Some health insurance plans don’t give you any coverage at all when you are away from your home area. For example, most HMO plans only cover emergencies (and some only cover LIFE-THREATENING emergencies) when you are away from home.
PPO plans (Preferred Provider Organization plans) let you use any doctor or hospital that is a member of the PPO network. Many health insurance policies sold here in Arizona use nationwide networks of providers, allowing you to see a doctor anywhere in the United States, as long as the provider is a part of the network.
The classic indemnity plans allow you to see any provider anywhere you are, without regard to a network. These types of plans are quite expensive and rather rare these days, because the health insurance companies are doing everything in their power to hold down costs. With an indemnity policy, the insurance company usually has to pay whatever the doctor’s fee is (subject to the fee being normal and customary). But when a doctor or a hospital becomes part of a network, that provider is agreeing to forego what their normal fee is for any given procedure, and to only charge you what the insurance company says they can charge you. For every possible medical condition, the insurance company and the doctor have agreed to what is called a “pre-negotiated rate,” and this is all the medical provider may charge.
For example, you may go to your doctor complaining about a sore knee. If you had no insurance, the doctor might charge you $150 for that visit. But if you have a PPO insurance policy and the doctor is a part of that insurance company’s network, the insurance company will tell the doctor that he or she may only charge you $60. If your insurance plan lets you go to a doctor for a $25 co-pay, you’d pay the doctor $25 and the insurance company would pay the remaining $35.
So the insurance company gets to pay less than the normal fee. Blue Cross Blue Shield of Arizona, Cigna and United HealthCare are three health insurance companies offering policies in Arizona that have huge nationwide PPO networks. If you live in Phoenix and have a Blue Cross PPO plan but find yourself sick at the Niagara Falls, you’d be able to see a medical provider on your vacation that would only be allowed to charge you the pre-negotiated fee.
Many health policies sold in Arizona have absolutely no coverage whatsoever when you are out of the country. The Blue Cross Blue Shield of Arizona PPO plans cover you anywhere in the world. United HealthCare also provides some coverage when you are out of the country, as does Cigna. But many of the smaller insurers will offer no benefits as soon as you leave the country. If you have a policy with one of these small insurance companies and plan on traveling abroad, be sure to find out, before you go, if you have coverage. If you don’t, a short-term travel health insurance policy would be a wise choice for you. Those plans are inexpensive and cover you for a set period of time. If your trip will last 35 days, you can buy a policy that will only cover you for those 35 days. The travel plans cover sickness, injuries and usually offer a benefit that will return you to the USA via air ambulance if required. That benefit alone might save you $10,000.
Lehrman Group offers travel health insurance policies, and you can see more about these plans here.
