Would you do this? Are we crazy?

[scholastica]

 

My dh works remotely and through an error on someone else's part, we have no in-network providers. It is a narrow network and we live outside the narrow network. There is no way to fix it. So, we are considering getting our preventive care (the no-cost at time of service stuff) by driving 6 hours to the city in which his company is located and getting it done in-network. We would then get those records sent back to our regular providers so they have complete records. Otherwise, we pay all charges out of pocket, up to the deductible and then 60% is covered by the insurance company. 

 

Would you just eat all that preventive care to put it towards the deductible or take a little trip for a couple of days and get it all done for no cost at the time of service?  We don't use that much besides the preventive, maybe a couple of sick visits a year. I have to get bloodwork a couple of times a year, and if we do this, I was thinking of asking the in-network PCP to issue a standing order to Quest, which is in-network, so that is covered at the in-network rate. My kids see an ophthalmologist once a year, might get that done there to only have to pay the co-pay.

 

Our only other option is to buy our own at much higher cost and lose some of our beloved providers.

 

WWYD

[Closeacademy]

We had to do that for a while. All the doctors and the hospital (I can see it from my house) went out of network for about 4 years. There was one urgent care place in network. So we would take an afternoon off and schedule everyone's visits and get it all done at the place that was a 45 min drive away. 

 

I'm just glad none of us had anything major happen during that time. 

 

Good luck and I hope it works well for you.

[SKL]

Personally, I would:

 

1) Research the plan to see if they have special provisions for people who don't have preferred providers in their area.  I've seen this kind of provision in all the plans I've read.

 

2) If (1) doesn't help, research supplemental insurance options that include local providers.

 

3) Look for the most reasonably priced, good quality health providers in your area.  I choose chiropractic because, among other reasons, they are a lot cheaper than MDs and give a lot more bang for the buck.  For blood tests, there may be a way to get it done locally.

 

4) If the above don't solve the problem, I would consider driving the 6 hours for high-cost services, but not routine ones.

 

5) If your medical expenses are high enough compared to your income, you may be eligible for a tax deduction for mileage when you drive for services.

Edited December 14, 2016 by SKL

[Jean in Newcastle]

I would compare the cost of paying for routine healthcare (I'm assuming this applies to annual exams?) out of pocket to how much it would cost to drive 6 hours and to stay there including meals.  Only then will you know which is cheaper. 

[Guest]

I'm okay grouping routine medical things into a big trip once or twice a year. Thats extremely common in many parts of Alaska, where so many towns aren't on the road system and flights out to the bigger cities are quarterly to annual things. It works out pretty well for people who are healthy and things like the dentist or eye doctor, or physicals and such.

[City Mouse]

I know of people who do this for the same reason. The retiree insurance through my D's pension is only "in network" in Texas. Many of the retired members come back "home" once or twice per year for this reason. For many it is much further than even 6 hours.

[Excelsior! Academy]

We basically do this, though our situation is a little different.  We use indian health and drive 45min+ to our appointments.  Fortunately, they group them and we can do them in just 2 trips.  Our dentist and eye doc are local, and we use urgent care for any appointments that can't wait.  It is worth it to us to avoid the fines, yet still get stellar, affordable care.

[TheReader]

I second SKL's advice. I would also check to see if your not-in-network provider could issue the orders for the blood draw to Quest, and that still be covered as in network, since the lab is in network even though the ordering doctor isn't.

 

I would also consider the cost of the drive, hotel, meals, etc... as well as ease or difficulty in scheduling all of your routine care appointments within a narrow time frame; you will likely need to schedule very far in advance, and it still may or may not be possible to get all of the appointments in the timeframe you need.

 

Once you've checked into both of those things, then I would consider your budget and if it can absorb the costs of both, making the 6 hr drive/2-day trip for "free" medical care, and the full deductible amount should something unexpected happen.

 

While the trip to get the in network medical care might save money, if the cost of the trip would be less than what you would pay for the medical visits locally, it would only truly be a savings if you don't need emergency care that requires you to meet your deductible anyway; if that happens in a given year, you'll then have spent the money for the trips and still need to meet the full deductible all at once rather than through staggered medical visits throughout the year.

[scholastica]

We've already done all these. I've spent the last two weeks researching all our options. The company is not big enough to qualify for a plan with out of state in-network providers. This is what they and we thought was going to be the case, that the remote employees would be eligible for in-network rates. Not even our labs are covered even though Quest is in-network, because the ordering doctor is out of network. It's really bad. The only bright spot is that the out of state contract binds the out of network providers from balance billing. So, once we meet the deductible, it's negotiated rates and 40% coinsurance.

 

Personally, I would:

 

1) Research the plan to see if they have special provisions for people who don't have preferred providers in their area. I've seen this kind of provision in all the plans I've read.

 

2) If (1) doesn't help, research supplemental insurance options that include local providers.

 

3) Look for the most reasonably priced, good quality health providers in your area. I choose chiropractic because, among other reasons, they are a lot cheaper than MDs and give a lot more bang for the buck. For blood tests, there may be a way to get it done locally.

 

4) If the above don't solve the problem, I would consider driving the 6 hours for high-cost services, but not routine ones.

 

5) If your medical expenses are high enough compared to your income, you may be eligible for a tax deduction for mileage when you drive for services.

[scholastica]

I second SKL's advice. I would also check to see if your not-in-network provider could issue the orders for the blood draw to Quest, and that still be covered as in network, since the lab is in network even though the ordering doctor isn't.

 

I would also consider the cost of the drive, hotel, meals, etc... as well as ease or difficulty in scheduling all of your routine care appointments within a narrow time frame; you will likely need to schedule very far in advance, and it still may or may not be possible to get all of the appointments in the timeframe you need.

 

Once you've checked into both of those things, then I would consider your budget and if it can absorb the costs of both, making the 6 hr drive/2-day trip for "free" medical care, and the full deductible amount should something unexpected happen.

 

While the trip to get the in network medical care might save money, if the cost of the trip would be less than what you would pay for the medical visits locally, it would only truly be a savings if you don't need emergency care that requires you to meet your deductible anyway; if that happens in a given year, you'll then have spent the money for the trips and still need to meet the full deductible all at once rather than through staggered medical visits throughout the year.

I did check about the non-network provider writing it and it would not be covered at the in-network rate, because it is a very narrow plan. Only orders written by an in-network doctor would qualify, until we met the deductible.

[SparklyUnicorn]

I would ask the company about it.  I would also consider seeing if a local doctor would accept a rate set by the insurance company.  This would mean coordinating between the insurance company and the local doctor.  They basically agree up front to the cost.

 

What a nightmare though.  Geesh

 

 

 

 

[scholastica]

I would compare the cost of paying for routine healthcare (I'm assuming this applies to annual exams?) out of pocket to how much it would cost to drive 6 hours and to stay there including meals.  Only then will you know which is cheaper. 

 

 

That's just it, there are six of us, all would get annual exams, kids would likely need vaccinations, I need a mammogram. The only thing I wouldn't do would be my annual well-woman. We travel pretty cheap, often pack meals for the road/food for meals in the hotel, etc. It's just so frustrating to go from having those covered, to having it all go to the deductible. And still only getting 60% covered once we meet the deductible. 

[scholastica]

I would ask the company about it.  I would also consider seeing if a local doctor would accept a rate set by the insurance company.  This would mean coordinating between the insurance company and the local doctor.  They basically agree up front to the cost.

 

What a nightmare though.  Geesh

 

It really is the worst of all worlds. We basically pay Gold premiums for a bronze plan with no preventive care coverage.

[Jean in Newcastle]

Have you checked out other plans?  It is actually cheaper for the kids and I to get our own independent insurance rather than to go on dh's work provided medical insurance.  Obviously that means more number crunching but it might be worth a look. 

[Pippen]

I think some of that might depend on your local doctors. Our pediatricians really frown upon their patients going elsewhere for yearly exams, sports physicals, etc. and then showing up at the office for sick visits. 

[scholastica]

I think some of that might depend on your local doctors. Our pediatricians really frown upon their patients going elsewhere for yearly exams, sports physicals, etc. and then showing up at the office for sick visits.

I was going to talk to our ped first to be sure she'd be ok with that. She's awesome and would totally understand.

[scholastica]

Have you checked out other plans? It is actually cheaper for the kids and I to get our own independent insurance rather than to go on dh's work provided medical insurance. Obviously that means more number crunching but it might be worth a look.

Yes. That was part of our calculus. Ultimately we ended up buying our own today. I lose my primary care doctor whom I love because she listens to me and knows I understand my own body, and my son at school only has emergency coverage, but we'll keep all our other docs and have preventive care covered. The prevention is what we access the most.

 

Thanks for all your experiences, advice and opinions. You were a big help.

[Jaz]

Yes. That was part of our calculus. Ultimately we ended up buying our own today. I lose my primary care doctor whom I love because she listens to me and knows I understand my own body, and my son at school only has emergency coverage, but we'll keep all our other docs and have preventive care covered. The prevention is what we access the most.

 

Thanks for all your experiences, advice and opinions. You were a big help.

 

Could you use some of the money you save not having to travel to see your primary care doctor and pay cash? Just an idea. Sounds like you came up with a good plan for your family.

[TrixieB]

Could you use some of the money you save not having to travel to see your primary care doctor and pay cash? Just an idea. Sounds like you came up with a good plan for your family.

 

This.  Call your PCP and inquire about cash pay rates.