What do you do for healthcare if your network is out of state
 

What do you do for healthcare if your network is out of state? It helps that I can meet virtually with my physicians but sometimes they might want to see blood work or get a urine sample.

Are there any clinics that do lab work without having to see a doctor? I'd have to pay out of pocket but it wouldn't be too bad if I didn't have to see someone. Has anyone done this and if so where?

Blood work can be ordered virtually, you just tell them where you need to go. Results are sent just like any local doctor

Good to know. What about urine samples?

The other option is a PPO plan which doesn’t limit in network drs, though drs might not take that pop plan, many should

I assume you are a snowbird, and the network is limited to another state? If so, why would you choose a health plan that doesn't have nationwide coverage?

Is this a Medicare Advantage Plan? Do you know their policy for Urgent Care Centers?

Because those plans are at least twice as expensive. The deductibles, premium and co-pays are significantly more. If I had to fly out numerous times to see a doctor, I would still come out way ahead.

My insurance would cover a trip to the emergency room and for non-emergencies I could make a virtual appointment with my many of the physicians in my network. It is the tests they might want to run that wouldn't be covered and a challenge to obtain.

I am 62. I was able to purchase my health care through my former employer.

IMHO, you are asking the wrong people, call your health care provider, and ask if QUEST can be used, I believe they provide both blood and urine tests. My urologist does in house urine tests, but all of my other doctors tend to use QUEST and they have sevweral offices in the area. Your doctor should be able to send the request directly to Quest.

LabCorp does the same thing. My doctor sends the request to LabCopr and I can go to any of their facilities to have my blood drawn or to leave specimens...

Have you considered what would happen if you were in FL and had a heart attack or stroke? You would end up in the ICU and no coverage. I'm healthy, but you never know, and it's not worth the stress of knowing I might have a huge financial issue. Your choice, of course, but in my opinion, a limited policy like yours is far from optimal if you snowbird.

totally agree. . healthcare is one of the categories where being cheap works, until it doesn't work. It generally doesn't work in the worst of times: when you need it the most. The fact that you are asking these questions, is where the coverage may not work.

good luck
66 y/o, on coachk's high deductible health plan for the HSA contribution
going on Medicare when coachk retires
filing IRMMA relief request for lost income

I'm with a Florida Blue Value PPO. Coverage is good in 46 states. Do not know why and which 4 are excluded - but full coverage in the 46.

I’m guessing you aren’t on Medicare because if you were, there is no ppo option unless you had advantage and you would be more restrictive.

PPO means in network and if you use their in-network drs, they pay more. If you go out of network, your insurance pays less but it still pays. I always had PPO plans and I was covered anywhere in the states. Do you think your insurance plans think you aren’t going to do any traveling? Read your policy and it will tell you what your insurance pays in-network and out of network

The 4 states where the Florida Blue Value PPO plan is not generally accepted are:

Alaska
Hawaii
Nevada
Oregon

The issuing state is irrelevant nsurance can be used throughout the entire US.
Blood work can be done in any state the results will be sent to the ordering physician. Prescription for blood work can be e prescribed or paper.
Virtual visits are a little different, technically you and the physician must be in the same state during the visit. (They will only ask where you are there’s no in-depth tracking used. Obviously they will know if a prescription needs to be sent to out of state pharmacy. ) However if there is a long standing relationship with a patient the doctor my offer the service ie: if your on vacation. (The telesystem was derived to avoid health care conglomerates in one state from capturing patients in distant states) Hope that helps

There is also Labcorp! :smiley::smiley::smiley:

If you are living part of the year in one state and part of the year in another state, you should be on a PPO plan. A health plan with a limited network does not work for you. Do not play games with your health -- without your health little else matters.

Mine is national, in or out of network doesn't matter, I pay $0.00 and my copays are $50 or less (including meds)

I use Quest. There are several locations within and close to The Villages, including one in the Brownwood Medical facility next to the hotel.

I believe you must be in the same state to have a virtual visit. I guess you could just not tell them where you are.

I have an advantage ppo plan based in Ohio. Since no services are in network in Florida, it becomes an extended service plan. That means everything here becomes in network. Hopefully, yours is the same.

I have an Advantage Plan through United Healthcare, and my physicians are in-network no matter where I am in the country. You should call someone that does this for a living and knows! There's no charge or commitment. I use Crystal Andrus<c.andrus@sphere-solutions.com>

I read your second post about flying to get treatment because it would be cheaper than paying the deductibles, co-pays, etc. What happens if you have an accident, fall or whatever? You need to spend time in the hospital followed by weeks of treatment in a rehab. Face the fact that you need a plan with national coverage -- you are looking to save money. You may save the cost of deductibles, etc however if you need extensive care it could cost you thousands of dollars.

It is open enrollment time
 

Choose another medical plan. If you work for big company or government, there are many plans from which to choose. if you're on Medicare, I would stay with regular Medicare and then choose a supplemental plan Medicare pays 80% of their going rate for that doctor's services and then the supplemental plan usually picks up 80% of what Medicare didn't. I had $55,000 surgery in 2023 and I only paid $67 total to MAYO Clinic. works for everyone I know who worked for BaltImore County.
Those who choose Medicare Advantage find themselves OKAY if seeking a plan-approved LOCAL doctor but you'd be stranded for care if you leave this State. I can go anywhere and choose Whichever doctor i like and there are thousands "in network" in the yearly booklets your employer or Plan mails out. GOOD LUCK.

Virtual calls to Docs OK for non-urgent care & trivial illness. If i were you, i'd be concerned about emergencies like heart attack or car accident--where you need ambo and care immediately -- not a "virtual call" to some doctor with office hours 8am to 5pm & answering service 5pm to 8am. In Another State.

Lucky for the OP the annual selection period is approaching. That would be the time to change health plans and select a plan with coverage at both home locations. One never knows when an emergency will occur and spending extended periods of time out of network is a dangerous financial risk that should be avoided if at all possible.

Check out Grassroots. I used them before being on medicare. You pick/choose the tests you want. The cost of each test is much less than Quest. Grassroots assigns your request to a doctor and sends an order that you can bring to any lab.

Grassroots Labs - Blood Tests are Expensive. We fix that.

Your doctor could send an electronic order to a lab like Quest Diagnostics. They also have a patient portal where you can view your results.

I was thinking the same. In an emergency situation many insurance companies would still pay. But how much? And if you can’t be moved back to your doctor’s location would your ins continue to pay?

I wonder too how many out of network emergency visits they would cover.

Actually, the patient can be in a different state. The law is that the provider must be licensed in both states. Meaning the state they are located as well as the state the patient is located. There are also quite a few states that offer limited reciprocity and Compacts that allow a provider to join for telehealth treatment. That's how companies like Hims can prescribe ED and GLP1 meds thru telemedicine.

My insurance allows for 2 primary docs so I had one in each state and was able to get my labs transferred easily.

However without going into a lot of detail in the end it was just so much easier to have everything done up north. Depends I suppose on how often you need to have your labs done. Be prepared for possible glitches and frustrations. Good luck to you.