Worrying about healthcare (networks/balance billing)

[Fermion]

If you are going to be traveling a lot in retirement (actually traveling so much that you don't have a permanent residence), is there a solution to healthcare insurance other than just have a fat pile of money?

I was looking at the silver level PPO plans on the WA state healthcare exchange (the state that currently claims us) and noticed under the category of Out of Network they only pay 50% and the max out of pocket is listed as "unlimited"

I like unlimited when someone is talking about the potential of a stock I own. I am not fond of the word when it refers to bills that may come due.

If we are traveling up in Alaska and hit a moose, rack up $200,000 at the local hospital before we can be safely transferred to a in network provider, are we really responsible for $100,000 out of pocket?

Is there a solution here? (other than drive slower)

 

[Tandemlovers]

We bought a policy this year that covered networks out of our area.

Unfortunately, it was very expensive, $1370/month for a family of four,
a Bronze HSA plan. We have just been informed that the premium will
go up to $1520/month next year, so I have started looking at options
on the exchange.

It's beginning to look like the "pile of money" comment you made might
be what we have to rely on to do any traveling and afford insurance at
the same time, since none of the policies on the exchange cover any
care beyond emergency room and urgent care visits in out of network areas.


Sent from my iPad using Early Retirement Forum

 

[daylatedollarshort]

I think it depends on the state. The answer to that appears to be in this chart, but it would take someone much smarter than me to make sense of it:

State Restriction Against Providers Balance Billing Managed Care Enrollees | The Henry J. Kaiser Family Foundation

 

[Fermion]

So hearing that a lot of RV'ers choose Texas for domicile, I checked out their exchange offering. Unlike Washington state, I can get a Blue Cross Blue Shield of Texas Blue Choice PPO that has a listed out of pocket maximum for out of network services of $3000 per individual.


$3000 is a lot better than unlimited

Really? I have to move to Texas just to get decent healthcare?

 

[tomz]

Blue Cross/Blue Shield of Florida PPOs consider Blue Cross providers anywhere in the country as in network. I bought a silver plan that highlights the National Provider Network on healthcare.gov. I don't know anything about Washington, bought I think the non HMO Blue plans have this provision.

 

[Fermion]

It may be that the Premera Blue Cross PPO plan in Washington would have the same network as Blue Cross Blue Shield of Texas (or Florida) but when you download the plan coverage, the Premera plan only pays 50% of out of network billing while the Texas plan pays everything past $3000.

In my moose example, we might save $97,000 by switching residence from Washington to Texas.

 

[brewer12345]

If you hit a moose, most likely your heirs will be the ones to deal with resultant medical bills.

A friend in college had an amusing moose story. Supposedly her mother and a friend were cruising backwoods Maine roads in an MG. They came around a corner and hit a moose broadside at speed. Allegedly the convertible MG (with top down) was so low that instead of being killed, they just disemboweled the moose and had the entrails land in the car. Again, no idea if it is true, but a hell of a (gross) story.

 

[aja8888]

Really? I have to move to Texas just to get decent healthcare?

A lot of things are better in Texas!

 

[Animorph]

Looking through some of the other plans I was offered, I thought the HMO plans covered emergency care (whatever was necessary before you could get home). It was just the elective/preventive/chronic stuff that wasn't covered. So hitting a moose should have some coverage even if it's out of network.


I use a BCBS bronze HSA eligible plan with access to a statewide and nationwide network. They do exist, and within the lower cost plan levels, though more expensive than the limited regional/HMO network plans.


Travel insurance might help out if you can't find an insurer with a national network.

 

[Fermion]

Actually I am seriously considering Texas now. The Escapees all use it, as a matter of fact they all are registered to vote in the same local area and that maybe encourages the local politicians to be pro full time rv. No state income tax just like Washington, lower sales tax, better healthcare plans. Sometimes you just need to follow the crowd I guess.

 

[Helen]

Travel insurance might help out if you can't find an insurer with a national network.

You might be right on this, but it really ticks me off that I have to pay a monthly premium and high deductibles and still not be covered everywhere in the US.

I'm struggling with this right now. An advantage of going on Kaiser is that if I am here in Portland I know that all the services will be in the network. If I go on a PPO, I don't know if all the services provided will be done in network. And, the PPOs that I have found that have extensive networks don't see that extensive when I look into them.

I'm thinking my two choices are Kaiser or a policy that puts a cap on out of network care.

 

[M Paquette]

Some states have regulations or laws that prohibit balance billing for out-of-network services under at least emergency conditions, for persons enrolled with managed care policies such as HMO or PPO plans.

This table lets you search and sort by state.
State Restriction Against Providers Balance Billing Managed Care Enrollees | The Henry J. Kaiser Family Foundation

The tricks here would be to enroll in an HMO or PPO for your 'fixed residence' with exchange privileges with other networks in states where you are likely to travel, and than to avoid traveling in or through any states that don't restrict out-of-network provider billing.

 

[photoguy]

It may be that the Premera Blue Cross PPO plan in Washington would have the same network as Blue Cross Blue Shield of Texas (or Florida) but when you download the plan coverage, the Premera plan only pays 50% of out of network billing while the Texas plan pays everything past $3000.

The 3000 max OOP for out of network care is very good - it's also better than most in network plans. Our blue shield ppo in ca has a limit of 8k for out of network (if I remember correctly).


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[Brat]

You might be right on this, but it really ticks me off that I have to pay a monthly premium and high deductibles and still not be covered everywhere in the US.

I'm struggling with this right now. An advantage of going on Kaiser is that if I am here in Portland I know that all the services will be in the network. If I go on a PPO, I don't know if all the services provided will be done in network. And, the PPOs that I have found that have extensive networks don't see that extensive when I look into them.

I'm thinking my two choices are Kaiser or a policy that puts a cap on out of network care.

I had Kaiser when I worked and traveled a lot. They cover emergency care and ship you home to their facilities when stable enough to travel - make sure you have your Kaiser card in your wallet & the receiving hospital will contact them. It is my understanding that if you have what you think requires urgent attention call their nurse advisor # and they can direct you to a covered urgent care facility (they have contracts all over the country). Kaiser coordinates with Group Health in WA so if you fall ill in Island County care is a slam dunk.

 

[papadad111]

Similar issues / concerns.

This is very complicated.

What a messed up system.

So much for universal health care.

God damn you , ACA.

 

[travelover]

..............
God damn you , ACA.

Good point. We never had any issues with coverage before the ACA.

 

[ERhoosier]

Some states have regulations or laws that prohibit balance billing for out-of-network services under at least emergency conditions, for persons enrolled with managed care policies such as HMO or PPO plans.

This table lets you search and sort by state.
State Restriction Against Providers Balance Billing Managed Care Enrollees | The Henry J. Kaiser Family Foundation

Always best to check the most current info for your state. This Kaiser table footnotes say it was last updated 18mo ago (Mar '13).

 

[Brat]

Similar issues / concerns.

This is very complicated.

What a messed up system.

So much for universal health care.

God damn you , ACA.

What we have is health insurance, not universal health care. I agree that a single payer system would be a whole lot easier but our citizenry isn't ready for that. I think we got what was do-able, nothing more.

 

[Helen]

I had Kaiser when I worked and traveled a lot. They cover emergency care and ship you home to their facilities when stable enough to travel - make sure you have your Kaiser card in your wallet & the receiving hospital will contact them. It is my understanding that if you have what you think requires urgent attention call their nurse advisor # and they can direct you to a covered urgent care facility (they have contracts all over the country). Kaiser coordinates with Group Health in WA so if you fall ill in Island County care is a slam dunk.

Thank you, Brat. This is more helpful than the information I received from their online chat.

The first time I 'chatted' with someone I asked them what would happen if I had bronchitis while out of network. She responded that I would only be covered if I went to an emergency room.

The second person I talked to I used the example of what if I fracture my hip while away from home; her response was that they would only cover emergency and urgent care for out of network.

I didn't think my questions were that difficult.

 

[Helen]

Similar issues / concerns.

This is very complicated.

What a messed up system.

So much for universal health care.

God damn you , ACA.

How was it for you before the ACA? Without the ACA, my only option would have been the high risk pool, and that would have been very expensive. In other states, I would have been uninsurable.

 

[Corporateburnout]

I'm in process of shopping for health insurance for the two of us on the exchange and the HMO policy that I'm looking at covers out of network urgent care and emergency services with the same copay as in network. All of our doctors, specialist and facility are in network but no other out of network services are covered.

So if traveling anywhere in the US we're covered for emergency and urgent care but if we have to cross the border into Canada that is a different story. Although when some friends needed emergency care while visiting Toronto a few years ago they received it free of charge and were never billed for it.

 

[M Paquette]

This is very complicated.

What a messed up system.

So much for universal health care.

God damn you , ACA.

Yeah. It was so much simpler when I was simply turned down for insurance.

(High risk pool? First, go without insurance for six months. Then, apply for the waiting list. When enough enrollees pass...)



http://articles.latimes.com/2008/oct/28/local/me-uninsured28

 

[ERhoosier]

What we have is health insurance, not universal health care. I agree that a single payer system would be a whole lot easier but our citizenry isn't ready for that. I think we got what was do-able, nothing more.

Health insurance and universal care are 2 distinct issues. Switzerland and Netherlands are private HI-based systems which are generally rated very highly in care delivery.
https://en.wikipedia.org/wiki/Healthcare_in_the_Netherlands
In Switzerland, A Health Care Model For America? : NPR

In fact, earlier this Fall the Swiss overwhelmingly voted AGAINST a shift to single payer HC.
Swiss voters reject shift to state-run health insurance - Business Insider

Even in the progressive (liberal) Commonwealth Fund's latest ranking of HC systems of 11 wealthy nations, the top 2 (UK, Switzerland) and bottom 2 (Canada, US) were evenly split between single-payer and private HI systems.
http://www.commonwealthfund.org/~/m...rt/2014/jun/1755_davis_mirror_mirror_2014.pdf

It is execution, not type of HC system, that matters.

 

[Animorph]

You might be right on this, but it really ticks me off that I have to pay a monthly premium and high deductibles and still not be covered everywhere in the US.

I'm struggling with this right now. An advantage of going on Kaiser is that if I am here in Portland I know that all the services will be in the network. If I go on a PPO, I don't know if all the services provided will be done in network. And, the PPOs that I have found that have extensive networks don't see that extensive when I look into them.

I'm thinking my two choices are Kaiser or a policy that puts a cap on out of network care.

One of the benefit changes I had for 2015 was that if my in-network provider somehow screws up and gets me an out of network provider (an anesthesiologist for example), I was no longer going to be charged a $500 fee and balance billed. I would be covered as if they were in network. I presume the ACA made them do that and your available health plans may do the same. That is a nice "gotcha" to get rid of, though my docs managed to avoid any problems previously.

 

[papadad111]

I was with a mega corp and that insurance covered me globally due to very frequent overseas travel. Was I think Aetna Global.