In Network/Out of Network?

[GA in GA]

Scenario, client with family plan in Georgia, the daughter is a full time student in Gainesville Florida. Does she have to come back to Georgia to be in network. What about emergency? I do have clients in North Georgia that routinely cross over to Chattanooga Tenn. and remain in network.

Just curious about others agents experiences and/or thoughts on this situation.

 

[YouGotMyMoney]

Depends on the plan, but most carriers: UHC/Humana/BX/Cigna/Aetna will have docs in both cities in network.

Emergencies are always covered in network.

 

[GA in GA]

Thanks Money, that's what I was looking for...some reassurance.

 

[Crabcake Johnny]

New legislation addresses some of this:

Out Of Network ER Visits Won't Cost More Under New Health Law - Kaiser Health News

"Under the new health-care law, you may not have to be a medical billing expert to avoid many out-of-network charges for emergency care. The law is designed to prohibit insurance plans from charging higher co-payments or coinsurance amounts for out-of-network emergency services or from imposing other coverage limitations that would not apply to in-network care. The provisions go into effect on Sept. 23, but plans are not required to implement the change until the beginning of the new insurance plan year.

Note, however, that the provisions apply only to new health plans, not existing ones that are grandfathered under the law and exempted from some regulations. Eventually, many of those existing plans are expected to lose their grandfathered status — by amending their plans beyond allowable limits — but for now they don't have to comply."

 

[YouGotMyMoney]

What's the definition of an "emergency" though?

Going to the ER for an upset stomach won't cut it?

 

[DS4]

What's the definition of an "emergency" though?

Trauma, loss of blood, broken limb, severe injury etc.
Be prepared to battle the ins carrier to rec in network PPO pricing on a out of network emergency claim.