We Help You Use Your Health Insurance Policy

What are the requirements to use your health insurance policy? We tell you!

When our health or our family's health is compromised, it is essential to seek the help of specialist doctors; who after performing a complete evaluation, supported by tests and studies, will eventually confirm a medical diagnosis, which may imply the need for a treatment or surgery. In these cases, it is a great relief to have a Health Insurance Major Policy that will allow us to cover a good part of the expenses related to the care we require.

At BlueNetHOSPITALS, we have an insurance department, dedicated exclusively to managing these cases, providing personalized advice to patients who have a health insurance policy and making the process of using the insurance policy as easy as possible. Contact our insurance team and allow us to help you in these times when your attention should be focused on taking care of and improving your health. Our team will help you understand the best way to use your health insurance policy and facilitate this administrative process.

What are the requirements to use your health insurance policy?

Do you need to use your health insurance and don't know where to start? At BlueNetHOSPITALS we will guide you through the process. The advice we offer starts from reviewing your policy, and includes steps such as confirming the contracted benefits, the policy validity, confirming the coverage, deductibles, co-insurances, periods, etc.

It is very important to bear in mind that health insurance policies have endorsements, i.e., clauses in the contract between the policyholder and the insurance company, where the coverage parameters or exclusions for certain conditions are stipulated.

Having validated the benefits, our insurance team will advise you in gathering the requirements to create the file for the programming process with your insurance company. The most common requirements are:

A recent study confirming the diagnosis;
The insurance medical report format, filled out by your treating doctor;
Insurance format of accident notice or scheduling request, filled out by the insured;
Copy of the insured's identification;
Copy of the contracted policy.

Some requirements may vary depending on the diagnosis and contracted policy. Despite the fact that some insurers request that insurance agents enter the programming request file with the insurance company, at BlueNetHOSPITALS we will support you in assembling said file, so you can be sure it is complete.

In which situation can I use my major medical expenses policy?

Many people are not fully informed about the different situations in which they can take full advantage of their insurance benefits. So, we have prepared a list of common situations for you to keep in mind:

You had a hospital stay of less than 24 hours, and you need a reimbursement

When we go to the hospital due to an emergency, either because of an accident or an illness, and our stay is less than 24 hours, direct insurance payment to the hospital does not apply.

Instead, the insured must manage a reimbursement from their insurance company. At BlueNetHOSPITALS, we are here to help you gather all the necessary information from your medical and administrative records with the aim of enabling you to submit a reimbursement request through your insurance agent. Upon arrival at the hospital, it is crucial that you mention to our admissions colleagues that you want a reimbursement with your insurance, so we can provide you with the appropriate attention and guide you through the process.

You are pregnant and have Health Insurance

Maternity coverage can vary significantly from one policy to another; however, what is common is that they all have a maximum coverage limit set. This means that within the policy, a fixed amount is specified as the maximum that insurance will cover for pregnancy and childbirth-related expenses.

This capped coverage applies to both hospital expenses and medical fees. Based on the maternity coverage amount set, we can advise you on the best way to use your policy.

In some Health Insurance policies, they include an additional benefit for newborn expenses. These coverages, also commonly limited, help you to cover expenses such as neonatal screening or simple attentions for your baby.

Once your baby is born, it is highly advisable to contact your insurance agent to include your baby as a beneficiary in your family's major medical expense policy, so they are protected from their first days of life.

Did you have an accident or do you suddenly feel very ill?

If you suffer an accident or experience intense symptoms that cause you considerable discomfort, and you are unaware of the nature of your condition, come to BlueNetHOSPITALS.

If you have a major medical expense policy, at the time of your admission, we will ask you (possibly with the support of your family members and/or companions) to present your policy, and we will take care of contacting your insurance company.

The objective is to verify the details of your policy and validate that your insurance authorizes the medical care through the collection of the administrative and medical records. In this way, we ensure that your insurance has all the necessary information quickly and efficiently to speed up the authorization process.

Need to perform a procedure, but looking for a specialist that fits your insurance's fee schedule?

All major medical expenses policies have a network of affiliated hospitals and doctors. However, in the Los Cabos region, there may be few specialists who are part of this network.

What does it mean for a doctor to be in-network? This implies that the doctor has established an agreement with health insurance companies and commits to obligatory adjust to the payments established by the insurance for the medical services provided. This type of pre-set payment is known as a "medical fee schedule."

Today, when a doctor is not part of the network but accepts the medical fee schedule, the insurance can pay the doctor directly. This means that the patient does not have to pay the medical fees upfront and then request a reimbursement.

At BlueNetHOSPITALS, we can help you find a specialist who meets the highest standards of service and medical professionalism and also fits the fee schedule established by your insurance. Our goal is to ensure that you receive the medical attention you need without worrying about additional costs.

What can I do if I do not have major medical expenses insurance?

If you do not have major medical expenses insurance, we can provide guidance on how it works and give you some recommendations at the time of acquiring a policy.

Our goal is to provide clarity and knowledge so that you can make the most of the benefits of your major medical expenses insurance policy. Our insurance team is available to help you understand how an insurance policy works and what options can best suit your needs and budget. Contact BlueNetHOSPITALS to clarify any questions you may have on this topic.

It's important to note that some of the concepts and procedures mentioned in this text are focused on Major Medical Expenses Insurance Policies, from Mexican insurance companies. At BlueNetHOSPITALS, we accept Domestic and International Insurance policies, the latter having some specific procedures that vary slightly from the ones mentioned here, and our team of insurance specialists will help you in the management.