How does American Health Insurance Work?

American health insurance is divided into various groups such as PPO insurance, HMO insurance, POS and EPO insurance, and federal insurance like medicare. At Nihon clinic, we accept various types of PPO insurance, Medicare, Tri-Care Select, and various overseas travel insurances.

**Disclaimer** Those with HMO insurance and Medi-Cal will have to pay for your medical treatment at this clinic as we do not accept it.

PPO (Preferred Provider Organization) insurance is a type of health insurance that allows you to freely decide who your primary care physician or specialist will be. However, depending on whether you are receiving treatment from an in-network (contracted medical institution) or out of network (non-contracted medical institution), the amount you have to pay as a co-payment will differ. Despite this, you can still receive great insurance benefits even if your primary care physician is out of network.

At Nihon Clinic, the Anthem Blue Cross (PPO) and Anthem BlueCross BlueShield (EPO) are in-network.

According to healthcare.gov, the amounts you pay for covered health care services before your insurance plan starts to pay. With a $2,000 deductible, for example, you pay the first $2,000 of covered services yourself. After you pay your deductible, you usually pay only a copayment or coinsurance for covered services. Your insurance company pays the rest.

• Many plans pay for certain services, like a checkup or disease management programs, before you’ve met your deductible. Check your plan details.
• Some plans have separate deductibles for certain services, like prescription drugs.
• Family plans often have both an individual deductible, which applies to each person, and a family deductible, which applies to all family members.

Generally, plans with lower monthly premiums have higher deductibles. Plans with higher monthly premiums usually have lower deductibles.

Except for tests at the clinic, all blood tests (including stool and cervical cancer tests) are sent to Quest Diagnostics. In this case, the insurance treats this as an in-network treatment, however, the examination fee is charged to the patient by Quest. For examinations such as MRIs or treadmill exams, the hospital you are treated at will send an invoice to you. The same goes for if you see specialists outside of the clinic.

If you use a medical institution that includes Nihon Clinic, your insurance company will send you an “insurance benefits statement” called an EOB (Explanation of Benefits) that explains the amount that will be paid by the insurance company and the co-payment for the patient. After this, the medical institution will send you an invoice based on the EOB that you received.

Before paying, be sure to carefully read the contents of the EOB and invoice before paying. (Invoices may come from hospitals, specialists, radiologists, etc.)

With the exception of acupuncture, moxibustion, chiropractic treatment, and dentistry, almost all medical treatments are covered by overseas travel insurance (Exceptions: an illness that exists prior to leaving Japan or home country, various health exams/vaccinations, injuries caused by traffic accidents, pregnancy, and childbirth-related illnesses, and illnesses that last for more than 180 days)

Please contact your insurance company directly in regards to this and also note that inquiries will only be covered for 180 days from the date of the injury.

In-Network Providers at Nihon Clinic

At Nihon Clinic, only the following two insurance companies are contracted as “In-Network”. You are able to use it if you have a PPO/EPO plan, but the deductible and coverage will vary depending on the plan. Please contact the insurance company directly if you plan on doing so.

Approved PPO Insurance

​The PPO insurances below are out of network but can still be used

• Medicare is only available when Part B is subscribed and your secondary insurance is a PPO
• Tri-Care is only available for SELECT (plan chosen by doctor)
• Your coverage may be better when you go to an in-network medical institution. Please contact your insurance company in advance if you decide to go to an out of network medical institution to seek medical attention
• If you have a high deductible or your coverage is low, we may recommend self-financed medical treatment (discount price may be applied)