https://docs.google.com/document/d/1zJD9T4nsyMd1T90aqcTxM6z4Rf_c9d73oi-uGj2jlAI/edit

##### Buying medical insurance for travel to the USA - DO’s & DONT’s
I’ve seen so many people struggle with this that I thought I’d share some best practices here based on my experiences over the last 17 years so people don’t get on the wrong side of the most expensive medical system in the world. (I’m not an insurance agent; feel free to go through the comments and ask questions here for everyone’s benefit)
  
-   Buy an insurance that gives you a PPO (Preferred Provider Organization) network insurance card. Hospitals/providers will NOT accept insurance if they are not in their PPO network. This also means you don’t have to pay upfront, the hospital/urgent care/doctor will bill the insurance company directly. This is the second most important rule of medical care in the USA. If you have to pay upfront and get reimbursed later - best of luck on large bills (an MRI in an Emergency room can cost $6,000, a 2 hour ER visit could cost $10,000). Make sure you visit a provider within the PPO network when seeking care and read the plan documents before buying them to understand the coverage.
-   NEVER EVER CO-SIGN ON BEHALF OF A PATIENT, whether they are your parents, siblings or friends. You can accompany them for support, but you are not required to co-sign for them, the patient should always sign for themselves and/or use their insurance. If you co-sign, then YOU are legally responsible for paying the provider (if the insurance company or patient doesn’t pay). Hospitals ER’s in the US are required by law to treat all patients (not doctors or urgent cares). If you co-sign, collection agents WILL come after you to collect unpaid bills, can ruin your credit score and also take you to court. This is the most important rule for medical treatment in the US. If you followed rule 1 and the patient has a PPO insurance card, they should get treatment within the PPO network with their own signatures. It is difficult to make rational decisions when you’re emotionally distressed, so practice and agree on specific phrases/sentences to use in such a situation with your partners/family before they travel, make a detailed plan and then stick with it.
-   Never buy fixed coverage insurance plans. These are amongst the worst plans because they pay a fixed sum for each treatment and the providers can charge anything. Eg, the fixed insurance will pay $100 for a doctors visit, doctor in turn can charge $1,000 (no I’m not kidding). Buy a COMPREHENSIVE COVERAGE plan that gives you a PPO network insurance card. These will cover typically 80%-100% of the charges (after the deductible which you can choose at the time of purchase) AND most importantly they have a negotiated rates with providers (eg doctors level 3 visit is $250) so providers are limited in what they can charge. (I’m over simplifying the billing system but having been burned very badly with fixed coverage plans on this point of lack of negotiated rates, they aren’t worth the money you’ll save in the premiums).
-   After visiting a provider don’t forget to file a claim with the insurance company, even if the provider filed a claim on behalf of the patient, OTHERWISE THE BILL WILL BE REJECTED de facto. Read your insurance contract, most insurance companies require the patient to file a claim with them (even for visits within the PPO network) with additional information like an ID card, description etc to pay the claim. In most cases you can do this online or with the help of the insurance agent.
-   Buy an insurance plan from an reputed agent who is willing to help you when you have to file a claim. Avoid buying directly from the insurance company. When you buy directly from the insurance company and they decide not to respond, there is little recourse you have. If you’re buying from a well known agent who sells lots of/multiple plans, they have some leverage over the insurance companies. I’ve had an agent step in and work with an insurance company to get the $$$$ bills paid; if the insurance company didn’t pay then the agent would stop recommending their plans and the insurance company paid the bills eventually (after 9 months of the agent and me persisting)
-   If the insurance company doesn’t pay the bills or stops responding and your agent isn’t helping, contact your state insurance commissioner or your state attorney generals offices and they could step in to help get a response from the insurance company.
-   Almost every plan will require that you need to get treated within 24-48 hours of the onset of the symptoms. Do NOT ignore this. If the doctor writes on the medical record that the symptoms started before what the plans sets as the deadline for treatment - insurance companies WILL REJECT the claim. Make a plan ahead of travel on how you want to handle emergencies and non emergencies and stick to it! You can often walk into an urgent care and get a doctors visit by paying about $100-$150 cash (ask upfront). Walk into an ER and your bills will likely start at $3,000.
-   Read the plan documents carefully. Do not take an agents word, read the plan documents for yourself. Some agents have excellent websites which provide specific language from plans that explain what’s covered and what’s not, especially for pre existing conditions. There are very very few plans that provide coverage for pre existing conditions, and even then with limited coverage. Many plans have look back periods (eg 2 years) and some plans have a no coverage period (eg first 3 days).
-   Look for community health centers depending on where you live. Many of them offer free/discounted access to basic care. Also look at telehealth providers which provide access to affordable care with low cash payments ($25-$100 per visit). GoodRx, Mission Health, SesameCare, KHealth to name a few. Google and you’ll find many more.
-   If you’re paying cash at an urgent care, doctors office or anywhere - don’t be afraid to ask for a discount. Most providers will offer you a significant discount if you pay with cash instead of going through insurance.
-   Many travel insurance plans don’t provide prescription coverage. Download the GoodRx app and use that when buying prescription drugs at a local pharmacy. It’s free, allows you to compared prices across pharmacies (yes prices vary a lot by pharmacy) and the discounted rates are very competitive (and in some cases I’ve found them even better than insurance negotiated rates). Also look at DiRx Health and Cost Plus online pharmacies which provide very compatible rates for prescription drugs shipped to your home.
-   Always read any document before signing it when visiting a doctor/provider. Cancel out any terms you don’t agree with before signing it and then take a picture for records. For example when at a doctors office some agreements will have a paragraph which states that the patient is responsible for all costs for procedures done even without the patients consent. I’ve cancelled out such paragraphs and told the provider that all procedures will be done only after my consent.
-   Locate different types of care providers around you before travel to avoid last minute problems. Create a list on Google Maps, add these providers and share the list with family. For example if you have a PPO plan, locate two ER hospitals in the network and try to find out their cost effectiveness (Google is your best friend). Identify atleast 2 urgent cares within the PPO network and call ask them how much they charge for a doctors visit with insurance. Some travel insurance plans don’t cover physicians visits because they cover only emergencies or acute onset of conditions (within 24 hours) and physicians can take a few days to get an appointment. So it’s safer to visit an urgent care in such scenarios and some plans offer a $0 copay for urgent care. Read your plan documents to see what’s covered.
-   Identify community health centers around you, they often provide free / affordable care for patients with no income. Find local clinics that provide free/affordable care using this website [www.freeclinics.com](https://l.facebook.com/l.php?u=http%3A%2F%2Fwww.freeclinics.com%2F%3Ffbclid%3DIwAR23QQk_gvODAuP04i0br45TNho4FAUgZOPITAJIVuksP74BK0vpePsImpw&h=AT0LR1YINrrXeVpjFV2Q2N4UDrk50AbikpASdBN7uGv7scu_w77xvYMKkuBToySKQBOLUdBB0zIxue-r9lTKIO2uB5jdXgOxEH9ownMHgCkYd_96IhzngQ8ucaivpwj0OA&__tn__=-UK-R&c%5B0%5D=AT1auE9v0br_lk3taT6Z2NVDHlWKU3g59a5mB_0MIELB6NuKXgyIfejh7a-NQlsMl-VfTgLzjBqk4YX5d44DMlJ2W6C4kaLJz1scaU8Jaq5NgGYtNz7medOdnn3h-Mh1jtyGZ3md6Vh1Cz7LjYK0-njiQRUd) . Locate pharmacies to buy medications using the GoodRx app to see which ones offer the cheapest prices. Doing some leg work in advance will save you a lot of money / headache down the line. An easy way to manage all this is to create a list in Google Maps and add the identified hospitals/urgent cares/providers and pharmacies and share them with family.