How does insurance work if someone is in another state and needs a doctor?

"Generally, most insurance companies (whether a P.P.O. or H.M.O. policy) provide coverage for the emergency room anywhere. The charge may be a co-payment (usual co-pay is around $150.00) or the charges may be applied to your deductible," says Cindy J. Holtzman, Director of Operations at Medical Billing Advocates of America (MBAA). Basically, it will work the same as if you were to go to the emergency room in your home state. The only exception is that you may end up with more out of network expenses than if you were in the state where you reside since just about everything will be out of network. Though most E.R. physicians even within your home state will not be in your network, nor any network, so it won't make that much difference to your bill. If you require an ambulance ride, the restrictions within your policy will apply here too. If your policy covers that with an E.R. visit you should be okay. At worst you may have a co-payment due but it's not too likely you'd have to pay out of pocket for that bill.

"It is always a good idea to call your insurance company, after an E.R. visit, to inform them of the situation, especially if you need any follow-up treatment and you are out of town," advises Ms. Cindy J. Holtzman. Health insurance companies would rather you receive follow-up treatment with your primary care physician or with a specialist in your network. This is because of costs, which it costs them less and you less to do so. You may either have to cut your trip short and go back home or bare the expense of seeing an out of network physician. Emergency situations sometimes are taken into consideration and your policy may already have protocol in place for what can be done in this circumstance. This is why it is best to check with your health insurance company on the particulars of your medical insurance policy. It is better to check with them and make sure everything is done in a way that agrees with your policy so you are covered to the fullest extent than to live with uncertainty only to find out later the enormous bill that awaits you could've been controlled had things been done slightly differently.

When traveling, it is best to keep a list of your medical conditions, your allergies (especially which medications you are allergic to), and the medications you are currently taking including over the counter drugs. Ideally, this list should be on a card that you keep in your wallet or purse with your medical insurance card. Should an emergency arise this information will be quick at hand and easy to find even if someone were to have to find it for you should your be unable to physically do so. This takes a lot of the guesswork out of the equation, which could mean fewer tests, fewer mistakes, and less expense for both you and your health insurance company. Should you end up in a life threatening situation, that list could even save valuable time ultimately saving your life.