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all right well um in this googlehangout we're going to be speaking with doris freyar, who's the head ofclaims for wea, the pa group, and wea insurance, specifically about precertification, or treatment, precertification authorization of treatment in the us if you have international insurance. so, thank you, doris, for joining us andtalking about some of the tips and tricks and importance ofprecertification authorization. thank you. ok, so i think i'm going to break this into little,

3 little segments, so we have our members who come to the united states, they're already in the us, they're visiting their family and the most important thing is always to have your id card, so that they know what numbers tocall where they can locate us so we can guide them. on their id card, they can contact us,we'll let them know what participating providers are in their, you know, zip code area. if there's a specificdoctor that they need to use

or one of their choice within the network,. basically, the way that would work isthey would make an appointment with their provider. the provider would contact ouroffice and and we would let the doctor know if a specific procedure requires preauthorization prior to it taking place. the doctors would provide us the medicalrecords. we would have it reviewed, see if it's covered under the policy. if it's covered,we would proceed to send a written approval to the doctor's office with the um, letting them know that thisis covered under the member's policy.

so this is the plan treatment,this is all something that takes affect within time. this is something that was planned. we also have where some of our members, you know they'retraveling from abroad, and done they're coming to the united states with limited time. well we would encourage those insuratists, if you're coming, andyou know you're gonna be seeking treatment with a specific doctor,specialty, or you know that you need to have a specific surgery,

or a procedure that falls underour pre-authorization area, then we would encourage them to send us their medical records ahead of time, let us know what facility they're trying to visit, who the contact person is there and we can contact the facility, let themknow what our requirements are, and we can assist them inexpediting the pre-authorization on their behalf,knowing that they're limited on time. we also encourage that they let us know ahead of time,

because a lot of times when they come, they may not have the medical notes,and we want them to send us whatever their physician hasin-country in order to help us expedite the processon their behalf. so it's kind of a cleaner process, not a last-minutething, which would probably take a little bit moretime, and it does help and alleviates everybody's roll in getting this to a positive outcome. then, we also have a last minute emergency, that perhaps you're here

and you know you broke your leg, and now you need a cast, or you need on mri you did not know when you're on a timelimit. i mean, the emphasis here, is always to have your id card, and tocontact our office whether it's during work hours, or afterhours, we do have 24/7 after hours service that if our members call they do initiate notification. that we're able to reviewthem, and you know be proactive. we do contact, if you need our phonenumber the after hours service,

we contact our members, or thehospitals, or the doctors and we let them know what their benefits are, what we require and it's just a cleaner process. we do encourage thisa lot because should you not follow the notificationor the pre-authorization process or its specific procedure, there is a 50% penalty, and so we want to avoid our members incurring unnecessary, you know, penalties. there are timeswhere perhaps we have been able to

you know we're our members to a facility a center of excellence facility that's in the network where perhaps they did notknow was in the network and also helps them avoid higher out-of-pockets by, we would prefer proactive steps in order to help them as well. so, now when you say that, theunderstanding there is that, yeah, they have their card with them before they would travel back to the states, they know who to contact definitelyif they're planning a

some kind of medical treatment in the us, and they know they're coming back hoping to get this kind of attention, thatthey let you know even while they're overseas before they make that trip, what their intentions are. correct i think one of the most importantthings, that i can tell you this be the so manyyears of experience that i've had is you know not everything under yourpolicy is covered. you know sometimes members have policies with a general exclusion or a specificendorsement,

and all of these things need to be reviewed prior to a person making a determination to get on an airplane, and perhaps finding out that oncethey're here it's not gonna be covered. you're gonna have limited resources, and you're gonna be like, why did you not tell me that? so we really encourage proactive, look, i'm feeling this way, and i'mgonna go to the hospital, is this gonna be covered, these are my contact details. if we can look at that, look at whatyour conditions under your policy is,

under what terms your application wasaccepted, does it fall under a pre-existingcondition or an exclusion? or maybe not! it will be 100 percentcovered. we want you to make an informed decision. so i think beingproactive would be the best way i really appreciate that, 'cause that that's really important informationfor our clients, our customers, and those seeking insurance should know we always try tobe helpful and upfront, and i know yourselves, i know wea is just wonderful at that. almost just exemplary.

the other number of clients that we have are people who are traveling, they're either on furlough, they're on a sabbatical, they're back in the united states with theirfamily or individually to visit family or support raising or for refreshment, and just a time away before the return back the field, whichis their residence. so they're in the united states fora short period of time, and so they're they're traveling, youknow, they're going from place to place, or they're visiting grandma and grandpa.

you, um, mentioned about having theirinsurance card handy, but in the emergency, the child fallsout of a tree, they're in a car accident, what would you suggest or recommendfor that family? is there anything specifically in regards to their care. right, i mean on one of the things that ialways recommend in the absence of having an id card with the number, i personally even with my insurance, have a phone number or a littlebooklet where i keep the important numbers just in case.

the number one thing i always recommendis to always have your insurance carrier phone number. our after-hours service, it's always there to guide you. they also have, if you don't have your policy numberavailable, we make that list available to our after-hours office, so if you were to call, you know and you say, i'm one of wea's insured person's and my name is such and such. they can review or research your name in a roster, and they're able to provide you your policy number. they also send us the notification,

they're also able to assist you withfinding a facility that's in the network so you know, the after hours service is also like a service, like if it was hours, but they become a key player as well. so the id card, or having our phone number on your cell phone, or in a little booklet, or something. emergency contacts, that would be, you know, the biggest suggestion that ican give you. yeah and they don't need to worry in anemergency, obviously if if they're hit by a car or somethingand they have injuries, they're gonna

be rushed to a local hospital, and atthat point, i mean obviously they're going to be covered. yes. i mean, except for their deductible of course, but i mean they're gonna be protected, they're gonna be taken care of, and then at that point if they have longer-term needs, they might be transferred to ahospital that might be cheaper for them or better care. oh well, i mean not necessarily. if youhave a a life-threatening situation like you got hit by a car and they took you to the closest facility and you end up being in there, and you're unconscious, they're gonna keep you there once you wake up.

if the hospital is not in network, and we determined that yes, this is a true-life situation, we will number one try negotiating discounts on our members' behalfto alleviate their out-of-pockets and the other thing is, if they don't negotiate then we'll definitely end up paying at the higher percentage, being that it is a life-threatening situation not necessarily have to transport them to another hospital. sure. well good, i think those are a couple of good tips

for people who are considering coming back to the united states. if they are considering some kind of treatment ahead of time, to contact you, and with medical records and if they'vealready seen a doctor overseas that's recommending a procedure, that they let you know about those, thatthat communication, and that medical treatment has been recommended, and then also that they have in their phone, they have on their person, in their wallet,at hand if they have that medical information as to where they're going to be traveling and how to contact you

in a unique emergency or even if it'snot a a life-threatening emergency how to reach you to find out where theyshould go, if they need some form of treatmentas they're traveling in the united states. right, i agree. now, the policies, just to clarify now, since some people might not know, the policies that they're buying, these are international policies. if they bought one of the standard policies not excluding united states, they're gonna be covered even with all the new regulations and stuff like that, they're going to be covered when they're

in the united states on the international insurance, correct? right. yes, they will. i mean, now on regulations, are you talking about the health care reform? yeah, i mean maybe there's some questions as to whether or not they're gonna be covered when they, you know, with their national insurancepolicy when they're visiting the united states. i mean, they're not coming back to reside in the states, but they're coming back on a visit, 2 months, 3 months. they're gonna be covered whenthey're in the states. right. if you buy an international coverage including us you will have coverage in the us, granted it's not a general exclusion under

the condition that under the general exclusions, or an exclusion that was provided to you specifically at the time of the application. other than that, it should be a straightforward. wonderful! well, of course it's gonna be always cheaper for a client, almost always, to be treated overseas than the us, just due to all the extra costs. but we realize that sometimes that can't be helped, and sometimes clients prefer to come home and see a doctor, family doctor or some kind of specialist that they've seen, as you mentioned.

before, as you were speaking, sometimes an oncology doctor, or somebody who knows their history, so as long as they contact you ahead of time and let you know their intentions and you can guide them,that sounds like wonderful advice. so, thank you so much for talking to us about pre-certifications in the us, and i'm sure if we have more questions, we'll reach out to you. you're welcome, anytime. thank you so much, we'll be talking to you soon. thank you, bye.