All international insurers require certain medical events to be precertified. Those include, but are not limited to:

  • Hospitalization due to an emergency {please see below to learn more} or a programmed medical event

  • Any type of surgery with general anesthesia

  • All diagnostic testing, ie. MRI, Cat Scan, Pet Scan, etc.

  • All cardiac procedures

  • Radiotherapy and chemotherapy

  • Palliative care and hospice

  • Air ambulance

  • Ambulatory therapies

  • Home health care

  • Durable medical equipment

  • Organ and tissue transplant

  • Repatriation of mortal remains

If you do not precertify for any of these events, you will be responsible for payment of 30% of all covered charges.

The main goals of a precertification are:

  • To notify the insurance provider of a future medical event or emergency.

  • To have the insurance provider verify that the procedure or treatment will be covered under your benefits, and not excluded by any exclusions on your policy.

  • If applicable, to set up a direct pay arrangement with the hospital to pay them directly for your procedure so you don't have to.

For a programmed procedure, give yourself 7 to 10 days to allow for the precertification process as the insurer may require additional testing or information from your doctor. If a form is required by the insurer, your doctor will need to fill it out and ensure they include all the pertinent information. That includes, but is not limited to:

  • The complete medical notes stating when the symptoms began

  • The doctor’s diagnosis

  • The estimated cost of the procedure

  • Where the procedure will be taking place

  • If applicable, the date of the procedure {if the insurer will be setting up a GOP, this information needs to be submitted}

This information then needs to be emailed to the insurer where it will then be evaluated by their medical committee. If additional information is required, the insurer will reach out to the broker who will then contact the insured. Each precertification is done on a case-by-case basis so be sure to check with your broker if you’re unsure of needing to get something precertified.

One important thing to note, a precertification approval does not guarantee that your claim will be approved. You will still need to go through the medical claim process to allow the insurance provider to do their due diligence. For example, you may get a heart stent approved, have the surgery, file a claim, then get the claim denied if they find out you lied on your application about your cardio history. If your claim is denied, there is an appeal process that you can take to try to have the insurer reverse their decision.

For emergencies, obviously they cannot be precertified as they are not planned, but you must notify the insurer within 48 hours of being hospitalized to avoid the 30% penalty. Please have your policy ID and birth date ready. We strongly recommend keeping a laminated copy of your insurance card on your person in case you are rendered unconscious due to an accident.

As always, when in doubt contact your broker or reach out to us directly at WhatsApp:+52 1 415 167 0886

Office Phone: +1 (800) 577-4308

Email: support@expatinsurance.com

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