USA

The US has some of the most renowned healthcare providers in the world.  And the most expensive.  And while you can find the best healthcare in the world, you can also end up in some of the worst.  Cost of care also varies greatly across the country, even within a state or city. With no standardization or regulation of costs, providers are free to charge any price for their services.  Global Excel is here to help purchase healthcare based on value; the highest quality of care for the most reasonable price.

PPO networks

In the US, most people access their care through one of the following types of health plans;

  • Preferred Provider Organizations (PPO)
  • Health Maintenance Organizations (HMO)
  • Government program (Medicare / Medicaid)

These plans are composed of ‘networks’ of providers, including physicians, hospitals, imaging centers, etc, who have contracted with health plans for defined reimbursement rates.

PPOs tend to be broad and include many providers, whom you can access freely, whereas HMO’s tend to have a more restrictive provider list and referrals are contained to physicians within the HMO.  The government offers Medicare (over 65) and Medicaid (low income) coverage.  Most Americans obtain their health insurance through their employer.

Providers identify network affiliation at time of check in.  Patients carry benefit cards which specify their affiliation, which the provider logs in the system.  Bills are then sent to the associated health plan and reimbursement is issued as per the contract.

Benefit Card

For Expats living long term in the US and requiring preventative or family care, being enrolled in a health plan is critical.  This ensures not only reasonable reimbursement, but more importantly for members is the ease of access.  When ‘network’ affiliation is presented, the provider will direct bill the network, who in turn will work with your insurer and/or Global Excel for reimbursement.  It also allows similar affiliation with a dental and pharmacy network.  Going ‘out of network’ may result in out of pocket payment being required and higher cost of care as there is no discount in place.