Questions about Protection America and Liaison

[Isha]

Hi Narendra and other experts,

i had a few questions about both protection america and Liaison. ur help in clarifying them will be appreciated pls

1- Deductable and Co-insurance. When we say 250$ deductable, this i guess is per year (not per policy) ? Similarly co-insurace of 80/20 means max out-of-pocket expense is 1000$ per year (not per claim).

If this is not annual, but per policy - then it seems beneficial to take shorter 1month policy rather than one 6 month policy (though we have the 5$ renewal fee)

2- The details about prescription drug is not specified in brochure. Is it 80/20% until 5000$ as specified in the provider details section for both Protection and Liaison plans.

And does this come from the same *pool* as the total co-insurance per year or is it different for prescription and doctor visits ?

3- Refund of the policy on early departure, Liaison lists that we have an option of refund if no claim is filed. For Protection america only non-satisfication refund is mentioned, could that be used even for refund for the unused portion incase one needs to return back early ?

4- Narendra, i read you recommendation regarding choosing protecion america, could u pls let us know, if your input is based on folks experiences with claiming/using the insurance (or) is it based on the plan details only as in the brochure.

5- Precertification :

A. do we need to call even before physician visit (basically before any doctor appointments/visits) that will result in a claim or is it just limited to inpatient/surgery treatment and not outpatient visits.

B. Is precertification necessary for prescription drugs as well ?

C. Is this telephone service available 24 hours for protection america ? Liaison explicitly says 24 X 7 support but not Protection america.

D. This statement is conserning - "Precertification/Prenotification doesnot gurantee that benefits willbe paid". So how do we get the assurance/guarantee that it is paid in that case ? is it the review
after submission & under what grounds can the benefit be denied ?

E. And finally, what is certificate wording and could we get a online copy of that please.

Thank you

[insubuy]

1. Annual.

2. Prescription drugs are covered as part of the medical expenses.

That means, you have to pay 20% for the first $1,000 just once for any combination of dr. visits, hospital stay and rx drugs.

3. After the effective date, as long as there are no claims filed from day 1,
Protection America: Fully unused months minus $25 cancellation fee. (This is mentioned in the brochure.)
Liaison International: Pro-rated duration minus $50 cancellation fee.

Here, unused means early departure. If you bought for 6 months and stayed in US for 6 months, you completely used the insurance and there is no refund in that case.

4. Both.

5.
A. Not for Dr. visits. Just for inpatient/surgery etc.
And in an emergency, you don't have to first call. You can call within 48 hours or as early as reasonably possible.

B. No.

C. Same timings in both companies. Anyway, it does not matter based on answer 5A.

D. There is no guarantee of benefits in any company. Even in the domestic group health insurance that I get through my employer from Aetna has no guarantees.

Precertification is more accurately described as prenotification. You just have to call the insurance company and let them know that you are going to do such & such so that they are better prepared in case the hospital calls to confirm the benefits.

Insurance company's claims dept. determines whether something is pre-existing condition or not based dr. opionion, attending physician statement, medical records and treatment details. That is done only after the treatment and when the claim is submitted.

That is exactly how domestic companies also work. Just that you don't realize that because most of things are covered in group health insurance. Even I get some things denied in group health insurance if it does not happen to be covered procedure.

E. Certificate wording has the official policy details. It is little bit more detailed than the brochure.
It is not available online. Contact us and we will make it available to you.

I hope this answers your questions.

If you have any additional questions, please feel free to contact us at any time or post them here.

[Isha]

Thanks for the reply narendra. Based on ur reply i shall go with protection america.

[Isha]

One more question on protection America - URGENT

narendra, looking at the provider directory the list of provides atleast in bay area seems to less for protection america compared to liaison. But on your web-site IMG/protection america is listed as the largest provider network.

could u please clarify this part ? is it because the liaison provider directory is not accurate but just lists all provider OR the people who accept Protection america in California (San Jose) area is less ?

would appreciate it if u could clarify asap as i need to make a purchase today.

thanks

[Isha]

Also didnt understand the *pay once* - part in ur reply for the 80/20 rule, have listed 3 cases below, could u pls clarify which one of it it is.

"That means, you have to pay 20% for the first $1,000 just once for any combination of dr. visits, hospital stay and rx drugs. "

If patient makes say following expenses for example


CASE 1
total expense (insurace pays/ patient pays)
---------------------------------------------------------
outpatient - 200$ (160/40$)
rx - 50$ (40/10)
outpatient - 100$ (80/20)

but for this case

------
CASE 2
expense1 - 5000$ (4000$/1000$) ONCE since patient hit 1000$
expense2 - 1000$ (1000$/0$) patient pays nothing.

is this what u are trying to say ?

----
CASE 3: guess *NOT* this as this means, patient incurs all expense for first 1000$ and only after that does the insurace starts paying.

expense 1 - 200 (0/200)
expense 2 - 800 (0/800) UNTIL total hits 1000, insurance pays nothing
expense 3 - 500 (500/0) only nowthe insurace coverage starts.

----
thanks

[insubuy]

Answer for posting 2 from Isha
--------------------

That's not true. I just searched within 10 miles of 95120 (San Jose, CA).

I found 1382 providers in Protection America, while I found 752 providers in Liaison International. I am sure you were not search properly. Some times, the same provider is listed differently in different plans (such as family practice or internal medicine or primary care physician. e.g., if you search using the term family practice, and one plan lists most of those types of providers as primary care physician, you would see less no. of doctors in family practice, but does not mean there are indeed less doctors.)

[insubuy]

Answer for posting 3 from Isha.
------------------------------

Case 1: This is correct
Case 2: This is correct
Case 3: This is NOT correct