By Trish Pearson
Insure Your Future
Trish Pearson
Summer is finally here and vacation season is upon us. Whether you are traveling in the US or abroad, there are a few things to remember about how your health insurance works when you are out of state.
The first thing to remember is that if you have an emergency or medical issue that requires immediate attention your insurance will cover you no matter where you are. However, how the bill is paid can vary greatly depending on the circumstances and location.
If you are traveling out of the area but within the US, most facilities such as walk-in clinics, emergency rooms or urgent care centers will accept your insurance. However, some insurance plans – especially HMOs – may require prior authorization before being seen. If possible, contact the member services department (the number is on the back of your insurance card) and explain the situation. This can save time and aggravation when you reach the front desk.
The other option is to schedule a telehealth visit if it is a condition that can be diagnosed easily and a prescription written. However, if it is a true emergency, seek immediate attention and provide the insurance ID card. An emergency facility will not refuse care and the insurance will cover you.
When filling existing prescriptions while away, if your current pharmacy has a location near you simply contact your “home” pharmacy and request that the prescription be filled at that location. Often, you can save time by doing it online. It is much easier if you have the Rx number. If there is not a match with a local pharmacy, then you may have to have the provider call in a prescription to the pharmacy near you.
The best way to protect against unexpected medical costs when out of the country is to purchase travel insurance. Depending on the length of the trip, the insurance is generally quite reasonable and will save time and aggravation. While US health insurance will usually cover you out of the country, the challenge is that the systems for paying claims in the US do not match with the billing systems abroad. Many countries have national health systems, and they deal directly with the government agencies. Often, they do not want to deal with US insurance companies. (Can you blame them?) Instead they will require payment upfront and leave you to file for reimbursement. In addition, there are currency issues; insurance companies don’t usually pay in pesos or lira. Travel insurance is sold by travel agents as well as insurance brokers.
Insurance will generally cover immediate medical needs away from home. Once the patient is “stable,” the expectation is that they will return home for follow-up treatment. This is often a judgement call by the insurance company in consultation with the medical provider on site. To avoid an unhappy financial situation, check with member services once the patient is out of immediate danger before taking the next step.
Trish Pearson is a licensed independent insurance agent and certified long term care specialist. Contact her at 203-640-5969 or trishpearson281@gmail.com.