Ensure Your Medical Event is Covered
Whether you are involved in an unplanned accident, a scheduled surgery, or a treatment plan, precertification is required with BMI. The reasons for 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 denied due to exclusions on your policy.
- To ensure the medical costs are within the UCR (Usual, Customary, Reasonable) costs of your country of residence.
- To set up a direct pay arrangement with the hospital for your procedure once the deductible has been met.
When do you precertify? When any of the following events take place:
- All overnight hospital admissions.
- All hospital or outpatient surgeries.
- Any major procedures: MRI, CT scan, PET scan, gastroscopies, colonoscopies, biopsies, etc.
- Physical/rehabilitative therapy, home health care or private nurse.
- Nasal surgery, cosmetic, reconstructive or bariatric.
- Emergency transportation via Air Ambulance.
- Implant or installation of durable medical equipment or a special medical device.
- Repatriation of mortal remains or local burial.
- If you aren’t sure your procedure needs to be precertified, it’s better to be safe than sorry: contact your broker.
Follow BMI's instructions for precertification to avoid the financial penalty:
- Medical Emergency: Must be reported within 48 hours of the event.
- Scheduled and planned procedures: Precertification is required at minimum 72 hours prior to the procedure (we suggest giving yourself at least a week to precertify as additional information, testing, etc. may be required).
- Travel Assistance: Precertification required within 24 hours of the event.
What are your first steps to getting covered by your insurance?
Firstly, to make sure you’re fully covered when you need to have surgery, or when an accident happens that requires hospitalization, contact BMI and contact Expat Insurance that an emergency has occurred and you are heading to the hospital. You will find their contact info on your ID card in the Welcome Email from BMI. We suggest printing and laminating a copy to keep on hand at all times.
Next, when precertifying for planned surgery, test, or treatment, you must send in the precertification form as well as all supporting documentation, at least 72 hours before it’s scheduled. We strongly recommend starting the process as soon as possible as delays are typically due to waiting for the provider to submit additional information. You can precertify up to a month before the event to ensure all documentation is sent in and the procedure will be covered.
Once everything has been received by BMI, they will authorize a GOP (guarantee of payment) to the hospital or provider. If the deductible hasn't been met, you will pay the remaining balance at the hospital. Keep in mind that not all hospitals or providers work directly with insurance companies and can refuse the GOP, meaning you will have to pay out of pocket for reimbursement. You then will need to file your claims.
Documents to submit for precertification for upcoming procedure:
Fully completed precertification form (English & Spanish versions found at the end of this article).
Include claimant/patient name.
Date of service (can be a tentative date).
- Evolution of diagnosis including original start date of the symptoms.
Medical facility where it will take place.
Estimated cost of the surgical team, each treatment, or session.
All written diagnostic test reports and any other supporting documents.
Once you have everything, email it to email@example.com and firstname.lastname@example.org. In the subject line include your first and last name, and policy number. In the email, specify which procedure or test you’ll be having as well as the scheduled date if applicable.
If you have an emergency, contact BMI immediately, then contact Expat Insurance so we can help coordinate your benefits. The hospital should also contact BMI as they will need to authorize the release of your records to determine coverage.
Once it’s determined that the accident will be covered and if the hospital accepts it, BMI will issue the GOP. You will be responsible to cover any remaining deductible, as well as anything else any other policy exclusions.
If the hospital does not accept a direct payment from BMI you will have to pay out of pocket and file for reimbursement. Expat Insurance is available to help you every step of the way.