Visitor Insurance FAQ for preexisting conditions - Page 8

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Question What is the meaning of UC & R ?
Answer UC&R (or Usual, Customary & Reasonable): UC&R (or Usual, Customary & Reasonable) Charges represent the average or most common amount charged by providers for a particular service, treatment, or supply in the same geographic area. Typically information on rates for procedures is compiled into a data bank and updated periodically. So when a claim is submitted for a plan with UC&R benefits, the insurance company before making the claim payment reviews the UC&R rate and double checks that hospitals and doctors are not billing excessively for the particular service or procedure. Most well respected plans from Blue Cross, Aetna, Lloyds, Unicare etc. follow the UC&R schedule.
   
Question What are pre-existing conditions?
Answer Pre-existing conditions are medical ailments for which a person has been diagnosed, is being treated for or has before the start of the insurance policy. Pregnancy, AIDS, high-blood pressure and stroke are all forms of pre-existing conditions. Different insurance carriers have their own policies for pre-existing conditions. Some insurance providers offer coverage after a certain waiting period while others totally exclude certain conditions. Having a pre-existing condition obviously puts you at a higher risk for compensation than people without pre-existing conditions and is therefore more difficult to get insurance cover for that condition. We have a page detailing coverage available for pre-existing conditions.
   
Question What is a PPO?
Answer PPO stands for Preferred Provider Organization and is a network of health care providers. Insurance companies form these in order to control the costs of health care.

   
Question What are Preferred and Non Preferred providers in a PPO plan?
Answer PPO is a network of physicians that have agreed, by contract, to discount their rates for the respective PPO members. These physicians, specialists are known as preferred providers, and PPO members are free to see any of them, without any reference from their primary physicians.

PPO members may also see non-contracted providers, these are known as non preferred providers. The co-payment fee for seeing a non preferred provider is generally higher than the preferred providers.

   
Question What are the advantages of a PPO network?
Answer The following are the main advantages of having a PPO network
  1. The co-insurance component which is an additional expense to the customer is reduced when using services within the PPO network. For example, the Atlas America plan waives the co-insurance within the PPO network while the Patriot America plan reduces the co-insurance to 10% within PPO network. The PPO network is usually 20% up to the first $5000/- expense.
  2. The customer can have the billing done directly within PPO network, while it is usually reimbursed outside the PPO network.
  3. Providers within the PPO network have a negotiated rate with the insurance companies, and hence bills incurred within PPO network can be lower than bills outside the PPO network for the same service.




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