Health insurance to see a dr. out of state

amother

Cerulean

Thu, Jul 26 2018, 12:35 pm

Hi,

I was wondering if anyone can guide me on how to navigate this. We live in NY. we have united healthcare community plan. we would like to go to Boston for a consultation.
am I supposed to procure private insurance that covers out of state doctors?
anyone done this before & can guide me on how to do this or who I can speak to?

Thank you!

pesek zman

Thu, Jul 26 2018, 12:49 pm

If you (and/or the doctor) can prove they have something to offer/treat that can't be done in your own state they may be able to get an approval for a single case agreement

amother

Cerulean

Thu, Jul 26 2018, 12:52 pm

pesek zman wrote:

If you (and/or the doctor) can prove they have something to offer/treat that can't be done in your own state they may be able to get an approval for a single case agreement

There is one doctor in state we are currently being treated by. would really love to get a second opinion.
How do you prove that though?

pesek zman

Thu, Jul 26 2018, 1:01 pm

amother wrote:

There is one doctor in state we are currently being treated by. would really love to get a second opinion.
How do you prove that though?

Honesty not sure they would authorize that. You can reach out to the doctors office (in Boston) and ask them how they approach this with other patients

ladYdI

Thu, Jul 26 2018, 1:17 pm

Some drs can give you a second opinion based on test results and scans. Call that dr. Also sometimes if you call the office and say you don’t have insurance coverage in that state they are willing to take a reduced fee that may be equal to a month insurance and much less hassle

SpottedBanana

Thu, Jul 26 2018, 1:50 pm

I also have UnitedHealthcare insurance (though a different plan). My father who I get the insurance from works in NY but I get all my healthcare here in PA. Are you 100% sure that your plan doesn't cover anyone out of state?

Amarante

Thu, Jul 26 2018, 1:58 pm

It depends on your insurance. If you have an HMO you are going to be limited to physicians in that HMO - that's why HMO premiums are less.

If you have a PPO you can see a doctor out of network but it will cost you as the copays are higher and not all amounts paid will go towards the deductible.

The issue is that insurance companies have contracts with doctors in terms of compensation so if a doctor doesn't have a contract with the insurance company, it doesn't work. Insurance companies also typically only operate within a state so no coverage out of state.

If you are employed by a large employer, it is a completely different type of coverage. Often a large employer is self insured and is only using the insurance company for administrative purposes. Also, the large corporation might have offices in other states so they can provide coverage across state borders.

Without knowing the reason you want an out of state consult, I think it would be difficult since it is going to be hard to prove that there is no doctor in New York which is a medical capital that would be suitable for a second opinion.

pesek zman

Thu, Jul 26 2018, 2:43 pm

SpottedBanana wrote:

OP is referring to managed Medicaid plan which is state based

amother

Seashell

Thu, Jul 26 2018, 6:51 pm

Are you eligible for medicaid waiver? Getting medicaid waiver is hard these days, but if you get on, you'll have no problem going to any doctor across the country, they'll even cover your travel expenses.

Are you in touch with chai lifeline? If you are, you can speak to Aron Neustadt, he's an insurance advocate, and there are ways to appeal to your insurance if you say to them that you can not get adequate care in your state they may approve out of state care. We were told this is nearly impossible these days.

When we were in this boat, we got one of the amazing organizations out there to pay for private insurance for our child, but this was hard too.

Another option: is your child eligible for ssi? If yes, you can use that money to pay for treatment.

One more option, a medical grant https://www.uhccf.org/

amother

Teal

Thu, Jul 26 2018, 8:14 pm

amother wrote:

Which organization pays for private insurance? I am in a similar situation to OP. As far as I know, only RCCS helps with insurance premiums, and only for cancer, which is not my child's medical condition.

amother

Seashell

Thu, Jul 26 2018, 8:26 pm

amother wrote:

It was RCCS.

amother

Burgundy

Thu, Jul 26 2018, 8:32 pm

Large academic medical centers expect to attract patients from out of state. Call the number that you would use to schedule an appointment and ask if they can work with you.

amother

Seashell

Thu, Jul 26 2018, 9:03 pm

amother wrote:

Large academic medical centers expect to attract patients from out of state. Call the number that you would use to schedule an appointment and ask if they can work with you.

We were very disappointed when we tried this approach with Boston Children's. Did not get anywhere.