Is your doctor covered by your insurance plan?

Dr'snetwork

Spend even a short amount of time looking for health insurance in Hong Kong and you will quickly find that there is a mind-boggling number of plans available. While to many, this choice is a good thing – you can find a plan that fits your needs perfectly – it can also be overwhelming if you’re not familiar with health insurance. A common issue that comes up when looking for a plan without thoroughly understanding the policy is that you may find your doctor or facility of choice is not covered.

In Hong Kong, there are a large range of medical facilities available. You can find facilities that charge 100 HKD for a visit, or some that charge over 1,000 HKD for a simple consultation. As such, not every insurance plan will cover all of the facilities in your area. In fact, insurance companies usually offer coverage based on health care networks – a group of medical facilities that essentially agree to accept payment from the insurance company. These networks, and actually finding where your plan is accepted in Hong Kong, can be confusing. So, to help, we have written this article which looks at the three most common groups of networks.

Group 1: Public and low cost facilities
As the name suggests, plans that support these networks provide coverage only for low cost providers and public facilities. These plans are often designed to be very cost effective with lower premiums and, subsequently, lower limits and benefits. This means that if you purchase one of these plans you will only have access to lower cost facilities because the limits will only really cover the costs at these facilities

While some insurers do not cover treatment outside of your network, others will. This really depends on the insurer you choose. In fact, many will give you the flexibility to still visit doctors and hospitals outside of the network, but they will only provide coverage up to the average cost of facilities that are within your list.

So if you do purchase a budget plan, and they tell you that your doctor or hospital is covered, you still need to be careful and check the limit that they will cover up to. The plan won’t be very useful if it only covers a small amount of what your desired doctor actually charges.

Group 2: Mid to high cost facilities
These are plans that offer higher limits and a larger health care network, but may still impose coverage limits, copays, or deductibles on your treatment cost. Essentially, these plans have been designed to allow you greater flexibility in selecting your hospital, but the cost will be shared.

A copay or deductible is a part of the treatment cost that you will pay out of pocket. This amount will be agreed to before the start of the policy, and is a good way to help manage the cost of your plan while allowing you to better set and manage risk. In this way, you can still get care from the doctor or hospital that you want when you need it, without paying a high annual insurance premium.

The main downside with this type of network is that it may still limit access to the most expensive facilities in your area, especially those who are extremely specialized or serve only a small niche market. Other plans will allow you to access these facilities, but the coverage limits will be lower, which means you will be paying more if you visit them.

Group 3: Unlimited Network
Plans with unlimited networks are typically offered by international insurers, and will have high or no limits. Yes, the premiums for these plans are typically more expensive, but they do let you rest easy knowing that you can have access to the very best care that the world has to offer, because you’re not limited to treatment in public or lower tier private hospitals in Hong Kong. In fact, because these plans are international in nature, they will usually cover medical treatment anywhere in the world.

Because of their international nature, these plans are also most suitable for expats and High Net Worth individuals because they provide coverage in facilities and locations that will feel most comfortable to them – e.g., an expat’s home country. Another benefit for expats is that these type of plans allow for treatment immediately, without waiting months to re-enroll in the public healthcare system if they move to a new city or country.

How do I find out if my doctor/medical facility of choice is covered?

Regardless of the insurance plan you select or the provider you work with, there is a chance that your doctor or medical facility of choice may not be covered. There are three common ways this can be found out:

1. Look at the documentation included with the plan
All plans come with documents that explain not only what is covered, but also where you can receive medical attention. For example, if you buy a plan through Pacific Prime, we send you a Quick User Guide with information on your plan, including where you are covered.

Other plans, especially local ones, will also come with a booklet or a link to a website that lists all locations, clinics, and hospitals where your plan is accepted. When you sign up for a new plan, it is a good idea to store this information in a secure location so you have access to it when you need it.

2. Contact your main doctor and ask
If you have had your plan for a longer period of time, or are unsure whether your doctor or clinic of choice will accept your insurance plan, it could be a good idea to contact the office directly. They will likely be able to tell you right away if they are part of your provider’s network.

3. Talk to Pacific Prime
Living in Hong Kong, English may or may not be spoken to a level where you can communicate effectively with the receptionist at the clinic or hospital you have selected, so calling and asking may leave you with more questions than you started with in regards to coverage. What we recommend is contacting one of our knowledgeable health insurance professionals. Because we work closely with virtually every health insurance provider in Hong Kong, we can provide you with the details you need, and even recommend a solution if one is necessary.

Transgender Health Care and Insurance

transgender-image

Across international news, we’ve been hearing the word ‘transgender’ a lot more. Some states in America are passing transgender bathroom bills to make public facilities more (or less) inclusive. The Amazon series Transparent picked up its first Golden Globe, and in March even Pope Francis set aside some time to meet with Diego Neria Lejárraga, a Catholic man rejected from his local church after sex reassignment surgery.

Transgender means a person’s gender expression doesn’t match their biological sex. Diego Neria Lejárraga (who, by the way, was welcomed into the Catholic church with open arms by Pope Francis) was born a woman. People who are transgender usually say that while growing up, they never identified with their sex, often experiencing a feeling of having been born into the wrong body. When the choice becomes available, many opt to take hormones or undergo sexual reassignment surgery in order to change their sex.

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Top 6 Hiking Trails in Hong Kong

hiking hong kong

When most people think of Hong Kong their minds tend to drift towards crowded sidewalks, soaring skyscrapers, designer shopping centres and astonishing luxury stores, but there is another side to this city. A cursory glance at a map shows that great swathes of the territory are open space to explore. In fact, 40 percent of Hong Kong’s land mass is protected, which means there is a wealth of tree lined plains, woods, mountains, wetlands and beaches to explore. With the health benefits of hiking including reduced risk of heart disease, lower risk of blood pressure, lower risk of colon and breast cancer, reduced depression and better quality sleep, there’s no reason not to get out there and tackle one of Hong Kong’s many hiking trails. We count down six of the best trails. Continue Reading…

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10 Reasons Why Fall is the Best Season of Them All

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Sure the weather is cooling down, your swimsuit isn’t hanging on the balcony ready for action at anytime, and you may even have dipped into your winter wardrobe once or twice for a long-sleeved shirt or a pair of fuzzy jogging pants: but that’s no reason to cry about the end of summer.

A new, arguably even better season has only just begun, and it’s got as much and more to offer as its predecessor. Here are 10 ways to get cozy this season, so cozy that the pleasures of summer may just fade into a distant memory. Continue Reading…

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ALS: What You Need to Know

ice

Wait – why are people dumping buckets of ice water over their heads and posting the videos to social media?

Because: ALS. It’s a degenerative disease affecting the nerve cells of the brain and spinal cord, eventually leading to loss of motor control throughout the whole body. In the later stages of ALS (which stands for amyotrophic lateral sclerosis and may also be known as Lou Gehrig’s Disease), a patient is paralyzed and will experience difficulty breathing and swallowing – factors which contribute to the high fatality rates amongst ALS patients.

The Ice Bucket Challenge asks celebrities – and indeed anyone – to drench themselves in ice water and publish the video, to raise awareness of ALS. Participants are also encouraged to donate to ALS research, and Time Magazine has reported that the Ice Bucket Challenge has already brought in more than US$50 million for the ALS Association.

All this ALS buzz is great for improving general knowledge and medical research, but it’s got some people wondering: what’s my ALS risk? If I become an ALS patient, will insurance cover my care? Should I take steps to protect myself right now? Continue Reading…

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Oral Hygiene: Getting to The Mouth of the Problem

oral hygiene

Most of us have grown up being instructed over and over by our parents, dentists and teachers to brush our teeth twice a day, to floss daily and that sweets will rot our teeth. We probably took that advice with a grain of salt (or perhaps ignored it completely in our youth) but we can agree that this is all sound advice to foster healthy teeth and gums. What most of us may not know is just how much the health of our teeth affects the rest of our body and overall health. Everyone wants their teeth to look and feel nice but they are also important to speaking, eating and avoiding bad breath and pain. And it’s not just our teeth. Gum, tongue and overall mouth health are equally important. Here we’ll let you know the risks of letting your oral hygiene suffer and what you can do to prevent it. Continue Reading…

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The Most Important Thing You Can Do to Prevent Diabetes

Glucose level blood test

Though diabetes is one of the most pressing issues facing world health at the moment, it isn’t nearly as scary as it looks. For the most part diabetes is entirely preventable. Just a few simple diet and lifestyle changes can reverse the disease in a matter of months. One study in the UK had patients on a strict diet of 800 calories per day, and saw most cases return to health in just a few weeks. Continue Reading…

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Ebola Insurance: Are You Covered? 

ebola

With no vaccination and no cure, Ebola is a disease you really don’t want to get. Unfortunately Ebola is also extremely transmissible, spreading from person to person through blood and bodily fluids, including sweat. Just touching an Ebola patient is enough to spread the disease – even if that patient is already dead. Add to this the fact that Ebola kills 90 percent of the people it infects, and it’s easy to see why the recent Ebola outbreak in West Africa is causing huge global concern. Continue Reading…

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Medical Tourism: What You Need to Know Before You Go

medical tourism For the most part, travellers are trying to stay out of a hospital whilst they’re on holidays. But across the world there is an emerging class of voyagers crossing international borders with the sole purpose of obtaining affordable medical services which can range from dental work to liposuction. The proliferation of affordable air travel, skyrocketing costs of healthcare in developed countries, extended waiting lists and strains on health services due to aging populations have all contributed to global expansion in medical tourism across the past decade. And business is booming. It’s not difficult to see why: the cost of heart bypass surgery is around $70,000 in the United States whilst the same surgery will cost just $7,000 in India — a saving of a staggering 90 percent. With rising costs of health care in developed countries, there are more and more people electing to have procedures completed abroad. But it’s not simply major invasive surgeries like gastric bypass or orthopedic operations being sought by medical tourists. There are equal numbers of people simply keen to regain their pearly white smile through laser whitening or seeking cheaper alternatives to some dermatological conditions. Here, we take a look through some of the considerations you should take into account if you are planning to hop on a plane for a nip or a tuck. Continue Reading…

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Tread Lightly: How to Minimize Your Impact and Travel Responsibly

travel responsibly

With the prices of airfare as cheap as ever, there’s never been a better time to escape the rushing monotony of ‘real life’ and jet off to a tropical island paradise, climb a mountain, go on safari or explore the ruins of an ancient civilization. Every corner of the globe is so accessible that we’re spoilt for choice on where to travel: and the question of how we should travel is often not addressed. Travelling and experiencing a different culture first hand is an important way to learn more about both ourselves and the world we inhabit, but a great number of tourists and travellers tend to disregard the impact that their travels have on local environments.

The ‘travel destinations’ that we head to on holidays or for extended trips are in fact, someone’s home. The impact of what you do and how you spend your time whilst travelling is felt long after you leave, so it is important that as responsible travellers, we respect the natural and often delicate balance of the places we visit and experience.

Tourism can have incredible benefits to local communities and indeed whole countries, but this economic gain should not be at the expense of culture or environment. By embracing a few simple principles, it’s easy to experience everything that a country has to offer without having a negative impact on the communities or environment of the areas you visit, maintaining the culture and natural beauty for generations to come. Continue Reading…

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