PPO / Insurance Carrier / Agent Differences

Agencies, Networks, and Carriers, Oh My!

As you’ve surely noticed by now, the healthcare system in the United States is a bit tricky. Agents, insurance carriers, PPO networks, — surely they’re all the same thing, right? Unfortunately not, but we will be going through what these mean and how they work together to make your insurance plan work. 

ISI – Your Trusted Insurance Agent

We, at ISI, are insurance agents. Insurance agents typically offer multiple plans from different insurance carriers, and can help you select an appropriate plan that would suit your situation. The main insurance carriers that we work with are Tokio Marine HCCMIS, International Medical Group (IMG), Seven Corners, GeoBlue, and Point Comfort Underwriters. We can answer questions about the benefits of the plans, help you purchase the plan, and help you through the claims filing process. We are also happy to help you cancel your plan, extend your plan, and send you information about your plan such as your ID card, visa letter, and other policy documents. 

The Insurance Carrier

Insurance carriers are the companies that actually issue your insurance policy and will pay medical bills for your eligible medical expenses. The insurance carrier is the company that will collect your premium for your plan, and issue refunds if you cancel your plan. The insurance carrier will also be able to verify benefits for a specific treatment when you are at the doctor’s office. 

Network of Doctors, Hospitals & Clinics

When you are trying to go to a doctor’s office for a visit, the doctor’s office probably will not recognize the names of the insurance carriers that we use, like Tokio Marine HCCMIS, IMG, or Point Comfort Underwriters. Luckily, our plans are Preferred Provider Organization (PPO) plans. A Preferred Provider Organization is essentially a group of doctors, hospitals, physicians, and other service providers who are contracted and agree to a standard price list for common services. Many of our plans use the UnitedHealthcare PPO Network, which is one of the largest PPO networks in the United States. A doctor’s office may not recognize the name of our insurance carriers, however they will know whether or not they are a part of the PPO network. If the doctor’s office does accept the PPO network that your plan uses, the doctor’s office will be considered “in-network”. Going to an in-network doctor will allow the doctor’s office to directly bill the insurance carrier. This means fewer out of pocket costs for you at the time of service. 

How These Parties Work Together to Process a Claim

After visiting the doctor, you will need to file a health insurance claim in order to have your eligible medical expenses covered. Typically, this involves filling out a short claims form which details why you went to the doctor, and attaching any receipts or bills that you may have received from the doctor’s office. These then need to be sent into the insurance carrier. Please feel free to reach out to your insurance agent, and we are happy to guide you through the claims filing process or you can go to your Student Zone to start the claim process. 

While insurance agents can assist you through the claims filing process, insurance agents do not have access to your claims information, due to a medical privacy law in the United States called HIPAA. This law essentially allows your personal medical information to only be shared with people that you explicitly name. When filling out a claims form, you will sign a HIPAA authorization form for the Insurance company, so that they can access your relevant medical information for your visit to the doctor. 

As puzzling as all of this is, ISI works closely to ensure seamless coverage to make the process as painless as possible for international students. Please feel free to reach out to us with any questions that you may have!

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