“Don’t Pay Out of Pocket: Your Guide to Hospitalization Coverage”


Each company manages different parameters to approve or deny hospital credit. There are three scenarios:

1. One reason a hospital credit may be denied is if the surgery is related to a declared pre-existing condition (this can be appealed by your agent), or an undeclared pre-existing condition. Therefore, it is EXTREMELY IMPORTANT to ensure that all pre-existing conditions have been declared at the time of filling out the form with your agent/broker.

2. In the case of an Emergency or Accident requiring surgery or hospitalization, here is the key: when asked about the payment method, the response should be “I HAVE PRIVATE MEDICAL INSURANCE”. IF YOUR ANSWER IS THAT PAYMENT IS BY CREDIT CARD, nothing can be done, and the client must pay the hospital first and then request reimbursement. It is important to inform your agent so they can work together with the hospital/clinic to initiate the process. In the event of an accident such as a fall, appendicitis, colitis, or any type of infection, IT MUST BE COVERED, and only the Deductible and Copayment must be paid.

3. For scheduled surgery, it is important that the surgeon fills out an insurer pre-approval form and provides your agent with examination results such as laboratory tests, X-rays, etc., to support the request. THE KEY IS TO DISCUSS WITH THE SURGEON AND ENSURE THEIR AGREEMENT TO USE THE INSURANCE. Otherwise, the insurer will cover hospital expenses, but payment must be made separately to the surgeon.

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Daniela Cordero


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