Health insurance out of state?

[DMK]

[QUOTE=jody jaffe;7891132]
Well you clearly have more knowledge than i have. However, this is not what the Anthem reps are telling people.

I was told emphatically by one rep that any hospital stay will not be covered out of state. The next rep told me I would be covered until I was deemed stable to move, though he had no idea at whose expense this moved would be. Ie, suppose you were “stable,” with IV and horizontal, how do you travel commercially if you are say, in Alaska or Hawaii or even California (assuming you live in Va).?

My point is that I keep getting different answers from so-called insurance experts, or at least those who work for Anthem.[/QUOTE]

On a similar note, people who sell you trucks will often tell you that you can pull a horse trailer with a super light SUV. Turns out not all sales people are experts, although at least these reps are erring on the side of caution!

Non-emergent transportation (meaning when they transport a stable “you” to another facility) happens all the time and is generally arranged by the insurance company/care managers in conjunction with hospital care managers. Typical situations are when you end up in a nonpar facility due to an emergency and need to be transported to a par facility (par = participating = in network) or when you are being downgraded from i/p admission to i/p rehabilitation. It also happens when you are transported back in network, either from out of the area or even out of the country, typically by suitable air transportation.

This seems like a pain, but truly, given the balance billing situation members face in out of network facilities, being in network is your smartest move.

Another thing I remembered about the Blues is a network sharing arrangement they have. It’s unique to National Blues affiliated plans so not a typical arrangement. This sharing arrangement allowed them to “rent” other Blues networks for a fee (which they happily tacked on to YOUR premium) and that is where you (and the reps) may have get the idea you could get care out of state. If your employer ponied up for this (not very cheap) benefit, yes, you could go to participating facilities out of network for non-emergent care. But the docs had to be participating so there is no guarantee you end up in a par hospital in an emergency (you end up where the ambulance takes you). So same rules I explained above apply. However I sincerely doubt that was ever offered to individual policies due to pricing pressures in the individual market (that long predated ACA). Also that arrangement was fairly unique to the Blues plans. Most other carriers would consider your Virginia network to be “your” network and if you went to a Florida based doctor for non-emergent care while in Florida, even if he was with that same carrier’s FL plan, they would consider that care “out of network” for you. Not always, but most likely.

[equisusan]

All I can say is that I’m glad I’m moving to FL and don’t need a Virginia plan because I couldn’t find a BCBS PPO plan even available in Virginia. I travel for business all the time and I’m sometimes out of state or country for a month or more so the whole concept of permanent state residence is a little wishy washy for me at this point since I sold my AZ house. Lease in FL is going to be it I guess. I talk to a FL BCBS agent tomorrow.

DMK what is the whole BCBS transfer process? They sent me paperwork saying I can transfer to another BCBS state and not have to go through underwriting or have waiting periods if I do that but aren’t those all gone now with ACA or should I do this transfer process from AZ to FL if I plan to have a PPO plan? They want me to authorize release of my PHI to the new state. Wouldn’t I have to do that no matter what? Not sure the purpose of this process or whether it helps or hurts me. I did have surgery in the last year so I don’t want somebody trying to exclude related follow up care.

[hype]

Health Care

If you are upset with what the government has mandated and set up, please let your elected officials know.

Not having health care out of state is a HUGE issue. Insurance should be valid EVERYWHERE in the ENTIRE country! Isn’t this what the law was supposed to cover?

We can’t expect people to never travel outside of their own states.

What happens if you get into an automobile accident and are rushed to the ER?

Not to get into which party is right and which party is wrong, but we as citizens under this mandate to have a right to expect that the laws will cover us within our own country.

I see this as a huge flaw which will eventually come to light but not until someone has brought their case to the media and that probably won’t come up until they are billed for 100K for an out of state accident which the insurance company refuses to pay for.

To put things into perspective, with active health insurance you shouldn’t be worried about showing or traveling within the US. This is wrong on many levels.

[poltroon]

hype, DMK has already stated that the law anticipates this kind of evasion and does not allow it for emergency care.

[RugBug]

[QUOTE=hype;7892893]
If you are upset with what the government has mandated and set up, please let your elected officials know.

Not having health care out of state is a HUGE issue. Insurance should be valid EVERYWHERE in the ENTIRE country! Isn’t this what the law was supposed to cover?

We can’t expect people to never travel outside of their own states.

What happens if you get into an automobile accident and are rushed to the ER?

Not to get into which party is right and which party is wrong, but we as citizens under this mandate to have a right to expect that the laws will cover us within our own country.

I see this as a huge flaw which will eventually come to light but not until someone has brought their case to the media and that probably won’t come up until they are billed for 100K for an out of state accident which the insurance company refuses to pay for.

To put things into perspective, with active health insurance you shouldn’t be worried about showing or traveling within the US. This is wrong on many levels.[/QUOTE]

And sadly, reactionary and uninformed posts like this stir the pot unnecessarily. :rolleyes:

No matter your thoughts on ACA, there hasn’t been change in access to emergency coverage.

[trubandloki]

[QUOTE=RugBug;7893090]

No matter your thoughts on ACA, there hasn’t been change in access to emergency coverage.[/QUOTE]

It sounds like it might be worth a letter or call to the higher ups at whatever insurance company this is to find out the facts and ask them to explain to their employees the facts because what the OP has been told does not sound like what you are saying. It is not that I do not believe what you are saying, it is just not a really clear fact that is being passed along, at least not in this case.

[jody_jaffe]

I didn’t think Equisusuan’s response was that reactionary (in the negative sense of the word). At the start of this thread, I’d asked for this thread not to devolve into a political debate, just a clearinghouse for information which DMK has generously provided.

That said, I am very disappointed with the way the ACA has rolled out and I have been writing letters to my elected officials and would urge anyone who isn’t happy with this new insurance situation, do the same. Just not here on this forum:)

Civility is highly under-rated and at a premium when you can post anonymously. So far, we’ve done a good job. And many thanks to DMK.

[equisusan]

[QUOTE=jody jaffe;7893275]
I didn’t think Equisusuan’s response was that reactionary (in the negative sense of the word). At the start of this thread, I’d asked for this thread not to devolve into a political debate, just a clearinghouse for information which DMK has generously provided.

That said, I am very disappointed with the way the ACA has rolled out and I have been writing letters to my elected officials and would urge anyone who isn’t happy with this new insurance situation, do the same. Just not here on this forum:)

Civility is highly under-rated and at a premium when you can post anonymously. So far, we’ve done a good job. And many thanks to DMK.[/QUOTE]

Whoa not my post that was inflammatory or political. Yikes! It was someone that posted after me. I support ACA but was certainly disappointed to see the options if I stayed in Virginia. I’m just trying to figure out what to do for my own situation moving to Florida.

[RugBug]

[QUOTE=jody jaffe;7893275]
I didn’t think Equisusuan’s response was that reactionary (in the negative sense of the word). At the start of this thread, I’d asked for this thread not to devolve into a political debate, just a clearinghouse for information which DMK has generously provided.

<snip>

Civility is highly under-rated and at a premium when you can post anonymously. So far, we’ve done a good job. And many thanks to DMK.[/QUOTE]

It wasn’t equisusan’s post. It was hype’s. S/he either didn’t read the thread pet peeve of mine or didn’t care to understand…also a pet peeve. Being in the insurance industry, I see misinformation flying around all the time, and being used as some reason way such and such party/law is terrible…and the worst part is that people take it as truth.

I am hardly anonymous these days…and my post was hardly uncivil.

[Darkwave]

Another concerning situation - those who live in a multistate area. I live in Arlington, Va - about 2.5 miles from DC. Though there are good hospitals in Virginia, I regularly go into DC for doctor’s appointments, which is also where some top hospitals are. The idea that, under this plan, I would be actively discouraged from going to DC for coverage reasons strikes me as ridiculous.

[DMK]

[QUOTE=equisusan;7892362]
DMK what is the whole BCBS transfer process? They sent me paperwork saying I can transfer to another BCBS state and not have to go through underwriting or have waiting periods if I do that but aren’t those all gone now with ACA or should I do this transfer process from AZ to FL if I plan to have a PPO plan? They want me to authorize release of my PHI to the new state. Wouldn’t I have to do that no matter what? Not sure the purpose of this process or whether it helps or hurts me. I did have surgery in the last year so I don’t want somebody trying to exclude related follow up care.[/QUOTE]

There is no more pre-existing condition in your health insurance, so follow up care should not be an issue. But it is your PHI and your do have to authorize releasing it under HIPAA laws.

If you have an address in FL right now you can probably just go sign up for a 1/1 effective date just as easily as discuss transferring coverage (the “transfer” option may just be a courtesy in place to speed along your paperwork, not have to re-enroll, but yes, you are correct - no waiting periods, etc.). It may be to your advantage to talk to a broker about what coverage best suits your needs. But if you want to get a flavor of the premium costs, you can go to their website or healthinsurance.com (this is a private exchange, not the federal exchange) to see what is available in FL. Since there is no medical underwriting, the price yo see there is the price you will pay, period.

I agree about hype’s post being a tad overwrought. Here’s the deal with ER care. It has always been covered out of network. The only thing ACA did is define a federal standard that had pretty much been in place in state laws and NCQA guidance looooong before ACA was a gleam in anyone’s eye. So, much ado about nothing and well explained before this post. But hey, anyone can skip to the end and fail to read the middle, so there is that.

However if you (the generic “you”) DO think ACA should be “undone” please be aware that the things people generally feel pretty strongly about (no pre-X, no medical underwriting, guarantee issue and dependents covered to 26), are part and parcel of the 100% participation requirement (aka the exchange and subsidy). You cannot have one of these things and not the other and have an insurance company left standing on the planet - it would undermine the entire basis of insurance to “undo” that part. I guess for those wanting to have a single payor, that would probably be the fastest route to implement it, although I doubt our economy could stand the journey. That said, there are many, many parts of ACA that could stand for improvement. But it needs to be a well thought out and measured. Not knee jerk, which of course rules out “Congress” in general. So I have little hope of improvement, and that was pretty much my assessment before the change in control. Cynicism. I has it.

[trubandloki]

[QUOTE=DMK;7893583]

However if you (the generic “you”) DO think ACA should be “undone” please be aware that the things people generally feel pretty strongly about (no pre-X, no medical underwriting, guarantee issue and dependents covered to 26), are part and parcel of the 100% participation requirement (aka the exchange and subsidy). You cannot have one of these things and not the other and have an insurance company left standing on the planet - it would undermine the entire basis of insurance to “undo” that part. [/QUOTE]
On the Pre-existing condition subject - in NY it has been for, well as long as I can remember, that as long as you are insured or had been insured with in the last six months, there was no such thing as an exclusion. You could change policies or have a gap in coverage and still not have things excluded. We did not have a 100% participation requirement, etc, so I am not 100% buying that part.

[RugBug]

@DMK;7893583

I agree about hype’s post being a tad overwrought. Here’s the deal with ER care. It has always been covered out of network. The only thing ACA did is define a federal standard that had pretty much been in place in state laws and NCQA guidance looooong before ACA was a gleam in anyone’s eye. So, much ado about nothing and well explained before this post. But hey, anyone can skip to the end and fail to read the middle, so there is that.

Hey DMK - you might want to correct the bolding when you see this to in-network.

However if you (the generic “you”) DO think ACA should be “undone” please be aware that the things people generally feel pretty strongly about (no pre-X, no medical underwriting, guarantee issue and dependents covered to 26), are part and parcel of the 100% participation requirement (aka the exchange and subsidy). You cannot have one of these things and not the other and have an insurance company left standing on the planet - it would undermine the entire basis of insurance to “undo” that part. I guess for those wanting to have a single payor, that would probably be the fastest route to implement it, although I doubt our economy could stand the journey. That said, there are many, many parts of ACA that could stand for improvement. But it needs to be a well thought out and measured. Not knee jerk, which of course rules out “Congress” in general. So I have little hope of improvement, and that was pretty much my assessment before the change in control. Cynicism. I has it.

I has your cynicism, too. BUT people need to understand that ACA has added a lot to insurance that without mandatory participation spells the demise of insurance altogether. The increased access model is not sustainable without the participation.

[poltroon]

[QUOTE=trubandloki;7893630]
On the Pre-existing condition subject - in NY it has been for, well as long as I can remember, that as long as you are insured or had been insured with in the last six months, there was no such thing as an exclusion. You could change policies or have a gap in coverage and still not have things excluded. We did not have a 100% participation requirement, etc, so I am not 100% buying that part.[/QUOTE]

But to some extent NY experienced the death-spiral that goes with that - ie that their rates were much higher than everyone else’s, which meant only people who thought they would need care bought as individuals, which raised the price higher, which meant fewer people bought… the end result is that many people could not afford to buy in.

It would be pretty simple to compare their rates to say those in Massachusetts in the mid 2000s.

As for your metro areas that span state lines - I have always wondered how all kinds of stuff works in those situations. Here in California, that is very alien to us. I imagine though that often the health networks in those areas do span the state line.

[equisusan]

@DMK;7893583

There is no more pre-existing condition in your health insurance, so follow up care should not be an issue. But it is your PHI and your do have to authorize releasing it under HIPAA laws.

If you have an address in FL right now you can probably just go sign up for a 1/1 effective date just as easily as discuss transferring coverage (the “transfer” option may just be a courtesy in place to speed along your paperwork, not have to re-enroll, but yes, you are correct - no waiting periods, etc.). It may be to your advantage to talk to a broker about what coverage best suits your needs. But if you want to get a flavor of the premium costs, you can go to their website or healthinsurance.com (this is a private exchange, not the federal exchange) to see what is available in FL. Since there is no medical underwriting, the price yo see there is the price you will pay, period.

Thanks DMK. I will sign up tonight.

[DMK]

[QUOTE=trubandloki;7893630]
On the Pre-existing condition subject - in NY it has been for, well as long as I can remember, that as long as you are insured or had been insured with in the last six months, there was no such thing as an exclusion. You could change policies or have a gap in coverage and still not have things excluded. We did not have a 100% participation requirement, etc, so I am not 100% buying that part.[/QUOTE]

The state of insurance in NY is precisely the cautionary tale for this very issue. Also, what you are talking about - credible coverage - is not the same issue. Credible coverage is a national requirement and relates to a one time preX based on no gaps in coverage. That is not even remotely related to guarantee issue/noDTQ and no preX from a risk perspective. Possible not even apples to oranges, it might even be steak to apples.

[RugBug]

[QUOTE=trubandloki;7893630]
On the Pre-existing condition subject - in NY it has been for, well as long as I can remember, that as long as you are insured or had been insured with in the last six months, there was no such thing as an exclusion. You could change policies or have a gap in coverage and still not have things excluded. [/QUOTE]

This doesn’t mean you didn’t have pre-ex, just that if you had prior coverage you didn’t have pre-ex. ACA removed the prior coverage qualifier and said there was no more pre-ex at all. That is VERY different from what you posted.

Speaking to just what I know: the no pre-ex with Prior coverage has always been the case with group insurance* in CA. As long as you haven’t had a gap in coverage that is more than 63 days, there is no pre-ex. HMOs never had pre-ex even if there was a long term gap.

Even if you had a pre-ex because of a gap, there is an exclusion period and a look back period that is state/carrier specific. For instance in CA - exclusion period was the length of the gap in coverage and lookback was up to 6 months. (no coverage for 4 months = 4 months of exclusion for anything you had been seen for in the lookback period, which was 4 months).

I’ve always felt the fear of Pre-ex was overblown in the group world because people didn’t really understand it and then someone heard of someone who had an exclusion, etc.

*Individual market may work differently.

We did not have a 100% participation requirement, etc, so I am not 100% buying that part.

You may not be buying it, but one big reason for pre-ex is to motivate people to maintain coverage. It discouraged people from jumping on and off plans, not paying premiums when they were healthy and then joining a plan when they weren’t to get services and then back off when they were healthy again.

Insurance works in that you HAVE to pay for it when you are healthy so that the funds are available when you are not. In large scale and very simplified terms, the premiums from healthy people offset the claims of sick people. If the healthy people have no motivation to have coverage, the insurance implodes from the liability of all the claims of sick people.

If you’ve ever seen what happens to an experience rated group (over a pooled product) you can see this clearly. I worked with groups with very high utilizing populations and their premiums were shocking…and there were no other options for them to shop their coverage because no carrier in their right mind would take on the risk.

In order for insurers to survive some of the ACA regs like the removal of Pre-ex, the 100% participation regs had to be enacted. Everyone HAS to maintain coverage so premiums are coming in the door to pay for the sick but also so they are getting coverage for illnesses/diseases sooner rather than being uninsured and then only seeking care (and insurance if they had an OE period) when something is major (read: expensive).

DMK mentioned earlier the lack of visibility into what kind of claims/costs the insurers will be exposed too due to the inclusion of the uninsured population. This can’t be underestimated. If ACA continues, the claims should stabilize (or at least become a known factor) rather than this gray area as the uninsured become insured. As someone who sees on a small scale the rush for services once an uninsured has access to coverage…it’s got to be a huge cost.

[poltroon]

[QUOTE=RugBug;7893728]
This doesn’t mean you didn’t have pre-ex, just that if you had prior coverage you didn’t have pre-ex. ACA removed the prior coverage qualifier and said there was no more pre-ex at all. That is VERY different from what you posted.

Speaking to just what I know: the no pre-ex with Prior coverage has always been the case with group insurance* in CA. As long as you haven’t had a gap in coverage that is more than 63 days, there is no pre-ex. HMOs never had pre-ex even if there was a long term gap.

Even if you had a pre-ex because of a gap, there is an exclusion period and a look back period that is state/carrier specific. For instance in CA - exclusion period was the length of the gap in coverage and lookback was up to 6 months. (no coverage for 4 months = 4 months of exclusion for anything you had been seen for in the lookback period, which was 4 months).

I’ve always felt the fear of Pre-ex was overblown in the group world because people didn’t really understand it and then someone heard of someone who had an exclusion, etc.

*Individual market may work differently. [/QUOTE]

The individual market did work very differently. I fell through this hole in California when my employer folded in 2001. I had been continuously insured, did not consider myself sick, and cheerfully applied for an individual plan when we started our business. My daughter and I were both denied coverage.

We eventually were able to get covered again when the small business group regulations changed in CA to force insurance companies to cover employer groups as small as 2. The group coverage didn’t have the preexisting exclusion.

It is really very surprising how different the individual and group plans can be, even when they read the same in the policy.

[RugBug]

[QUOTE=poltroon;7893754]
The individual market did work very differently. I fell through this hole in California when my employer folded in 2001. I had been continuously insured, did not consider myself sick, and cheerfully applied for an individual plan when we started our business. My daughter and I were both denied coverage.

We eventually were able to get covered again when the small business group regulations changed in CA to force insurance companies to cover employer groups as small as 2. The group coverage didn’t have the preexisting exclusion.

It is really very surprising how different the individual and group plans can be, even when they read the same in the policy.[/QUOTE]

poltroon: being denied coverage because you are a bad risk and pre-ex are two different things. Related, but not the same.

In the individual market, you can be denied as a bad health risk or you can be rated up. For instance, I was almost denied when I had to go into the individual market because I was high risk. I didn’t think I was high risk, but my familial high cholesterol that is well controlled with meds means I am not a good risk in the insurer’s eyes. One carrier did deny me, another rated me to their highest level.

That said, once I was on the plan, I didn’t have any pre-exclusions. Terrible coverage, but no pre-exclusions. Thankfully I’m a very low utilizer and was only on the plan for a short time.

[IPEsq]

[QUOTE=Darkwave;7893571]
Another concerning situation - those who live in a multistate area. I live in Arlington, Va - about 2.5 miles from DC. Though there are good hospitals in Virginia, I regularly go into DC for doctor’s appointments, which is also where some top hospitals are. The idea that, under this plan, I would be actively discouraged from going to DC for coverage reasons strikes me as ridiculous.[/QUOTE]

I lived in DC and at the time, the Anthem office was regional. DC-metro area residents were on one plan that was different than from say the Virginia plan for Virginia residents outside of NOVA.