Frequently Asked Questions

Frequently Asked Questions

**  FAQ section has been updated  * * 

 

1- I am traveling and I need to know if my plan coversme.

 R- If you are traveling to the United States or other countries outside of Panama; your plan covers medical emergencies reported within 48 hours with a (co-pay of $ 5.00). It covers accidents reported within 72 hours (NO CO-PAYMENT).

Medical Emergencies are defined under Section 5 in your plan brochure. If you are under POS – the plan covers you 100% of POS benefits.   If you have the FFS plan – you pay, and the plan will reimburse you 50% of the reasonable and customary rate.

 The medical services received during a trip out of the service area with conditions not severe enough to be classified as emergency cases will be reimbursed under the FFS benefits.

 2- When traveling to any country outside of Panama and need to buy prescription drugs, How is it managed?

 R- When you travel to any country outside of Panama, you must purchase the medications and file the claim to PCABP, P.O.  Box 31-0940, Miami, Florida 33231-0940.

3- If I am traveling to the United States or any country outside of Panama, which doctor or hospital I can go to?

R- When traveling to any country outside of Panama, the members can go to any doctor or hospital. The providers are not contracted therefore they do not have to accept the Panama Canal AreaBenefit Plan. This may require you to pay for your services and submit your claims to the U.S. to process.  If you are over 65, it would be of your best interest to choose a participating Provider with Medicare, and your claim in the United States would be reimbursed according to Medicare rates.

4- Could you please confirm how many visits a year I have with the Gynecologist?

R- Under the preventive care benefit, you are entitled to 1 visit to your gynecologist, without referral and without co-payment.

5- How can I obtain my hearing aid?

R-You need to visit your Primary Care Physician (PCP) to obtain a referral for the specialist (ENT-otorhinolaryngologist) you will be required to have a hearing test done, then send the results of the hearing screening along with the PCABP form to PCABP office for the proper approval. Once you obtain the approval you must take the approved PRE-AUTHORIZATION to the assigned doctor and clinic, you are required to pay the co-payment of $ 5.00 dollars to obtain the device.

6- What does my health insurance cover on dental procedures?

R- Maintenance of Oral Prophylaxis limited to two (2) visits per year.  Dental Surgery, Dental Periodontics, Endodontics, prior to these treatments you are required to submit a complete estimate on the Dental Treatment form to obtain approval for the treatment of these benefits.

If approval is not obtained, we will limit benefits to 50% of the fee schedule.

7- What are the steps to obtain my medications for diabetes when I travel?

R- In order to obtain your diabetes medications before traveling, your Primary Care Physician (PCP) or endocrinologist should complete the Diabetes Disease Management Prescription Form, detailing the medication prescribed. Attached to this form you must submit the results of  glycosylatedhemoglobin test and your doctor should write a note stating how long you will be traveling.

8-  Can an urologist be my Primary Care Physician?  

R-It is not recommended that a specialist be a Primary Care Physician, but the specialist may request additional consultation.

9- Can I include my grandchildren to my Plan and what are the requirements for the inclusion?

R- The grandchildren are not eligible members of the plan, however if you have the Guardianship and Custody  for the grandchild and the grandchild lives with you, then that grandchild may be an eligible member in your plan.

10- How many PSA exams do I have the right to take in ayear?      

R- Under the preventive care benefit, you are entitled to one (1) PSA test a year. If you have a pre-existing condition, for example, Prostate cancer or elevated PSA, then there is no limit.

 

 

If you are 65 years or more, and it is of your best interest to select a participating provider with MEDICARE because your claims are paid based on the Medicare rate.