FAQ's
Current FAQ's
- What is the difference between an international cost containment network and a PPO?
- Is it acceptable for international accounts to be processed through domestic PPO's?
Previous FAQ's
- Are the depth of discounts related to volume steerage to medical providers?
- Will my discounts be audited, and will the discounted amount be demanded back by the provider of service?
- Is selecting a Network/Discount Provider, based on average returns on discounts obtained, reliable?
Answers
What is the difference between an international cost containment network and a PPO?
This is an incredibly important question that has been misconstrued and is being misrepresented in the market today.
Preferred Provider Organization (PPO)
A Preferred Provider Organization (PPO), comparable to a Health Management Organization (HMO) is a domestic network that is designed to help local medical service providers and local insurance companies coexist in a cost effective environment. Local insurance companies agree to direct and or use "steerage" (insuring patient volumes) so that insured people receive care at specifically agreed hospitals, and that bills are paid within a given time frame (usually 30-45 days) from date of billing. This mode as described is labeled as domestic and for a number of reasons, is very different from the travel insurance or international market.
International Networks
The international travel insurance market is based on the premise that those who travel require affordable insurance to cover the expenses of emergency medical care in a foreign destination. While domestic insured persons are usually treated in a hospital within a geographical area based on their policy, international insured persons often receive care in an emergency situation and are taken to the closest available facility that is equipped to treat the patient.
Is it acceptable for international accounts to be processed through domestic PPO's?
Although this frequently occurs in today's marketplace, healthcare providers are starting to oppose international accounts being processed through domestic networks, they are refusing discounts attempted through such avenues, and are even seeking retribution for old international accounts that were illegitimately discounted through domestic networks.
Are the depth of discounts related to volume steerage to medical providers?
Steerage of patients (i.e. volume of work) only occurs in certain domestic markets. In the context of travel insurance, steerage is non existent. A person, collapsed in their hotel room or RV park does not call up their insurer to ask them which hospital they should go to so the insurer gets the best rate.
Will my discounts be audited, and will the discounted amount be demanded back by the provider of service?
Another scare tactic used by some unscrupulous discount providers to coerce your business in their direction. A legitimate discount, obtained in a legitimate way, is a legal contract. If indeed an audit by the provider is sought, it should be your discount provider's responsibility. Check the wording of what you signed in your contract, and remove the inclusion by your discount provider of exonerating themselves of this responsibility. This is after all why you are paying the access fee for having obtained the discount in the first place.
Is selecting a Network/Discount Provider, based on average returns on discounts obtained, reliable?
Average returns have very little basis on which to rely for your selection process. Certain states, e.g. Maryland, give miniscule discounts due to state regulation. If your work mostly resides in Maryland, your average will be low. Conversely, one discount provider returning a 3% average and another returning a 15% average, are both very low. However, the second provider at 15% is 500% greater than it's rival. In reality, it is what YOUR year end underwriting results (loss ratio) show, which should be used to evaluate the success or failure of your discount provider.
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