medicines that will be required for duration of stay. For prescription medicines, by law, you need to have a prescription when bringing those to USA . Many people have a misconception that if you carry a prescription from home country , you can buy medicines in US. This is not correct. • Carry a spare pair of glasses/contacts (if applicable).

What to do when visiting a Doctor

• First check if the insurance has a network provider. If they do not have a network provider and if it is something minor , go to Minute Clinic; it is relatively cheap even if the insurance do not reimburse • Check local community resources – some church and Indian temple has doctors who provide basic medical service free of cost. • Remember, the cost varies by where you go – usually Minute Clinics are cheapest, followed by Doctor’s office, followed by Urgent Care followed by Emergency. • The I-134 which you signed has no value. However, if you sign financial liability in Doctor’s office or Emergency you will be billed for service.

What to do if insurance denies a valid claim ?

• Double check policy terms if insurance is really on wrong side • Collect ALL papers from Provider. This should include all bills, reports, doctor’s notes etc. • Check internet (or visit local library) to understand the ICD-9 procedure codes. Insurance companies go by ICD-9 (or CPT) codes. I had one instance where the doctor’s visit was for an accident (fracture) but they billed for a Physical and insurance denied. In such cases, get it corrected by Doctor’s office. Make sure all communications are made through certified mail and include supporting document (doctor’s note, diagnosis etc.) • Educate yourself with insurance claim processing process. If you know the codes and demonstrate to insurance that you are aware of claim processing and you re on right side of law, they often pay out. • If the insurance company (underwriter) is licensed by any Department of Insurance, file a complaint with DOI. You will need all papers. It might not work though if you are not residing in the State where the insurance is licensed. • While you are in dispute with insurance, negotiate with provider. If it is not a big amount (less than $1000 or so), make an offer to pay 50-60% and close the account. Usually they agree. If it is more still negotiate and start making part payment. Even very small monthly payments will prevent it from going to collection. • If it is a US based insurance and if the bill is huge (thousands of dollars), consider consulting an Attorney on contingency basis. Remember, do not go to Attorney if you have a complaint filed with DOI • If it is a foreign based company , file a complaint with local authority in home country (in India it would be Insurance Ombudsman). Just filing a complaint often makes the insurance company running to you to negotiate.

Important Terms

Surplus Line Insurance: Excess line insurance companies (also known as Excess and Surplus) typically insure risks not covered by the standard lines insurance market. They are generally not licensed or authorized in the states in which they write business

ICD code : The following is a list of codes for International Statistical Classification of Diseases and Related Health Problems. This is what most insurance uses to decide whether a medical procedure is payable. This decides the diagnosis

CPT Code: The CPT (Current Procedural Terminology) code set describes medical, surgical, and diagnostic services

Rider: An insurance rider provides the policyholder extra protection beyond the provisions contained in a standard insurance agreement. For example, a rider may add that hazardous sports are covered or pre-existing conditions are covered up to some limit.

UCR (usual customary & reasonable) : Amount charged by most providers in same area. Normally insurance companies try to keep it as low as possible. To reverse this decision , you can use search tools to find regular charge by most providers in same area where your provider is located. OR send email to some providers about their regular charge and average it.

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