Insurance - Out and In network (plan, hospital, surgery, coverage)

[wankel7]

Just wondering how this works at other companies across the board.

You are in a car wreck...unconscious they take you the hospital. So, you have no choice in your health care. They take you to an out of network hospital according to your insurance.

What happens? You have to pay the out of network rates? Is there any relief to that since you had zero choice?

Just curious!

Thanks

[Burgi]

In an emergency situation, our insurance pays full coverage (BCBS of Washington)

[wankel7]

Originally Posted by Burgi

In an emergency situation, our insurance pays full coverage (BCBS of Washington)

So you get in network deductibles and coverage?

[Burgi]

Originally Posted by wankel7

So you get in network deductibles and coverage?

Yes, but only in an emergency. We may be the exception instead of the rule (our insurance plan is really amazing)

[CarolinaWoman]

I was in an accident in another state, unconscious and in ICU for two weeks and my BCBS of South Carolina paid. I would think most insurance would have to pay under those conditions. If you have a planned hospitalization/surgery that is a different story and allows the insured to stay within the policy guidelines. I know BCBS of SC came through for me.

[wankel7]

I understand these companies will pay.

But the question is what do they pay...in network or out of network? If you were taken to an out of network hospital when you had no choice

[mm_mary73]

Originally Posted by wankel7

I understand these companies will pay.

But the question is what do they pay...in network or out of network? If you were taken to an out of network hospital when you had no choice

Why not simply call your carrier or your insurance agent or read the literature you are sent.

[ahava]

Try reading the back of your insurance card, it might say. Mine says that if we call within 24 hours after an ER admission we'll receive full benefits. So I'm guessing if we call, we get in-network, and if we don't, we get out-of-network.

[BagongBuhay]

Most insurance plans have a fixed deductible for ER ($100-$500 usually) with no requirements for network membership. If admitted, deductible is waived, but any charges outside of the ER admit will fall under the in- or out-of-network rule. You are always covered, just that your share in OON is higher.

[mckinneydeb]

In cases of emergency care, most plans will pay at an in network level until you are deemed "stable for transfer" if you need continued care. At that point, you or a family member, would be asked about possible transfer to an in network facility or if you want to stay and pay an out of network level. However, don't count on it. If you know for a fact that you are at an out of network facility you should contact your insurance provider ASAP. They along with the facility case manager or discharge planner should be able to help you decide about moving to an in network facility.

One other thing, if you are in an automobile accident, the hospital will want to coordinate benefits with your auto insurance. For a company that I worked for, that meant listing the auto insurance as the PRIMARY payor source. I would point out that insurance laws differ state to state, that's why you really should read your policy carefully to understand your benefits and responsibilities. If you travel a lot, keep a small packet or notebook with you that includes copies of all of your insurance information along with a copy of a living will or treatment protocol that has been notarized and emergency contact numbers. This is especially true if you travel out of the country. The insurance info should be placed with your passport.