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My health insurance doesn't cover out-of-state care.

ChellyBelly42ChellyBelly42 Posts: 334Registered User Member
edited April 2009 in Parents Forum
I went to the health center yesterday for a strep test. Quick test was negative but the doctor and the nurse were both really grossed out by my tonsils so they sent off a sample to a lab for a throat culture. I had to call my health insurance company to get some information that was missing from my forms, and when I told the woman that I was at school in PA (my home state is MA), she said "well... your insurance policy only covers emergency care outside of New England."

Fortunately it's just a culture so it shouldn't be too expensive (and I'm actually hoping it comes back positive because otherwise they're going to test me for mono). But this was obviously something my family didn't even think to check when I enrolled in an out-of-state school, especially since the last time I was really sick was when I had the chicken pox in kindergarten (seriously, I've never even had the flu or anything in my entire life).

So the lesson here is, if you're going (or your kid is going) to an out-of-state school, make sure the insurance will cover out-of-state things like lab fees! Just another thing to double-check.
Post edited by ChellyBelly42 on

Replies to: My health insurance doesn't cover out-of-state care.

  • twomulestwomules Posts: 1,207- Senior Member
    Yes, I looked into it. I even sent my daughter to school with a list of doctors that were with the health insurance so she wouldn't have to try to figure it out when she got sick.
  • mafoolmafool Posts: 6,453Registered User Senior Member
    Hoping that it is nothing serious and that you are feeling better very soon.

    Did you need to sign a waver to opt out of a student health-insurance plan? That is often the impetus to check with the family insurance plan to verify coverage.
  • mominvamominva Posts: 2,263Registered User Senior Member
    Find out what your insurance company designates as 'emergency care'. If you are ill while out of state, and antibiotic treatment is indicated, many companies consider that an emergency because it was unanticipated; but screening for high cholesterol without a precipitous urgent event is not.
  • JamiecakesJamiecakes Posts: 551Registered User Member
    As a medical provider who deals with insurance issues for my patients, your post renewed my frustration with the stupidity of some of the insurance rules!

    Okay, so the throat culture might indeed be able to be billed as an urgent care or emergency situation. Strep throat is potentially dangerous and I would instruct the clinic to go ahead and send the bill to the insurance and see if they deny it.

    Second, I would have your parents CONTACT your insurance company and see specifically what they say about out of state students and health care for illnesses. It may be that your annual physicals and preventative services must be at home but sick care can be through urgent care at school. Tell your parents to be insistent and noisy. Inquire WHAT you are supposed to do if ill and needing services out of state.

    Third I would see if you can pay for an inexpensive health care option at school if your primary insurance company fails you.

    Finally, you might have to go to the EMERGENCY ROOM for all your care which is stupid and expensive. You might want your parents to MENTION that since ER care is nuts (although sometimes the copay is $50-75 which makes it prohibitive to you-->but the insurance company doesn't know that).

    Also, amoxil at WalMart, Target etc is just $4 usually so don't pay more until you check that out.

    Good luck!
  • HImomHImom Posts: 18,172Registered User Senior Member
    Also, at many Us, it depends on where you receive your care. ALL students at our kids' U are covered for visits to the Health Center--a mandatory fee. They administer basic care there.

    If you need care beyond that (like at a family practice/internal med clinic, med school), your student health or other insurance needs to kick in--if your policy doesn't meet U standards, you HAVE To buy the U's insurance because of situations like the one you described. I did check on this before our kids left the state--as long as the provider is "participating & preferred" with our Blue Cross/Blue Shield plan, it's the same reimbursement as if the provider were in-state for us.
  • ChellyBelly42ChellyBelly42 Posts: 334Registered User Member
    oh, I should have mentioned this in my first post- the woman on the phone did say she would file the culture under emergency care. so it will hopefully work out okay. I figured this would be an important thing to make people aware of, though. so parents of students going off for their first year in the fall would make sure to check their plans.
  • heyalbheyalb Posts: 956Registered User Member
    Finally, you might have to go to the EMERGENCY ROOM for all your care which is stupid and expensive.

    No question it's stupid and expensive, and yes, it's what many insurance companies require if you're out of state and need to see a doctor.

    I've told my kids that preventive care takes place when they're home on vacation. If it's a cold or sore throat, they go to the school's health center. If it's worse, they go to the emergency room.

    This is how insurance companies make money. They either hope you will see the stupidity of going to the ER and just decide not to go (thereby saving them money), or you'll go to a local doctor who is not in their network (thereby denying your claim and saving them money), or you'll just say "oh screw it" and not see anybody at all (thereby saving them money).

    Notice carefully what is common to all three scenarios. Argh.
  • sueinphillysueinphilly Posts: 4,207Registered User Senior Member
    another option could be 'walk in clinics' that some drug stores and supermarkets have. They have nurse practitioners who can write scripts. Not sure how lab tests work.

    I switched from a PA based plan to a national plan the year before my son started college in NY. I realize not everyone has this option, but knowing he can be in ANY state and get care is a good thing (one less thing to worry about)
  • originaloogoriginaloog Posts: 2,645Registered User Senior Member
    The same situation with us mandated that we take ds off our employee policy and place him on the college's student policy which was good because it covered him on his summer internship in Cali too.
  • mamabear1234mamabear1234 Posts: 3,001Registered User Senior Member
    We have the same situation - HMO does not cover care out of the area except emergencies. The student health center will treat students for a low fee. We did not buy the school's package, which was around $1300. It did not have providers in our area when she is home in the summer, and I think our HMO would have considered that plan primary for her. She is rarely sick - had to go to the health center once this year for sore throat, and the fee for visit, culture, and antibiotic was $60.
  • mom60mom60 Posts: 5,587Registered User Senior Member
    I am surprised that the college did not catch this before you enrolled. At my son's private university we had to provide proof that we had coverage that would cover him at his school. The health center does some routine stuff that is covered in a student fee but they also sell a policy for everything else. Every student must show proof of a level of insurance to register for classes. You must continue to provide proof on a yearly basis.

    My friend whose son attends a Univ of Ca campus had private insurance with Blue Cross with a high deductible. The school did not feel the coverage was enough and they were required to up their personal policy or buy a policy from the school.
  • northeastmomnortheastmom Posts: 12,379Registered User Senior Member
    We have a PPO and experienced a slightly different situation. Our insurance plan has OOS physicians that are in network to students, but it does not help if the nearest specialist is 45 minutes away by car and the student does not have a car. He has ended up using the ER when he could not be treated by the university health center adequately. There is an ER within a block of the school. I was not about to pay for a car service to and from the in network doctor's office, even if I could find one. We have paid the copay for the ER instead. What a pain, but heck, this is the system that has been set up. If the insurance company does not like it, they can change it.
  • arabrabarabrab Posts: 4,637Registered User Senior Member
    If your insurance claim is denied, follow your health plan's process and appeal it.

    If they deny again, seriously consider filing a complaint with the Mass. Department of Insurance. Insurance companies don't like that, and the state can be pretty tough with them. (Furthermore, the number of complaints for each company is public data, and widely reported. No insurer wants to be leading that list.)

    Strep infections can be very serious -- it isn't the kind of problem that can wait until you get back to Mass.
  • FourierFourier Posts: 34Registered User New Member
    A solution to this is to purchase a policy for your child with a company that has a nationwide network. (see a broker or ehealthinsurance.com)

    If you go for a high deductible you can frequently save enough to pay cash for acute care at urgent care centers or local physician practices. Policies for healthy 20 year olds are relatively inexpensive. If you get one that is health savings account qualified, money can be deposited in the account tax free. It pays interest, tax free, and can either be used for current health care expenses (as defined by the IRS, not an insurance company) or be saved for unrestricted use at 65.
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