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Seeking Medical Treatment While on Vacation
This is the time of year when many people are starting to take summer vacations. When planning for a trip, it is unlikely for individuals to think about their medical coverage, especially if they are healthy when they depart. Yet, if an accident occurs or illness sets in while away, it can be confusing for a person to understand his/her options for seeking treatment.
Here are some general guidelines that should be helpful if you or a family member is in this situation:
- In the event of an emergency, seek immediate care from the closest hospital emergency room. The "prudent layperson law" requires insurance companies to pay for care when a patient perceives the situation to be an emergency, regardless of the ultimate diagnosis. In this case, your only financial responsibility will be your emergency room co-pay, even if the hospital is not in your insurance company's network.
- If your situation is not an emergency, you should follow the same guidelines as if you were at home, which vary according to the type of health plan on which you are enrolled. First, regardless of your plan type, you should identify whether or not there are doctors close to your vacation spot that participate in your health plan. You can call the Member Services phone number on your ID card to find out. Second, you should understand how your particular plan works.
Here are some general rules to follow depending on the plan:
HMO - Contact your Primary Care Physician (PCP) to discuss your health condition, and obtain a referral for specialty care if needed. Please keep in mind that your plan will only pay for services by contracting health care providers, even if you are away from home. If you do seek treatment by a non-contracting doctor or hospital, you will be responsible for payment.
POS - Contact your PCP for advice on your best course of action, but remember that to minimize your out-of-pocket expenses, you must stay in the network and may need a referral for specialty care. If you decide to obtain care from a non-contracting doctor or hospital, your plan will pay a percentage of the claim after your deductible is satisfied.
Open Access/PPO - You have the option of seeking treatment from any health care provider. If you go to a contracting health care provider, you will keep your expenses at a minimum. If you choose to see a non-contracting provider, you will have to pay for your deductible and some percentage of the claim.
Hopefully you will stay healthy on your next vacation, but please remember that RSI Gallagher is available to answer your questions in the event you need our help. Just contact your RSI Gallagher Benefit Service Specialist at 1-800-394-6111.
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