I “stayed home” over the Thanksgiving holiday weekend — but “staying home” meant that I crossed from my home address, in New Jersey, into New York, to go shopping. That took about ten minutes.
Many of you probably crossed one or more state lines to visit relatives over the holidays.
Most of us probably still have “good employer-sponsored health benefits,’ or solid grandfathered or grandmothered policies. Or we do have new, Patient Protection and Affordable Care Act (PPACA) coverage that offers access to some kind of multi-market provider network.
But it looks as if many of the broke consumers who shopped for individual PPACA public exchange coverage based mainly on price probably have narrow, one-state networks, with no out-of-network coverage for anything other than emergency care.
On the other hand, some of those narrow networks may be fine networks. It seems as if providers who are angry about being shut out of networks are making more of a fuss about narrow networks than the patients are. Uninsured patients who have been shut out of the health care system altogether would probably prefer a short list of a few competent, licensed, but unexciting doctors that they can afford to see to a thick directory of providers who will slam doors in their faces.
But, on the other hand, even people who are broke go on vacation. And broke people who have been uninsured may not necessarily the most efficient handlers of insurance forms who ever lived. Parents going through hard times may send children to live with out-of-state relatives, or move in with out-of-state relatives themselves, without necessarily thinking to transfer their health coverage. People who travel from one place to another may wake up with 104-degree fevers in the new place. Conditions not serious enough to warrant a trip to the emergency room, but serious enough that any prudent person might want a sick visit.
And, really: If patients might have early pneumonia or early-stage kidney infections, do the plans themselves really want those patients skimping on a $50 sick visit, and a $4 generic prescription from the discount store, because they happened to wake up sick out of town?
Regulators could come up with a few more feet of regulatory documents and add minimum out-of-state urgent care benefits to the existing plan coverage standards.
A better approach might be for agents and brokers — and insurers, health insurance enrollment sites, and public exchange helpers — to make a point of emphasizing when a major medical plan lacks out-of-state urgent care coverage.
Insurers and plan sellers could also make a point of offering any major medical plan with no out-of-state urgent care benefits in conjunction with some kind of optional travel medical or out-of-state network access products, to make sure consumers knew they had a gap in their coverage and at least had a chance to fill the gap.