In an earlier post, I wrote about the lack of out-of-network coverage in many ObamaCare policies. Recently, I posted something about it as a comment to a Megan McArdle piece:
At least in my State (NJ) most ObamaCare plans have no out-of-network coverage other than covering an Emergency Room charge. None of the Bronze policies offer out-of-network coverage; only the AmeriHealth Silver, Gold, and Platinum have this coverage. No out-of-network coverage means no access to specialized medical facilities like MD Anderson, Memorial Sloan Kettering, Mayo Clinic. As far as I can tell (and I find this hard to believe so I need to double-check this), it also means that if a policy holder is traveling and has a heart attack or breaks something major and has to spend time in a hospital in another State, those expenses (beyond the ER charges) are not covered by insurance.
Someone pushed back in a reply and inspired me to do what I’d said I was going to do: double-check. I talked to a sales rep at my insurance company and here’s what the rep told me:
- If I’m traveling and I have a heart attack or break something major or whatever and have to spend time in a hospital and get medical care because I can’t make it back to New Jersey (in other words, in the case of a true emergency), my insurer will cover my out-of-network care just as if I was in-network. Same deductible, same co-insurance.
- If I need care I can’t get in-network, there is a process by which I can apply to get that care paid for. The sales rep couldn’t describe the process in detail but it apparently involves paperwork and attestations by my doctors that I can’t get the care from an in-network doctor.
Being able to buy out-of-network coverage is still preferable, of course. I can imagine some lively disagreements over what constitutes an actual emergency and at what point during one I’m well enough to travel. And I can imagine even livelier discussions over whether I really need to see the guy in Manhattan who’s done fifty reverse shoulder replacements with a 90% success rate or I can get by with the in-network guy in New Jersey who’s done two, neither of which turned out very well. If I have out-of-network coverage, I make those decisions myself - so long as I’m willing to stand the higher deductibles, co-pays, and out-of-pocket maximums. If I don't, the insurance company makes those decisions.
Still, the situation is better than what I thought it was. I imagine I'll be saying that about a lot of things in ObamaCare, as the now outrageous becomes the new normal.