Anyone experience with an EPO restricted health insurance policy?

[LARS]

Specifically I am wondering if there is a secondary insurance product that will provide a high deductible coverage for out of EPO network for other states.

The point being to have access to specialists outside of state EPO network in the event of an out of the ordinary event, which would require going to Cleveland Clinic for example.

 

[MBSC]

If my EPO does not have an in-network specialist for a rare medical condition, they grant a waiver and the OON provider's claims process as in-network. YMMV.

The waiver is not granted just because I want a provider rated 9/10 when an in-network provider rated 5/10 is available. An illness indemnity plan may be as close as you could get in that case.

If you are married and have a business TIN, you may qualify for a "2 person group PPO" or group EPO connected to a national provider network.

In some instances, however, you may be able to go to an out-of-network provider and still pay in-network prices. Suppose you or a member of your family has a rare, serious sickness or health problem, such as a genetic disorder. Suppose no provider in your network has the training or experience to treat it the right way. In such a special, uncommon circumstance, with prior approval from your insurer, you may be able to go out of network while sharing the costs at the lower in-network rate.

Further reading: https://fairhealthconsumer.org/reim...out-of-network-care-can-be-covered-in-network

 

[LARS]

Thanks for response. You raised the issue I am trying to deal with: what if Specialists in network are 5/10 and I want to get someone out of state that is 10/10.

Have thought about business approach which would get PPO, but not certain I want to deal with creating an entity (if I did it would most likely be a non-for-profit to carry out charity work).