Knowing how to choose the right medical provider with international medical insurance during your travel to the USA ensures that you receive the most efficient treatment, at the lowest out of pocket cost.
As soon as you make a purchase, you get a virtual ID card in the email. You can also download it at any time from MyAccount for many international medical insurance plans. Most international medical insurance plans from the USA will also send you the insurance card by postal mail to the mailing address you specified. The visitor should keep the insurance card handy at all times while in the U.S. and if possible, during travel as well.
Most hope that they would not need to use the international medical insurance. However, the insurance is meant for unforeseen circumstances that unfortunately do occur, when visitors fall sick or injured. Therefore, it is very wise to understand what kind of provider to use under what circumstances. However, in any case, you should be the best judge of your situation as it is not possible to give generic advice regarding what the most suitable place would be for you to go in a given specific situation.
Irrespective of the type of medical provider you use, keep the list of participating providers in the PPO network handy, if the particular plan you have taken participates in the PPO network. You can always go to any provider of your choice, but visiting a provider in the PPO network (when applicable) is beneficial. You can look into MyAccount for PPO network directory, if applicable. Please read the international health insurance claims process for more details about the claims.
Doctor's Appointment
If you have a minor condition that can be treated with over the counter medication or with the medication you brought with you from the home country, you can try that.
If you have a minor ailment such as cold, flu, fever, diarrhea, stomach upset or other such illnesses, it is best to take the doctor's appointment. While some doctors schedule the appointment right away (some even on the same day), most schedule the appointment after a few days. Many people from other countries who are new to the U.S. do not realize this and want to see the doctor right away, and avoid taking the doctor appointment which is not recommended for the reasons discussed below. You would have to just get used to the healthcare system of the U.S., while in the U.S.
Urgent Care
If your medical condition requires urgent attention (especially during the night or weekend) and you can not wait for a Dr's appointment, but at the same time, you don't have a real emergency, you should consider visiting an urgent care facility which welcomes walk-in patients. Urgent cares typically have long hours and some of them are open on weekends too.
Of course, if the urgent care determines that you have an emergency that they can not handle themselves, they may ask you to to go to the emergency room or in extreme situations, call the ambulance on your behalf that would take you to the emergency room of the hospital.
Particularly, Atlas America Insurance provides you an incentive to go to the urgent care instead of an emergency room, whenever appropriate. All you have to pay is the $15 copay. You are not subject to any deductible.
Emergency Room
If you have a medical emergency that you can't wait to take the Dr appointment or even go to the urgent care or they would not be able to handle it, the next step would be to go to the emergency room (ER).
Emergency rooms are typically operated by the hospitals and they are open 24 hours a day, 7 days a week.
Abuse of Emergency Room System
Many people go to an emergency room when there is really not an emergency (like for mild fever or cold, for example) simply because they don't want to wait for an appointment for the doctor, or appointment is not available etc.
As a lot of people visit the emergency room even in a non-emergency situation, they typically have a triage section whom you will see first. They will determine the urgency of your situation and prioritize the patients accordingly. If you don't have a real emergency, you may end up waiting there for several hours.
Of course, each situation is different and you may not exactly know what the most suitable place is for a given situation and you don't want to take any chances. However, emergency room costs a lot of money. Even if they hardly do anything or just do some basic tests like x-ray or blood report, or monitor your situation for a few hours, the bill can run into thousands of dollars.
People going to an emergency room when not needed increases the cost for the insurance company and in turn increases the premiums for everyone. Therefore, in order to control the costs and to avoid an abuse of the emergency room system, most insurance companies have some kind of penalties in place.
In case of Atlas America,
- You go to an emergency room for an accident, you are covered just like any other eligible expense.
- You go to an emergency room for a sickness for which you are admitted right away after that, you are covered just like any other eligible expense.
- You go to an emergency room for a sickness for which you are not admitted, you are covered just like any other eligible expense. However, you will have to pay $200 penalty for such visit.
In Patriot America Lite, Patriot America Plus, Patriot America Platinum etc., in situation C above, there is a penalty of $250 per visit.
Plans such as VisitorSecure and Visitors Care do not provide any emergency room coverage for an illness (not for accident/injury) that does not result in inpatient admission for further treatment.
Even domestic insurance plans such as Aetna, Blue Cross Blue Shield, United Healthcare etc. for U.S. residents also have separate and stricter rules for an emergency visit with higher co-pays and higher out of pocket expenses.
This is simply so that people don't go to an ER for everything.
It is completely understandable that sometimes, you just don't know how serious or trivial the problem is and you don't want to take the risk and logically thinking, it might be the most suitable thing to do is to go to an emergency room. And it turns out to be nothing. However, insurance companies need to make the rules that can be uniformly enforced and are fair to most people as it is not possible to read the state of the person's mind and their intentions in every situation. Therefore, in some unfortunate situations, you will have to just bear the extra charges that are not covered.
911
When the situation is so severe that you need medical attention right away (such as heart attack or major accident) and you don't have time to go to the emergency room yourself, you should call 911 and the ambulance would arrive in a very short time in most parts of the U.S. They would take you to the nearest or most appropriate hospital. Of course, depending upon the circumstances, you may be able to direct them to the emergency room of your choice or according to the one in the PPO network, if it would be medically appropriate for them to allow you to choose from several options. But you don't always have that option.
Please note that calling 911 and getting the ambulance is neither a free service, nor provided by the U.S. government. Ambulance companies are independently owned and operated and they would send you a separate bill. (Of course, the phone call to 911 itself has no phone charge.) Most ambulances in the U.S. are typically well equipped. If the patient is not in a medical condition to call 911 himself/herself, anyone such as relative, friend or anyone can call the ambulance on his/her behalf.
It is important to note that most insurance plans have restrictions regarding ambulance payment if you are not subsequently admitted into the hospital.
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