What is cashless visitors insurance?
The exact phrase 'cashless insurance' is used in India by Indian insurance companies and people in India. This exact wording is not used in the United States.
In any case, 'cashless insurance' is insurance for visitors where you don't have to first pay upfront to the provider (hospital or doctor). Instead, the provider can bill the insurance company directly and the plan pays the provider directly. Therefore, the insured does not have to pay upfront and file for reimbursement later.
Which cashless visitors insurance plans are available?
Some reliable comprehensive visitors insurance plans include access to a PPO network (Preferred Provider Organization), where participating providers may bill the insurance company directly. The main differences come from the network used and how each plan handles the deductible and coinsurance.
Patriot America Plus
Patriot America Plus provides access to the UnitedHealthcare PPO network or First Health PPO network, depending on the insured person’s country of residence. With direct billing, medical charges are sent to the insurer rather than collected in full from the insured. The deductible applies, while coinsurance is waived when using participating providers.
Overview
Outside PPO network: After deductible, pays 90% to $5,000, then 100% to policy maximum.
Direct Billing
Acute Onset of Pre-Existing Conditions
Atlas America
Atlas America uses the UnitedHealthcare Options PPO network in the United States. Participating doctors and hospitals send medical charges directly to the insurer instead of requiring the insured to pay upfront and file for reimbursement. After the deductible, the plan pays 100% of covered expenses up to the plan’s maximum coverage amount.
Overview
Direct Billing
Acute Onset of Pre-Existing Conditions
Beacon America
Beacon America includes access to the UnitedHealthcare PPO network. Medical charges from participating providers are billed directly to the insurance company rather than requiring full payment first. After the deductible, the plan pays 100% of covered expenses up to the plan’s maximum coverage amount.
Overview
Outside PPO network: After deductible, pays 80% to $5,000, then 100% to policy maximum.
Direct Billing
Acute Onset of Pre-Existing Conditions
Direct billing can reduce the need to pay a large medical bill upfront, but each provider decides how payment is handled. Before receiving treatment, confirm the billing process with the doctor or hospital and review the plan’s deductible and cost-sharing details.
Do you offer cashless health insurance?
Many visitors insurance plans that we offer participate in the PPO (Preferred Provider Organization) network which is a network of hospitals and doctors all across the United States. When you visit the providers in the PPO network, they can bill the insurance company directly instead of you having to pay first and file for reimbursement later. However, it is up to the doctor to determine whether or not they will bill the insurance company directly, or if you must pay first and file a claim for reimbursement. Regardless, the term "cashless health insurance" is not typically used in the USA.
Therefore, the better question to ask would be 'Do you offer visitor insurance that participates in a PPO network?'. And the answer is, absolutely! Get quotes today to find your coverage.
If I buy visitors insurance that participates in a PPO network, does that mean they will cover it 100% and I don't have to pay anything?
No. Other than the provider billing the insurance company directly, all terms and conditions of the insurance policy still apply. For eligible expenses, you still have to pay the deductible before the plan pays anything (unless the deductible is specifically waived for certain expenses in some policies). After that, in comprehensive coverage plans, you will have to pay the coinsurance (typically 10% or 20% for the first $5,000 in eligible expenses) and then it will pay 100% up to the policy maximum. In fixed coverage plans, the insurance company will pay according to the schedule of benefits (sub-limits) and you will have to pay the difference yourself. In any case, the insurance company will not pay anything beyond the policy maximum, or for ineligible or excluded medical expenses.
Why do I have to file claim form in visitors insurance that participates in a PPO network?
Many people associate claim forms with having to pay first and then file for reimbursement. But that is not the only purpose. In order to determine the eligibility for a particular claim. The insurance company needs the medical records from the provider, which they can't release until they get written authorization from the insured. Filling out the form gives such authorization and also gives additional information to the insurance company regarding what happened, where you were treated etc.
If I get pre-certification in visitors insurance that participates in a PPO network does that mean such expenses are guaranteed to be covered?
No. Pre-certification is not the determination of eligible expenses. It is more like a notification where you are letting the insurance company know what happened, where you are getting treated etc. Eligibility for a given expense can only be made after the fact when the insurance company gets the medical records from the treating provider; not before that.
Is PPO network treatment available only for hospitalization or also for outpatient treatment?
There are providers that participate in the PPO network which are hospitals, doctors, labs, urgent cares and so on. Therefore, the cashless facility is available for all kinds of medical treatment. However, please note that sometimes, a doctor's office may still refuse to accept the insurance card in spite of participating in the PPO network. But that is an exception and not a general rule. If that happens, please inform us and we will pass that information to the insurance company who will try to educate that provider. Such possibility is a lot higher in fixed coverage plans compared to comprehensive coverage plans.
Is cashless treatment available only in the PPO network or outside the PPO network as well?
Providers in the PPO network may bill the insurance company directly. That is exactly why they are in the PPO network. However, for the providers outside the PPO network, it really depends upon the provider. As a practical matter, we are yet to see a U.S. hospital who refused to bill the insurance company directly. But in case of a doctor's visit, you may end up paying out of your pocket and filing for reimbursement later.
Are there any eligible medical expenses for which the PPO network participation is not available?
Yes. Prescription drugs are a good example.
Where can I find further information?
Please look at the 'Claims Process' section in our guide.
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