When you buy visitor’s insurance for the USA, basically you are buying short-term health insurance for the duration of your stay in the United States.
During the research and buying process, you will come across these terms:
PPO is a term specific to the United States domestic health plans. PPO stands for Preferred Provider Organization.
You must be aware of the fact that healthcare costs in the USA are extremely expensive and medical cost trends are only moving north!
Visitors, tourists, and parents visiting the U.S. find it extremely difficult to get the medical care they need given the exorbitant cost.
To overcome this issue and make medical care more accessible and affordable for patients, Preferred Provider Organizations (PPO) Networks like First Health PPO have revolutionized the healthcare industry.
With the First Health PPO network, you have access to a vast network of healthcare providers, ensuring you receive the medical care needed during your stay in the United States.
Some travelers may be familiar with the term PPO, but if you are not and you need more information, then, let us understand more about PPO and the First Health PPO Network.
What Is A PPO Network?
What is a PPO Network? In the U.S. PPO network refers to the Preferred Provider Organizer having contracts with medical providers such as hospitals, clinics, pharmacists, laboratories, and other healthcare providers.
These providers have contracts with third-party insurance providers who provide healthcare facilities at a reduced rate to the insurance provider’s clients or members.
Why Use PPO Network?
The policy provides better-discounted rates for medical treatment and services availed in the network.
What Is First Health PPO Network
The first health PPO network is one of the largest PPO networks in the U.S. with more than 1 million healthcare providers and facilities. First Health PPO is accredited by the National Committee For Quality Assurance (NCQA).
First Health PPO Network – Broad Access:
The First Health PPO Network has in its network more than:
- 868,000 Providers
- 695,000 Healthcare Professionals
- 5,000 Plus Hospitals
- 110,000 Plus Ancillaries
To help reduce out-of-pocket costs for medical care, First Health PPO Network provides healthcare services to its members at a discounted rate. Members can have access to these in times of need.
Members can choose their healthcare providers from within the network, without the need for a referral from a primary care physician.
To locate a First Health PPO Provider Visit: https://www.myfirsthealth.com/
Is First Health A PPO?
Yes, First Health offers a PPO Network that travel insurance companies use and extend the benefit to their customers.
With First Health PPO Network, you can use any doctor, clinic, hospital, or healthcare facility in their national network.
How Do I know If The Policy I Purchased Follows A Network?
- The ID card usually has a logo of the network it participates in
- Most plans have the logo on top of the card
- The card has the logo of First Health Network, or
- The card has the logo of United HealthCare or
- The policy document will have details of the PPO
- By looking at the logo on the card we know the network the policy follows
Please note that not all visitor insurance plans offer access to a PPO network. Read the policy document carefully for the health benefits and other support services that the plan provides.
Using First Health PPO Network With Visitors Insurance Plan
While using your First Health PPO Network keep these things in mind:
When You Contact A Medical Provider Or Present Your ID Card, What Should You Say?
When you contact a medical provider or present your ID card, Please indicate the PPO Network when you have to use the insurance.
The first thing you must say is:
“My Insurance uses the First Health PPO network and I found your name on the First Health PPO network search”
When You Contact A Medical Provider Or Present Your ID Card, What Should You Avoid Saying?
When you contact a medical provider or present your ID card you must avoid saying “I have XYZ Insurance” or “I use XYZ Network”, or “I have XYZ Plan”,
Providers might not be aware of all the visitor insurance plans and plan names and in this confusion, your insurance may not be accepted.
Trawick International Travel Health Insurance Company
The following travel insurance plans from Trawick International provide First Health PPO Network
- Safe Travels USA Comprehensive
- Safe Travels USA Cost Saver
- Safe Travels USA Insurance Limited Benefits
Find A Provider In The First Health Network
If you have a visitors’ insurance plan that includes coverage through the First Health PPO network, you can locate participating providers by visiting the First Health Group Corp website. They provide national and regional PPO network providers
Knowing The Billing Process – Within The First Health PPO Network
Choose An In-Network Provider
If your visitors’ insurance plan offers coverage through the First Health PPO Network offering travelers healthcare and facilities that are In-network
You can use the First Health PPO Network’s online provider locator tool to look out for healthcare providers and facilities that are in-network (offering discounted rates)
Receive Medical Care
Patients can receive the needed medical care once the in-network provider is identified.
NOTE: To ensure your care is billed appropriately, Inform the healthcare provider that you have coverage through the First Health PPO Network.
Provider Submits A Claim
The claim generally includes details about:
- The service provided
- The cost of the services
- Patients Insurance information
The healthcare provider submits a claim to First Health for the payment, Once the patient has received the medical care,
However, The traveler must keep copies of any bills, receipts, or doctor’s notes as these could be needed in case the policyholder is to submit a claim directly to their specific administrator.
First Health Reviews The Claim
To ensure the services provided were necessary and covered by the patient’s plan, After the claim is submitted, First Health reviews the claim, to ensure it meets the network’s guidelines.
First Health Pays The Provider
Once the claim is approved the healthcare provider directly receives for the services provided at the discounted rate agreed upon according to the contracted rate with First Health.
The Patient Receives An Explanation Of Benefits (EOB)
Explanation of Benefits (EOB) statement is the statement outlining:
- The services provided
- The amount billed
- The amount paid by First Health
Once the claim is processed the patient receives an explanation of Benefits (EOB) statement.
The patient is required to review the EOB statement to ensure the accuracy of the services received
History and Background of First Health PPO Network
To offer affordable healthcare solutions to patients across the U.S.:
- In the year 1985. First Health was founded. As a subsidiary of Coventry Health Care Inc.
- Then Later on it was acquired by Aetna Health Inc.
- Which improved offerings and expanded the network reach of First Health PPO Network
Popular Visitors’ Insurance PPO Plans Using First Health Network
Popular Visitors’ Insurance PPO Plans Using United Healthcare Network
Visitors’ Insurance PPO Plans For Pre-Existing Medical Conditions Coverage
Frequently Asked Questions
What Is A PPO Network?
PPO or preferred provider organization is a network of many established highly qualified medical practitioners and well-recognized hospitals in the USA, known as the PPO Network.
In short Preferred Provider Organization (PPO) is a type of health plan that contracts with medical providers, such as hospitals and doctors, to create a network of participating providers
Why Use A PPO Network?
The policy provides better-discounted rates for medical treatment and services availed in the network
Which Are The Best PPO Insurance Plans For Travelers To The USA?
The most popular plans are:
Atlas America and Patriot America Plus are comprehensive coverage visitor insurance plans that cover 100% of the costs within the PPO network.
However, if you go out of network providers, Patriot America Plus will pay 80% of $5,000, then 100% of the policy maximum, while Atlas America will still pay 100% of the policy maximum
Alternatively, you can also opt for the Travel Assistance membership program for your international trip with guaranteed cashless claims via medical concierge-like:
Hop! Trip Assist Plus: Hop! Trip Assist Plus is exclusively a Travel Assistance Membership Program for international trips that provides worldwide Medical Assistance, Emergency Consultation Services, and Travel, Legal, and Personal Assistance, including coverage for Pre-Existing Conditions, for travelers, traveling anywhere worldwide outside their home country.
Which Is The Best Fixed-Coverage Visitor Insurance PPO Plan?
There is nothing like the best plan it depends on the individual and their insurance needs, you can explore the following plans:
- INF Premier: If you need coverage for pre-existing conditions for your USA trip or if you have parents visiting the USA needing this coverage, you can explore this plan. This is a very popular visitor insurance plan.
- Visitors Care: Visitors Care is a fixed coverage insurance plan that participates in a PPO network. This plan provides coverage for medical emergencies, including hospitalization, emergency medical evacuation, and repatriation.
- Hop! Mindoro: this option is an alternative, you can opt for a travel assistance membership program providing fixed benefits for eligible medical, travel, legal, and security assistance for travelers, traveling anywhere in the world, outside their home country.
It is recommended to carefully review the plan details, network providers, and associated costs while evaluating travel insurance options. It is also important to understand the differences between comprehensive coverage and limited/fixed benefits coverage.
What Are Provider Networks?
Provider networks are networks of Hospitals, Doctors, and other healthcare providers and facilities who have agreed to offer services to insured persons (of certain medical plans) at negotiated rates. These rates are negotiated with the insurance provider’s office and passed on to plan holders of the respective providers.
What Is National Provider Identifier (NPI) Information
The National Provider Identifier (NPI) is a unique 10-digit identification number issued to healthcare providers in the United States by the Centers for Medicare and Medicaid Services (CMS)