Outside USA:
There is no network outside USA and you may have to
first pay and then get reimbursed from the insurance company by
filing a claim form. The doctor's office or local hospital has
choice to be paid by the patient or by the insurance company.
However, for larger eligible expenses like hospitalization/surgery etc,
the insurance company can make arrangements for direct payment
to the provider.
Inside USA:
Atlas America from HCC Medical Insurance Services (HCCMIS)
participates in
Hygeia/First Health PPO Network.
Hygeia/First Health PPO Network is
a separately-organized network of
large number of physicians and privately owned and operated hospitals.
As it is a well known network in every major
area of US, there are good number of doctors and hospitals.
When you go to the doctors in the network,
please mention that you have Hygeia/First Health PPO Network plan, as the doctor
sometimes
may not be aware of HCCMIS or Atlas America.
When you go to the doctors and hospitals in the network, they can
take the insurance card and contact HCCMIS to verify the benefits.
HCCMIS can pay directly to the
provider if it is determined that it is an eligible expense(covered expense in the policy).
Providers will also charge only the Network Negotiated Fee(NNF) which is a discounted
fee in many cases.
When you go to the providers outside the network, you can
present the insurance card. The insurance card has all the information
doctor's office will need to bill the insurance company directly such as the certificate
number, claims filling address in US, toll-free number to call and verify the coverage.
It still depends upon the doctor whether
to bill the insurance company directly or not. Even if the doctor accepts the card,
there is no network negotiated fee. If you have to first pay, you can
get reimbursement by filing a
Claim Form.
You can either use the claim form you receive in the mail along with the insurance
card or you can download the
Claim Form from this web site.
MNU will reimburse you usually within 4 weeks of they receiving the claim.
However, when there is hospitalization/surgery involved and the costs
are quite high to pay first, HCCMIS can make necessary arrangements to pay the provider
directly.
Whether you go inside the network or outside the network, after the annual
deductible, insurance company will pay 80%/20%
for first $5000 expense and after that 100% up to policy maximum.
There is no network of providers for prescription drugs(medicines).
Even if the provider agrees to bill the insurance company directly,
you should still file a
Claim Form to expedite
the claim process. When the provider sends the bills to insurance company,
insurance company would need to request medical records from the provider
which provider can't give until they have authorization from you to release
the records. Filing a claim form provides such authorization.
All your claims will be handled by HCCMIS in USA. You never have to contact
the carrier, Lloyds, for any purpose whatsoever.
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