Will Your Health Insurance Cover You When You Travel?
You planned your vacation months in advance. The hotels are booked. The rental car pickup arranged. You even asked friends for a list of restaurant recommendations.
But did you consider placing a call to your health care provider as part of your travel plans? If not, you should.
Accidents can happen anywhere. It's an old adage we all know well. But checking into an emergency room halfway across the country is the last place to find yourself wondering if your version of an emergency will indeed be covered by your health insurance plan.
Insurance plans and the coverage they allow are often as personal as the people holding them, but a few generalizations can be made across the board.
"It's really important for people to ask their insurer what their benefits are when they are out of the area," says Kari Hedges, Executive Director of Inter-Plan Programs for Blue Cross Blue Shield Association. "What kind of out-of-pocket costs they may have associated with emergency care, if they need it, or if there are any pre-authorization costs if they needed to be hospitalized. Also, to ask about availability of network providers when they are out of area."
As a general rule, if you're with a major health care provider and your U.S. health insurance plan covers you for emergency situations in your home state -- whether you're on an HMO or PPO plan -- chances are that you'll be covered for emergency situations that happen when you're in another state, too.
And as long as you're seeking care at the nearest hospital emergency room, this general rule says that emergency care is covered -- whether you arrive by ambulance or not.
But general rules are hardly a comfort when a mountain of potential hospital bills is looming on the horizon after an urgent health care situation. And as it turns out, insurance companies rarely define "emergency" in the black and white terms that you'd like them to.
"For most of our customers, they have coverage out of state," says Amrita John, a Director of Product Management for Cigna, one of the country's largest health service providers. "All members have coverage domestically out of their home for emergency care. If they're traveling on vacation or business, for example, and break a leg, they can go to the nearest emergency center and get it fixed and they will be covered under their health plan."
The way most insurance companies choose to define emergency, however, is vague -- which means that your version of an emergency may not exactly be your insurance company's idea of one (and as a result, it may not be covered).
According to Cigna public relations spokesperson Mark Slitt, the company relies on the "prudent layperson's" definition of emergency. "If an average person, using prudent judgment, believes the situation puts their health in danger, then it would be considered an emergency," Slitt wrote in an e-mail to AOL Travel. "Things like trouble breathing, chest pains, heart palpitations, broken bones (or a severe sprain that might possibly be a broken bone) would be considered an emergency, while a mild headache or the sniffles would not."
According to a list of FAQ's on insurance provider Aetna's website, "emergency care is covered 24 hours a day, seven days a week -- anywhere in the world." And generally speaking, says the website, an emergency is defined as "a situation in which you could reasonably expect that the absence of immediate medical attention could result in serious jeopardy to your health, or if you are a pregnant woman, to the health of your unborn child." A qualifier at the end of the paragraph states that "this definition may vary based on state regulations." And that qualifier is a loaded statement.
No matter who your insurance provider is, knowing the state-to-state regulations of your individual plan is pertinent when it comes to seeking reimbursement for health care in emergency situations. And simply calling your insurance company to ask these questions before you start your travels can save you a lot of hassle down the line.
Says Hedges of Blue Cross Blue Shield Association: "As a Blue System, we don't have a single definition of what emergency services are. As an individual, they really should make their own decision on what they feel is an emergency situation -- and if they feel they're in that situation, they should try to seek care."
However vague the definition of emergency, Hedge's advice is definitely worth heeding if you find yourself in an emergency situation, whether at home or abroad. When you feel that your health is in danger or an accident has happened that you feel requires professional attention, seeking urgent care is the best course of action. But you should know that there's a chance it will not be covered by your insurance company.
For non-urgent health care issues that arise when you're traveling out of state (think flu, or a case of those aforementioned non-emergency sniffles), finding an in-network provider -- whether a doctor or an urgent care clinic -- is important to ensure that you're only responsible for your usual co-pay. And if you're an HMO customer requiring a referral for health care under your plan, you'll also require a referral when out of state.
If you're thinking about checking into an urgent care center rather than a hospital for emergency care -- and you have time to consider one facility over another -- it's best to go to an urgent care center that's in your health insurance provider's network (urgent care in a hospital emergency room, on the other hand, is almost never required to be in-network for reimbursement).
By visiting an urgent care center in your provider's network for an emergency situation, you will be expected to pay just your co-pay up front -- the same thing that you would do at home. And while some health care providers treat emergency care at urgent care centers the same as at hospital emergency rooms (covering both equally), this is not true across the board.
People who need ongoing care for a chronic condition may require treatment while traveling away from home and need to consider more than just emergency care when they travel, as these chronic conditions likely won't be considered an emergency.
For those individuals, Hedges recommends making sure there is an in-network provider (be it urgent care or an individual doctor) where they are traveling. "One of the most important aspects is whether you're able to access an in-network provider. It makes a difference typically in the type of cost sharing the member has," she says, referring to the benefit of paying just your usual co-pay rather than for the entire service up front.
If you're traveling outside of the U.S., call your insurance provider to see what is covered. You might be surprised to learn that emergency care is covered abroad, too, as is often the case for many of the largest insurance providers, including Aetna and Cigna. The difference, however, is that you will be expected to pay for the services up front in their entirety, saving the receipts in order to get reimbursed by your insurance company later. Blue Cross Blue Shield offers the option of the BlueCard , a product that links health care providers across the country and around the world into a single network to further streamline the claims process and eliminate the need to submit claim forms. Many other companies offer similar products for travel outside of the U.S. when emergency care abroad is not covered.
Just remember that the widely interpreted definition of emergency will be key to determining whether your situation is covered or not.
Whether at home or abroad, when it comes to travel and your insurance coverage, being informed about your benefits is a form of insurance in and of itself. Here, a few tips to remember:
1. Always have your insurance card on you when you're traveling. It gives important information to the hospital about who you are and the kind of coverage you have and can make the billing and reimbursement process smoother.
2. Before you travel, call your insurance provider to make sure you understand what is covered out of state or internationally and if pre-authorization is needed to cover costs in situations that require hospitalization.
3. Be sure to specifically ask if emergency care is covered at urgent care centers, as well as at hospital emergency rooms. In some cases, you're only covered at urgent care centers if they are in your insurance provider's network. Tell your health care provider where you are traveling and request a list of in-network urgent care centers and doctors.
4. If you require ongoing care for a chronic condition, call your health care provider before traveling away from home and ask for a list of in-network doctors at your destination.
5. Understand your health care provider's definition of emergency, and ask for the name of the person you spoke to -- in case you have to reference the call at a later date.
6. Finally, if you're not confident that you'll have all the coverage you need when you travel, consider a travel insurance plan that covers medical expenses, as well as travel delays and lost luggage.
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