Medical Benefits Question (IMG Visitor)

[zeon267]

Couple of questions, appreciate any information on this.

1. In the benefits section of the brochure for Visitors Case IMG, It has 2 sections Inpatient and Outpatient.
My question is, if I take the insured to an ER and from where he gets shifted to a hospital room. In the meanwhile, the doctors are doing all kinds of tests like X-Rays, blood work, urine tests, MRI, ultrasound etc. However, the "diagnostic x-rays and lab" are mentioned in the outpatient section of the brochure. Thus are all these tests covered if the insured is in the hospital (in patient) at that time ?

2. Secondly, say an insured gets infected by a Hepatitis A virus and needs to be treated, however, the virus has a 15-28 day incubation period, now, if the insured gets sick like on the 10th day of the visit, will it be considered as pre-existing, bear in mind that the insured had no idea of the infection whatsoever, or neither did it show up on the first 10 days ?

3. The brochure also states the following:
"16. Treatment required as a result of or arising from complications from a treatment or condition not covered under the Visitors Care plan. ". Now, ofcourse every one takes like a tylenol or something before makes it to a doctor, however, tylenol would prove harmful in the above scenario, would that stop the insurance firm from reimbursing me ?

It will be very helpful if I get any knowledge (may be by experience) on these questions.

Thanks in anticipation,
Pratik Pai

[insubuy]

These are little unusual questions and I had to get clarification from IMG.

Following is their reply.

1. All those eligible tests would be covered under hospital room & board including miscellaneous.

2. This is a hypothetical situation that is difficult to answer. The determination is made based on the medical information and records we receive. My instinct is: for a disease with a minimum incubation of 15 days, if the insured is found to be infected as of day 10, that would probably be deemed pre-existing lacking any evidence to the contrary.

3. It would depend on whether or not the above disease was covered. Complications of a non-covered disease are also not covered.

[zeon267]

Thanks for the information

Thankyou for the information, I appreciate the prompt response.

Some how, the answer to the second question bothers me, because, how would any one even know about it, unless the doctors find out that there is a virus which is making all the trouble and I believe incubation periods of various viruses is not common knowledge.
I hope the answer could be wrong.

Anyways, thanks again.
Pratik Pai

[insubuy]

The precise answer is "Any condition that manifested before the effective date would not be covered".

Everything else is derived from that.

For some condition to be considered pre-existing, it is not necessary that the person knows about it, or has symptoms.

If incubation period is not common knowledge, then it would be determined based on doctor's opinion whether the condition manifested before the effective date or afterwords. And claim would be adjusted accordingly.

[zeon267]

Define Manifest

From what you suggest :
"Any condition that manifested before the effective date would not be covered"

Manifested: (dictionary says) is "Clearly apparent to the sight or understanding; obvious"

So if the disease is not clearly apparent to the sight or understanding, which can be the case with (my example) Hepatitis A virus, the insurance should not have a problem reimbursing.

Again, thanks of lot for the information and I appreciate your help, this is nothing against you or what you have written, rather just seeking clarification for my better understanding.
You definitely provide a greater service by helping people like me with these questions.

But some how I have come to believe that this whole insurance thing does not serve the purpose.
For older people, one can very well assume one or the other condition like diabetes, bp or heart disease, which ofcourse they do not cover. They should charge more premium if that is needed, but provide "insurance", and not just extort money and turn away when called.

[insubuy]

1.
I am not saying it would not be covered.

As I said before, it is impossible for anyone to tell in advance whether something is going to be definitely covered. It is all decided when the claim is submitted and the adjuster has all the information in front of her/him including but not limited to the treatment, test results, exam notes, attending physician report and medical records.

Everything else would be just hypothetical discussion and we can continue to discuss it forever. However, unfortunately, I don't have any more precise answer for you.

2. There is no insurance plan from any company anywhere that would cover pre-existing conditions for visitors to USA. There is no other choice or better option. It is simply not economical for any insurance company to cover pre-existing conditions. No matter what premium they charge, they will always end up paying more money than they collect.

Insurance is for future protection. And they will generally cover any new medical conditions, sicknesses, injuries or accidents that may occur after the effective date of the policy.