Cashless Visitors Insurance

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 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.

Do you offer cashless visitors 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, and it will never be referred to as "cashless insurance."

Therefore, the right question to ask would be 'Do you offer visitors insurance that participates in a PPO network?'. And the answer is, yes.

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.