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Understanding U.S. and Global Medical Networks

Ask Doug about understanding U.S. medical networks and international medical networks better will help you and your organization use your global employer group medical insurance better.

In this 3-part series we will address

  • Two key medical insurance network models throughout our globe
  • Some key differences in comparing your medical networks
  • How does my U.S. and International medical network stack up to others?

Click on the links below to go to the videos

  1. Two key medical insurance network models throughout our globe
  2. Some key differences in comparing your medical networks in the U.S. and outside the U.S
  3. How does my U.S. and International medical network stack up to others?

 

Today we will be discussing the two key medical insurance network models throughout our globe

In general, U.S. medical care networks

  • Provide access to medical facilities to doctors, hospitals, and specialty care centers.
  • Your insurance company has contracts with medical providers for negotiated pricing.
  • This keeps your premiums down, as well as, out-of-pocket costs such as copays, deductibles, and coinsurance for the policyholder.
  • If you go to a doctor or other medical provider that is not in your network, you don’t have that cost safeguard.
  • This also allow a more streamlined experience when paying for a medical service. The doctor just bills you the co-pay and submits the rest for reimbursement.
  • Lastly, U.S. medical facilities handle a lot of the “heavy lifting” by connecting with your insurance company to ok the needed medical procedures.  This allows you, the policyholder, to get the care you need with a more hands-free approach when dealing with a medical concern in the U.S.

In general, for medical care outside the U.S, you are not obligated to use a medical network. You can use any western style medical provider you choose, there is not a Network price versus non-Network price.

  • The advantage of using the “network” is usually the provider is willing to wait for the insurance company to pay them directly. If you have a $0 deductible plan, you may experience receiving cashless medical care.
  • The list price and discounted model that we have in the U.S.  is not that common internationally.
  • A few countries have set list prices for medical procedures but that is primarily used for their national health care providers. 
  • Generally, even private international medical providers charge so much less than U.S. providers that having a negotiated price with them is not usually a concern for the global medical insurance company.
  • In many countries, the national government is the payer for medical care.  So, there is a limited understanding of private medical insurance as third-party payers. Either you pay a subsidized amount or the government pays.
  • Thus, medical care networks do not play a key role in the medical markets since the national government dictates pricing.
  • Private medical insurance does have a role in countries with nationalized health, which allows insureds to get care via private hospitals and doctors without having to wait for government paid specialists. Depending on the medical specialty, one can wait months for the appropriate medical provider.
  • Countries that have medical networks will have varied models due to the different style of medical care in that country compared to the U.S. They may be a local network. Some international insurance companies’ contract with local medical networks.
  • If a medical provider is listed in the international insurance company’s provider search, it usually means that there is an established relationship, so that the company can pay the provider directly.

Some best practices to keep in mind when you are using your international employer group medical insurance outside the U.S., https://www.gninsurance.com/group-health –

  • Realize that you will be responsible to check with your global medical insurance company for major (i.e., expensive) medical tests and procedure(s) as a medical necessity.  
    • This is usually called pre-certification or pre-authorization
    • Depending on the country this can take 48 hours to 2 weeks unless it is a medical emergency and how much the provider is willing to cooperate to provide requested information.
    • Please note that pre-certification does not guarantee payment but does provides confirm that there is medical necessity for the test or treatment.
    • This pre-certification also checks that the medical facility is not inflating the medical cost of that procedure.
  • To find out if the medical procedure is a covered benefit on your international employer group medical insurance please
    • Connect with your global insurance company through your insurance portal on their web site or on the phone.
    • Or call us here at GNI (Good Neighbor Insurance) if you are not able to connect with your international medical insurance company.

Having a medical procedure outside the U.S. will usually save you money over having the same medical procedure completed in the U.S. You may even find it to be financially advantageous to go to a nearby country that has excellent medical care and take advantage of a lower deductible and 100% coinsurance for care outside the US.  Some international medical insurance companies will actually pay you so much per day when hospitalized outside the U.S. This is to cover your incidental expenses, and you don’t have to account for how it’s used.

Here are the general steps of how a medical network function inside the U.S. on your international employer group medical insurance, https://www.gninsurance.com/group-health –

  • Step 1 – When you enroll, you receive your medical ID card which shows your U.S. network.
  • Step 2 – You can search for Network (U.S.) and Direct Pay (International) medical providers through your global online account with your global insurance company.
  • Step 3 – You may access your medical care in-network by making appoints with medical network providers and showing your ID card when checking in.
  • Step 4 – Your medical provider recognizes your global medical insurance company since they have a contract with your global international medical insurance company and takes care of your medical request.
  • Step 5 – The medical provider you saw informs you and your global employer group medical insurance company the agreed discounted rate.
  • Step 6 – Depending on the medical service provided, you may pay a co-pay, deductible or co-insurance for the “patient responsibility.” If you haven’t met your deductible yet, you only pay the discounted amount of the eligible medical expense. Your international insurance company pays their amount to the medical facility you just visited.

Because there is no one global network model, there are a variety of ways global employer medical insurance companies provide an almost claimless or cashless (and sometimes 100 percent claimless) experience for you, the policyholder/patient.  When getting medical care outside the U.S., there are three major ways your global employer medical insurance company will help you pay for your medical care.

  1. Option 1 – your international employer group medical insurance company contracts with various healthcare provides, facilities, and service providers around the world based primarily on quality and service to their clients, you.
  2. Option 2 – Or your global employer group medical insurance company establishes a relationship, which is not as strong as having a contract, with a variety of healthcare providers, facilities, and service providers outside the U.S.
  3. Option 3 – You get the medical care needed locally, pay the invoice and then submit the claim for reimbursement.

Please note that you may use any legally licensed (western style) medical facility outside the U.S.

Here are the general steps of how a medical network functions outside the U.S. on your international employer group medical insurance

  • Step 1 – You, the policyholder, will be able to see a list of medical provider networks located on your online portal.  If there is not an in-network list of medical providers in your desired geographical area, you may connect with your global medical insurance company to see what options they would recommend.
  • Step 2 – You, the policyholder, can show your medical ID card to your medical facility.
  • Step 3 – If the medical provider recognizes your international medical insurance card, they will go ahead and start the medical procedure they know they need to complete to be paid for the services rendered. You won’t have to do anything else (unless a deductible is owed).
  • Step 4 – If your medical facility does not recognize your international medical ID card, they may call or email your international medical insurance provider. Sometimes, the person at the front desk of a Direct Pay facility may not be familiar with your international medical insurance company. In that case, you may ask to speak to a supervisor or have your global medical insurance company reach out to the medical provider directly on your behalf.
  • Step 5 – Your medical facility may request you, the policyholder, to pay and then you can fill out a claim form and submit to your global medical insurance provider. Always request an itemized receipt which lists what services were rendered and the cost of each one. 

Many global medical insurance companies have a mobile app that allows you to do a provider search in the U.S. and abroad, download travel documents, and submit medical claims.

Thank you for watching our Ask Doug about International Employer Group video series and please keep your eye out for part 2 and part 3 of this 3-part series about U.S. and International medical networks. Please like and subscribe.

For the most up-to-date information on our different international employer group insurance options, please –

Your GNI team here in Gilbert, Arizona, wish you all safe and awe-inspiring expatriate travels!

https://www.gninsurance.com

 

 

Ask Doug about understanding U.S. medical networks and international medical networks better will help you and your organization to use your global employer group medical insurance better, https://www.gninsurance.com/group-health/resources/employer-group-videos/understanding/medical-networks.

In this 3-part series we will address:

  • Two key medical insurance network models throughout our globe
  • Some key differences in comparing your medical networks in the U.S. and outside the U.S.
  • How does my U.S. and International medical network stack up to others?

There are a few key differences between the U.S. healthcare system and the rest of the world healthcare system.  One of those key differences is how medical network facilities work. 

Difference One

  • In the U.S.
    • Formal medical insurance contracts between employer group medical insurance companies and the medical providers are a key part of a U.S. network in the U.S.
    • These include how much the provider can charge for various services.
  • Outside the U.S.
    • many countries have their national / provincial government who are the payer and thus, there is a limited understanding of how private medical insurance works. 

Difference Two

  • In the U.S.
    • there is a very structured and well-ordered way of collecting the patients’ amount of pay and any remaining balance that is paid by the insurance company.
  • Outside the U.S.
    • When using private insurance, it is hard for the medical providers to feel confident of being able to collect the rest of the medical bill from the insurance company if they have not previously dealt with that company.
    • Once the client walks out of the medical facility, outside the U.S. the provider may feel they are unable to collect any balances that are still due.

Difference Three

  • In the U.S. network
    • Insurance contracts are designed using the same language which allows for all medical providers to easily follow.
    • This also allows for medical facilities to opt into the in-network since the exchange for a lower price point becomes less of a concern with the extra volume of patients.
  • Outside the U.S.
    • Insurance contracts are more considered threats due to not understanding insurance wording. 
    • Also, due to lack of possible volume, medical facilities outside the U.S. may not see the need to be part of the international insurance medical network.

Difference Four

  • In the U.S.
    • Even though the Federal government has become more involved in health insurance over the years, the pricing model is usually based on the free market coupled with common cost via ZIP codes and contracted pricing.
    • Almost no one except those that do not have insurance, pays the “full” dollar amount of the medical facility bill. Those with insurance always have a “discount”.
  • Outside the U.S.
    • Public Medical facilities may have a single price fee schedule which regulated by the national and / or local governments.
    • Private Medical Facilities typically have better trained professionals, more modern equipment, and less regulated pricing structure.

Thank you for watching our Ask Doug about International Employer Group video series and please keep your eye out for part 3 and part 3 of this 3-part series about U.S. and International medical networks. 

For the most up-to-date information on our different international employer group insurance options, please –

Safe expatriate travels – from your GNI Team here in Gilbert, Arizona,

https://www.gninsurance.com

 

Ask Doug about understanding U.S. medical networks and international medical networks better will help you and your organization to use your global employer group medical insurance better, https://www.gninsurance.com/group-health/resources/employer-group-videos/understanding/medical-networks.

In this last 3-part series we will address

  • Two key medical insurance network models throughout our globe
  • Some key differences in comparing your medical networks in the U.S. and outside the U.S.
  • How does my U.S. and International medical network stack up to others?

This question may be an easy one to answer at face value.  However, there are many variables that may cause the answer to be different to each expatriate such as

  • The country one is residing in. 
  • How often one visits the U.S. during any given year.
  • How far one is Western style medical facilities when outside the U.S.
  • The network question compared to monthly premium and other factors may differ in importance from one expat to another.
  • Some want a cashless experience when getting medical care, others may be willing to pay and claim for a less expensive insurance plan.

Thus, the answer is really going to be subjective to each expatriate.  Here are some key take-aways to consider when looking for the best international group medical insurance plan for your team members (please keep in mind these numbers below and percentages are rough estimates)

Take away One

  • Out of all the international health insurance plans sold in the U.S., over 72 percent of medical claims are paid out of the U.S. 

Take away Two

  • At least 38 percent of all global health care policies for expatriates are issued here in the U.S.
  • Thus, U.S. expatriates may want to make sure their international group insurance has a strong in-network medical facilities in the U.S.

Take away Three

  • Over 80 percent of global employers believe having a strong quality medical care for their expats is what primarily matters when selecting an international employer group insurance.
  • Thus, finding a global employer plan that has both a strong U.S. in-network medical facility as well as a solid International network of providers that will accept direct pay will be a plus for the international company.

Take away Four

  • Each global employer may need to determine how to balance these five key parts of any global employer group plan for their expatriates
    • A lower monthly premium
    • Increased access to medical care
    • A deductible plan that will fit expatriates needs and budget.
    • Better health outcomes through the use of preventative and other types of services provided by the global insurance company.
    • And the member experience when dealing with customer service and claims of the international insurance company.

Creating the right balance for all employees in your organization can be challenging.  Especially if your expatriate employees are spread out throughout the world.  Some may prefer getting their medical care outside the US, others may prefer using their US providers that they have had for years.  Creating a balance of the requirements of your organizations’ business goals and listening to your expatriate employees is a good first step in finding the best international employer insurance for all your team members.

Thank you for watching our Ask Doug about International Employer Group, https://www.gninsurance.com/group-health/resources/employer-group-videos, video series of this 3-part series about U.S. and International medical networks. 

For the most up-to-date information on our different international employer group insurance options, please –

Safe expatriate travels – from your GNI Team here in Gilbert, Arizona,

https://www.gninsurance.com