Most people do not spend much time considering their health insurance before making travel plans. Before you leave your home, however, it’s a good idea to check with your insurer to see how your coverage will transfer to other parts of the country. Otherwise, you put yourself at risk for losing money on emergency healthcare expenses if difficulties arise during your travels. This is especially important if you travel a lot for business purposes or have a major vacation planned. Knowing what to expect in advance can help you plan your trip accordingly.

Why Traveling Can Interfere With Insurance Coverage

There are three general types of health insurance: HMO, PPO and POS. The difference between these policies lies in the insurance company’s relationship to preferred providers or in-network doctors. Essentially, all insurance companies will favor certain doctors due to their rates or other factors. When a doctor is outside of that preferred network, however, insurance companies will react differently.

– With an HMO, you must choose a primary care physician within the insurance company’s network. If you seek medical care outside of that network, you may be responsible for paying the total cost out of pocket. The primary exceptions to this are when the HMO doctor refers you to an out-of-network specialist or if you seek emergency care for a true emergency.

– In a PPO, you have the choice between receiving care from either a doctor inside the network or one outside. If you choose a doctor out of the network, you will pay a higher percentage of the cost, and you may need to pay for everything out of pocket before seeking reimbursement.

– A POS plan combines elements of both HMO and PPO providers. In a POS plan, you can receive health care from doctors in or out of your network, and you do not need to designate a primary care physician. You will, however, pay more for out-of-network care than you would have from an in-network doctor unless acting under a physician’s referral.

Because all insurance companies prefer their insureds to seek out in-network physicians and hospitals, obtaining care away from your home can sometimes be difficult. If there are no in-network doctors at your destination, you may face denied claims and hefty out-of-pocket expenses.

Will My Health Insurance Work Out of State?

Every insurance company is different, so there is no simple answer to the question of whether your insurance coverage will protect you out of state. Many large national insurance companies will have a nationwide network. This will allow you to choose medical facilities in any state without paying the high co-pay or other expenses. On the other hand, some insurance companies do not service certain states, so finding an in-network physician can be impossible.

In most cases, insurance companies are required to pay for reasonable emergency medical expenses regardless of the hospital you go to. This means that if you’re involved in a car accident and taken by ambulance to a hospital outside of your network, your insurance company should still be responsible for paying this expense.

Unfortunately, there is no concrete definition of “emergency,” and some insurance companies will deny claims that they judge as being not true emergencies. It’s always better to understand exactly what your insurance coverage will pay for before traveling than to run the risk of a denied claim after an emergency occurs.

Aside from emergencies, some patients may find that they need to visit doctors for other reasons. They may have chronic health conditions that need to be dealt with, or they may simply come down with a non-emergent medical problem that still requires swift attention. This may be especially problematic for people traveling for extended periods of time. Clarifying how coverage works and what doctors can be visited will help reduce the stress and expense associated with these situations.

What to Do Before Traveling

Before traveling, be sure to contact your insurance company to clarify how out-of-state claims will be handled:

  • Ask if there are any in-network physicians or hospitals at your destination
  • Get clarification about how “emergency” is defined by your insurance company
  • Determine what you would need to pay out of pocket when visiting a doctor
  • Verify whether urgent care facilities are acceptable or if only emergency rooms can be covered
  • Ask whether there are any specific requirements to filing a claim for an out-of-network physician

Once you know how your insurance company will handle the claim, you can make decisions regarding your best course of action. This may mean creating a list of approved medical providers for easy reference. It may also mean purchasing temporary travel insurance to cover your emergency expenses. Whatever you do, confirming your plans with your insurance company is the best way to prevent unwelcome surprises during your travels.