True or False….My Health Insurance Covers Me Everywhere

Answer: It Depends…Read your policy

If your health insurance is a Health Maintenance Organization (HMO) plan, you must secure your healthcare services from that insurance company’s network of health care service providers in your home service area, unless your health problem is a life-threatening emergency situation. HMO members may, or may not, have access to their insurance company’s network of providers when traveling outside their home residence area…read your policy. If you live in city A, travel to city B and wake up one morning feeling punk…coming down with a flu bug, what doc can you call? Your HMO might not cover you in city B, if you are considered “out of area”.

Of course you are free to visit any doc anywhere. It’s your choice. However, you may be forced to pay the doc’s full bill out of pocket if that doc is not in your HMO insurer’s network of contracted healthcare service providers and/or your travels have taken you away from your home area network. Read your policy.

There are HMO plans providing out-of-network benefits, (so-called POS or PPO plans). Typically, such offer one set of benefits when utilizing the insurance company’s network of contracted healthcare service providers and a second set of benefits when such services are provided by non-network providers. You will pay more of the bill when using out-of-network providers but, unlike pure HMO plans, at least some of the bill may be covered.

Due to the effects of the Patient Protection and Affordable Care Acts of 2010 (Obamacare), most health insurance plans available these days are HMO plans, with only a few POS/PPO plans remaining.

Oh yes…don’t forget to Read Your Policy.

Carpe Diem

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