Primary Health Coverage From My Employer

[CK77]

I spoke with my H.R. Manager and she told me that our Health Insurance covers "In Network" when we are traveling out of the U.S.A. We would of course have to file a claim once we return home if there is a problem etc.

 

Would I be able to save some money and get a less expensive Travel Insurance plan without worrying about buying more Medical coverage than needed?

 

Or am I missing something that I should factor into the equation?

 

Thanks

[6rugrats]

Do you think you would be able to find an "in-network" provider easily out-of-the country?

[sirwired]

Some of the providers have "custom" plans available where you can pick and choose, but if you remove just one or two features, they usually end up being the same price as a comprehensive plan.

 

That said, depending on where you are traveling, finding an In Network provider could be challenging.

[cruiseco]

I spoke with my H.R. Manager and she told me that our Health Insurance covers "In Network" when we are traveling out of the U.S.A.

 

I'm not real clear on this. Do you mean that anytime you are traveling outside the US you would be reimbursed at the "In Network" rate regardless of where you received the services (on the ship, at a port of call, etc). I can guarantee that any medical services received on the ship will be WAY above your "In Network" billing rates so it sounds like you might be responsible for any differences.

 

Or does it mean that the insurance will only cover you if by some chance you do indeed receive care from an "In Network" provider?

[CK77]

I'm not real clear on this. Do you mean that anytime you are traveling outside the US you would be reimbursed at the "In Network" rate regardless of where you received the services (on the ship, at a port of call, etc). I can guarantee that any medical services received on the ship will be WAY above your "In Network" billing rates so it sounds like you might be responsible for any differences.

 

Or does it mean that the insurance will only cover you if by some chance you do indeed receive care from an "In Network" provider?

 

Sorry, let me clear this up:

We would be reimbursed at the "In Network" rate regardless of where we received the services (on the ship, at a port of call, etc). When we arrive back home we would file a claim etc.

[cruiseco]

Sorry, let me clear this up:

We would be reimbursed at the "In Network" rate regardless of where we received the services (on the ship, at a port of call, etc). When we arrive back home we would file a claim etc.

 

Realistically I think your loss exposure would be primarily for onboard medical services. The ship's doctors/clinics are notorious for charging much more than what shore-based providers charge. They would almost certainly be charging you more than your health insurer would be willing to pay under their in-network contracted rates.

 

On the other hand, any services received in a foreign port of call would probably be billed at a rate lower than your health insurer would normally pay so you're probably going to be reimbursed 100%.

[klfrodo]

I spoke with my H.R. Manager and she told me that our Health Insurance covers "In Network" when we are traveling out of the U.S.A. We would of course have to file a claim once we return home if there is a problem etc.

 

Would I be able to save some money and get a less expensive Travel Insurance plan without worrying about buying more Medical coverage than needed?

 

Or am I missing something that I should factor into the equation?

 

Thanks

 

ck, a couple more questions to ask your HR manager. I also recommend that you not just take their word for it. I would hope they are showing you where "in writing" that the policy says what they are telling you.

 

1. My medical policy also states that I am covered for emergency evacuation/transportation. However,, that is ONLY for stabilization. Once I am stabilized, any transportation back home is on my dime. Even if that transportation has to be by medical jet. Some/most travel insurance companies do cover this.

 

2. Many hospitals around the world require proof of ability to pay before any medical treatment begins. Thats cash or credit card up front. No, they don't accept your insurance card. I specifically asked my health insurance provider if they offered up any such cash, line of credit, promissary note,etc, and they said No. Some/most travel insurance companies do.

 

3. Repatriation of Remains. If the worst should happen. My health insurance provider offers no help. Travel insurance does.

[CruisinGerman]

A really good travel or international health policy (at least the ones they sell here in Europe) includes the services of an assistance company that coordinates your evacuation and medical care, and provides a payment guarantee to a local hospital so that you don't have to foot the bill and file for reimbursement.

 

While many U.S. policies offered through employers do offer coverage outside of the United States, I believe the assistance and payment guarantee services are well worth having an added policy.

 

Kind regards,

 

Gunther and Uta

[harris.margaret9]

Have a very clear word with your H.R. Manager; clarify each of your queries because different companies have different policies.

[mortgagemaster]

I spoke with my H.R. Manager and she told me that our Health Insurance covers "In Network" when we are traveling out of the U.S.A. We would of course have to file a claim once we return home if there is a problem etc.

 

Would I be able to save some money and get a less expensive Travel Insurance plan without worrying about buying more Medical coverage than needed?

 

Or am I missing something that I should factor into the equation?

 

Thanks

This sounds promising...we just returned from a 9 day caribbean cruise on Silversea and onboard my wife fell after dinner. She was wheeled down to the hospital and they ran an EKG as well as blood tests and other tests. They determined low sodium and low blood pressure, as well as low potasssium. She was given a saline drip and released 3 hours later. We ended up with a $1350 bill which I have sent to United Healthcare for review. If they treat it as "in-network" that would be good. Thoughts?

[6rugrats]

This sounds promising...we just returned from a 9 day caribbean cruise on Silversea and onboard my wife fell after dinner. She was wheeled down to the hospital and they ran an EKG as well as blood tests and other tests. They determined low sodium and low blood pressure, as well as low potasssium. She was given a saline drip and released 3 hours later. We ended up with a $1350 bill which I have sent to United Healthcare for review. If they treat it as "in-network" that would be good. Thoughts?

I don't know the terms of your plan. The other poster states any costs incurred would be reimbursed at the in-network rate for him/her.

 

If this is the case for you (and I have no idea what your coverage is), what if your in-network rate for this procedure is only $500? That's all you will get back; your costs won't be reimbursed in full.

 

It's always prudent to purchase travel insurance and I just don't understand why people don't do so. Good luck with your claim and come back to post what happens.

[cruiseco]

 

If this is the case for you (and I have no idea what your coverage is), what if your in-network rate for this procedure is only $500? That's all you will get back; your costs won't be reimbursed in full.

 

Yes. Ship's doctors laugh at those negotiated in-network rates that network doctors and hospitals agree to be billed at. They probably have a contest each year to see who can blow past those rates the most.

[klfrodo]

This sounds promising...we just returned from a 9 day caribbean cruise on Silversea and onboard my wife fell after dinner. She was wheeled down to the hospital and they ran an EKG as well as blood tests and other tests. They determined low sodium and low blood pressure, as well as low potasssium. She was given a saline drip and released 3 hours later. We ended up with a $1350 bill which I have sent to United Healthcare for review. If they treat it as "in-network" that would be good. Thoughts?

 

I had United Healthcare last year and was told that I would be reimbursed at Out Of Network coverage.

Good luck though and let us know. Each and every policy is different as negotiated by the employer.

[LuckyZ]

I also checked with our HR group and confirmed that in most areas of the carribean, you are covered under "in network". We are covered under Anthem.

 

The reason is that they don't have in network doctors developed in these countries but don't feel it's fair then to charge you out of network.

 

Therefore they charge you in network to be fair.

[6rugrats]

I think some of you do not understand your benefits correctly. For those who state their insurance company will pay for these charges at an in-network rate:

 

If you receive services from a noncontracted provider, they may charge you whatever they please; they have no contract with your insurance company. The doctor or medical provider is not bound by any rate rules nor are they concerned about in-network versus out-of-network rates. Their fees are their fees. You then must pay this provider their fees in full, and they will give you an itemized bill.

 

You then submit this statement to your insurance provider for reimbursement.

 

You will be reimbursed at the in-network rate.

 

For example:

 

You visit the ship's doctor for a sprained ankle. They treat you and present you with a $3000 bill which you pay. You get home and submit this statment to your insurance company. The in-network rate for payment for the services provided is only $900. You get a check back from your insurance company for $900, yet you paid $3000.

 

It won't be free and this is why you should be purchasing trip insurance, even if your employer's coverage will pay for services outside of the country.

[cruiseco]

I think some of you do not understand your benefits correctly. For those who state their insurance company will pay for these charges at an in-network rate:

 

If you receive services from a noncontracted provider, they may charge you whatever they please; they have no contract with your insurance company. The doctor or medical provider is not bound by any rate rules nor are they concerned about in-network versus out-of-network rates. Their fees are their fees. You then must pay this provider their fees in full, and they will give you an itemized bill.

 

You then submit this statement to your insurance provider for reimbursement.

 

You will be reimbursed at the in-network rate.

 

For example:

 

You visit the ship's doctor for a sprained ankle. They treat you and present you with a $3000 bill which you pay. You get home and submit this statment to your insurance company. The in-network rate for payment for the services provided is only $900. You get a check back from your insurance company for $900, yet you paid $3000.

 

It won't be free and this is why you should be purchasing trip insurance, even if your employer's coverage will pay for services outside of the country.

 

Yeah, while there might be some savings in being reimbursed at in-network vs out-of-network rates, neither will probably protect you from at least some loss if you have to receive medical services on a ship or in many ports of call.

 

If billed at out-of-network rates for that same sprained ankle the insurer probably won't accept the doctor's bill without some pushback. Even if not using their own negotiated rates they'll probably limit what they'll pay to "usual and customary" fees. Maybe they feel generous and figure "usual and customary" fees for a sprained ankle should be $1100 max. Then maybe they slap you with a 20% co-pay for being out-of-network. So now you're only getting back $880. In-network or out-of-network, a trip to the ship's infirmary is almost always going to cost you some $$$ if you don't have a supplementary travel policy. The travel insurers know the ship's doctors are gonna screw them on the billing and figure that into the premium. Absent any out and out fraud, I've never seen a travel insurer squawk about the size of the bill, no matter how ridiculous it is when compared to your local doctor or hospital charges.

[CruisinGerman]

On any cruise line that caters mostly to Americans, I find it disgraceful that the doctor's schedule of charges exceeds what is considered "reasonable and customary" in America in the first place.

 

Even what is perceived as "reasonable and customary" in America is still ten times more expensive than what medical care actually costs in Europe, Asia and Latin America, so why not price the ship's infirmary in the first place in line with U.S. charges so that the cruise line and its doctor does not earn a windfall at the sick passenger's expense and there is not a shortfall between what is billed and what "customary" insurance in the U.S. will cover.

 

If I get sick on Pullmantur Cruises or Iberocruises from Spain, the ship's doctor charges me what I would expect to pay for a standard, private doctor in Spain, not some super-inflated fee that may be charged in another part of the world that doesn't represent the demographics of the ship's customers.

 

Kind regards,

 

Gunther and Uta

[mellerswa]

I spoke with my H.R. Manager and she told me that our Health Insurance covers "In Network" when we are traveling out of the U.S.A. We would of course have to file a claim once we return home if there is a problem etc.

 

Would I be able to save some money and get a less expensive Travel Insurance plan without worrying about buying more Medical coverage than needed?

 

Or am I missing something that I should factor into the equation?

 

Thanks

 

In general, it seems that with most cruise insurance I've seen, medical is factored into the equation--it might mean you have a bit more flexibility as to when you purchase the insurance. Even at that, however, I would try to get cruise insurance with the pre-existing conditions waiver.

 

The problem is, most if not all insurers consider pre-existing condtions when they evaluate ANYTHING that could cancel your cruise--for example, your sick Aunt Jane's cancer--say she takes a turn for the worse and you have to cancel your cruise--if she had cancer at the time you got your insurance coverage , and then she becomes so ill you can't cruise, you would be responsible for your lost money. It's not just your pre-existing conditions, or those of your traveling companions, it's anyone who could keep you from your cruise.

 

There may be exceptions to this, but I don't know of any.

[cruiseco]

In general, it seems that with most cruise insurance I've seen, medical is factored into the equation--it might mean you have a bit more flexibility as to when you purchase the insurance. Even at that, however, I would try to get cruise insurance with the pre-existing conditions waiver.

 

The problem is, most if not all insurers consider pre-existing condtions when they evaluate ANYTHING that could cancel your cruise--for example, your sick Aunt Jane's cancer--say she takes a turn for the worse and you have to cancel your cruise--if she had cancer at the time you got your insurance coverage , and then she becomes so ill you can't cruise, you would be responsible for your lost money. It's not just your pre-existing conditions, or those of your traveling companions, it's anyone who could keep you from your cruise.

 

There may be exceptions to this, but I don't know of any.

 

Actually, there are several well-known insurers that do not apply the pre-existing condition exclusion to non-traveling family members. For example, this is from a Travelex plan:

 

"Pre-existing Condition means an illness, disease, or other condition during the 60 day period immediately prior to your effective date for which you or your Traveling Companion, Domestic Partner, Business Partner or Family Member scheduled or booked to travel with you:

 

received or received a recommendation for a diagnostic test, examination, or medical treatment; or

took or received a prescription for drugs or medicine."

[mellerswa]

Actually, there are several well-known insurers that do not apply the pre-existing condition exclusion to non-traveling family members. For example, this is from a Travelex plan:

 

"Pre-existing Condition means an illness, disease, or other condition during the 60 day period immediately prior to your effective date for which you or your Traveling Companion, Domestic Partner, Business Partner or Family Member scheduled or booked to travel with you:

 

received or received a recommendation for a diagnostic test, examination, or medical treatment; or

took or received a prescription for drugs or medicine."

 

Thank you, that's good to know.