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Old 11-18-2015, 11:42 AM
 
5 posts, read 9,597 times
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I'm not sure if this is the right forum to post this in, so if not I apologize in advance.

I'm an individual that lives in NJ and has my own small private business (self-employed), so I don't qualify for health insurance through my job. While I don't make that much, I make enough so that I mostly don't qualify for any subsidies through the health exchange/marketplace (and when I checked a year or two ago, the plans that I did qualify for some subsidies through didn't offer anything that I needed - namely the ability to see doctors in NYC).

As I just mentioned, the one thing that I really need out of my health insurance is the ability to continue to see my doctors/specialists in NYC. Unfortunately, I have a few relatively major health issues that I've been seeing doctors/specialists in NYC for treatment on for several years now. The current health insurance plan that I've been paying through the nose for is UnitedHealthcare Oxford Gold HMO - mainly because it was basically the only plan I could find that would allow me to see NYC doctors while living in NJ.

Unfortunately, it now seems that Oxford is changing their plan from an HMO to an EPO, but more importantly is also changing the network so that only NJ doctors/specialists are allowed under the plan. As a result, this plan won't work for me any longer, and it now seems that I can't find ANY other plan offered to private individuals that will work for seeing NYC doctors/specialists.

NJ apparently significantly limits how many health insurance providers can offer private health insurance (for some unknown reason), and now it appears I'm going to get completely screwed by this because I can't find a plan that will allow me to see my NYC doctors while living in NJ.

Does anyone have any advice or help regarding this? Any info is greatly appreciated! Thanks very much!
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Old 02-02-2016, 02:57 PM
 
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I'm in the same boat as you. I have Oxford and I can no longer see my NY doctors. Did you ever find a solution?
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Old 02-02-2016, 05:11 PM
 
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Horizon allows for this. We have the option to see doctors in NYC, and we do.
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Old 02-05-2016, 06:10 PM
 
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Do you know which Horizon plan? I'm not having luck with their website. Thanks
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Old 02-06-2016, 12:06 AM
 
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It's my understanding that no individual plans in NJ, whether bought on the exchange or directly from the insurance company, allow for out-of-state doctors. I changed my state of residency from NJ to Texas because Texas does offer multi-state plans. (I spend half of the year in each state.)

@JerseyGirl415, do you have an individual plan or a group plan?
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Old 02-10-2016, 11:39 PM
 
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I just messaged JerseyGirl415 to ask for more information, but I'm thinking that maybe she has a Horizon BCBSNJ plan that isn't through individual insurance. I have done a ton of research and contacted all 5 health insurance providers in NJ that offer individual plans and basically there isn't any hope right now for seeing NYC docs. I believe that one plan had some provisions for seeing out-of-state docs in non-emergency situations, but it was so limiting (and none of my doctors or specialists participated in it) that it wasn't worth it. Any other info that anyone has would definitely be useful, and if anyone wants to form a "company" so that we can all qualify for employer/employee coverage (which I'm betting has more options for out-of-state docs), let me know...lol...j/k
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Old 02-11-2016, 06:04 PM
 
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Wow, this is crazy.

Lots of people who live in NJ work in New York City/Manhattan.
It would be convenient to go to a Dr. in Manhattan, say at lunchtime.

So you're saying it's impossible to buy health insurance on the exchange that allows that?
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Old 02-11-2016, 09:27 PM
 
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Quote:
Originally Posted by DarkHelmet View Post
I just messaged JerseyGirl415 to ask for more information, but I'm thinking that maybe she has a Horizon BCBSNJ plan that isn't through individual insurance. I have done a ton of research and contacted all 5 health insurance providers in NJ that offer individual plans and basically there isn't any hope right now for seeing NYC docs. I believe that one plan had some provisions for seeing out-of-state docs in non-emergency situations, but it was so limiting (and none of my doctors or specialists participated in it) that it wasn't worth it. Any other info that anyone has would definitely be useful, and if anyone wants to form a "company" so that we can all qualify for employer/employee coverage (which I'm betting has more options for out-of-state docs), let me know...lol...j/k
Sorry, meant to answer on this thread but forgot to.

Yes it's a group plan at a business.
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Old 02-12-2016, 12:33 AM
 
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Quote:
Originally Posted by Shoshanarose View Post
Wow, this is crazy.

Lots of people who live in NJ work in New York City/Manhattan.
It would be convenient to go to a Dr. in Manhattan, say at lunchtime.

So you're saying it's impossible to buy health insurance on the exchange that allows that?
I know that if you are buying personal health insurance (i.e. not part of a group plan or a business that's providing it for you), then yes - it seems like NJ health insurance companies are not offering insurance that covers you for seeing docs/specialists in NYC (from what I could tell). Like I said previously - I do recall one plan or health insurance company had very limited NYC coverage but none of my docs/specialists were participating so it was basically just as useless to me. If anyone has any other info about this that allows for NJ individuals health coverage to see NYC docs, please post it here!

I also wonder what the rules are for forming one's own group (amongst those of us on here that are getting individual coverage and would be interested in teaming up to get a group plan so we could see NYC docs potentially) - anyone have any info or want to find out? I'd certainly be interested in doing that with others (and we all just pay our share into the group's total) to get that NYC coverage back!
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Old 02-12-2016, 01:01 AM
 
1,298 posts, read 933,703 times
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Look into the Freelancers Union. They've been providing health insurance and other benefits to freelancers and other self-employed people in NY for some years now. They're legit. They only started providing health insurance in NJ pretty recently. They offer BC/BS and Oscar, seemingly as group plans. I went through the signup process and searched for NY-based docs. I didn't find any for Oscar, but I found a bunch through BC/BS. You will want to verify this. Also, you need a qualifying event to be able to buy a plan, since open enrollment is over.

I would have been very interested in forming a group a couple years ago, but luckily I'm set now with an employer-based group plan.

Good luck!
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