Health care isn’t just something you get from your local physician. You should be able to get care from an appropriate physician when you need it. Sometimes, this might mean leaving town, and even crossing state lines. The question that many people ask, however, is whether their plan will cover them when they travel outside of their state of residence?
On one hand, health plans are not restrictive in terms of geography. Different plans can cover physicians of all kinds in hospitals, practices and communities across the country. However, the point is that not all plans cover all doctors in all places. Therefore, you will have to carefully review your benefits so that you can determine when coverage is provided for out-of-state services.
Why don’t all health plans work in all states?
Perhaps you are on a trip when you get sick and need to seek medical attention. Maybe you want to visit a specialist physician who practices at a large, well-known hospital in another state? In either case, you should of course seek the attention you need. However, you must be aware of how your own insurance benefits will cover the services.
Health insurance is a tightly regulated industry, and all states have a lot of leeway to set different rules on how insurers can operate within their borders. As a result, not every insurance company in your state (including your own) might be able to operate in the state where you want to seek care.
Even if an insurer might have branches in two different states, the plans benefits offered might differ between the two branches. The plans you can buy in your state might not be the same as those offered in another. Therefore, your own ability to receive care outside of your home state could be limited.
How can I see if I have coverage for out-of-state care?
If you are planning to receive out-of-state medical care, then the place to start is by checking your insurer’s physician network.
A network is a list of physicians, hospitals and other care providers who accept your health insurance plan. By visiting them, you have a guarantee that you will receive both covered care and optimized prices on any out-of-pocket expenses.
Many major health insurers have networks that span multiple states and physician groups. Therefore, even if you live in Oklahoma and receive your benefits there, you might be able to easily see a doctor in Texas, provided that they accept your plan. Usually, your insurer will provide you with an easy way to search your provider network and make informed decisions about your care. Therefore, you’ll know before you go exactly what you can expect to pay for your care.