Will Blue Cross and Blue Shield of Tennessee pay 80/20 out of state? (medical, plan)
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When I travel to another state to visit I wonder if I need medical care if BC & BS of Tennessee will pay my 80/20 like it does in Tennessee? Someone told me it only pays 50/50 which could cost me big money.
Do you have Medicare supplement - or are you under 65 and is yours a PPO BCBS plan?
If you are on a Medicare supplement, you are covered in any state. If you are on a BCBS Medicare Advantage plan, you need to remain in-network except for ER visits. Many Advantage plans allow out-of-network ER visits when out-of-state.
If you are not on Medicare and if you see doctors out-of-network anywhere on a PPO, you may be subject to higher charges - you don't necessarily have to be out-of-state.
Call your plan's 800 no. CS and ask if you can't find your documents.
Generally speaking, the 80/20 rule is limited by policy language which says that it applies to "reasonable and customary" charges for medical treatment. The reasonable and customary charges for medical care will vary considerably from Mississippi to New York. I have learned this hard way. Sometimes, after your insurance pays for out-of-state treatment, you may get a bill that is larger than you expect. You can negotiate with the provider and sometimes, they will reduce charges. It is a pain in the butt and one more reason why the USA really needs a single payer health insurance system.
Generally speaking, the 80/20 rule is limited by policy language which says that it applies to "reasonable and customary" charges for medical treatment. The reasonable and customary charges for medical care will vary considerably from Mississippi to New York. I have learned this hard way. Sometimes, after your insurance pays for out-of-state treatment, you may get a bill that is larger than you expect. You can negotiate with the provider and sometimes, they will reduce charges. It is a pain in the butt and one more reason why the USA really needs a single payer health insurance system.
The 80/20 language refers to coverage IN NETWORK. If the doctor you see in New York or Mississippi is in network, they CAN'T bill you for above what insurance pays. If that happened to you, report that doctor to your insurance company since they signed a contract with that provider to provide in-network patients coverage at that cost. It's insurance fraud, plain and simple. If they were NOT in network, they can charge you whatever you want.
John--the best answer is "maybe". Look on your provider website to see if there are doctors or clinics in the area you are in that are in-network. Make sure you only use those doctors if you need medical care. They may even have a smartphone app that helps you locate doctors. I had to get medical treatment out of state, looked up in-network doctors before I went in, everything was paid just like I went to my doctor down the street.
I'm to young for Medicare because I'm only 52. I had a lady that went from Tennessee to Michigan and had to go to a hospital and she said her BC&BS of Tennessee only paid half of the bill.
I'm to young for Medicare because I'm only 52. I had a lady that went from Tennessee to Michigan and had to go to a hospital and she said her BC&BS of Tennessee only paid half of the bill.
That hospital might not have been in your network. If she had an emergency, however, most insurance plans will pay for care anywhere like they are in network. I wouldn't worry about it too much. Now, if you have an HMO type plan, getting care paid for out of state or out of your area is very difficult.
You need to call your benefits customer service for the correct answer. The 800 number will be on the back of your card.
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