How do Insurance Companies & Medicare
handle claims if you are out of the area, out of state or out of country?
Please check the official policies and brochures below or on your insurance companies website (view our companies page, look for the companies administrative page) to see how travel is covered. In general, it’s emergency or urgent care ONLY.
Health Net PPO Travel Guide
HMO 16 pages each
Blue Cross – Specimen Platinum PPO –
Policy – Travel Section
Sorry, under ObamaCare – Blue Cross does not appear to participate in the Blue Card Program unless it’s an emergency or urgent care. Double check this – 2016 might have changed!
- SBC – Federal Summary of Benefits
- Evidence of Coverage
US News & World Report 10.2015 – Coverage while outside USA
Medicare Coverage Outside of USA # 11037
- MYTH: Medical evacuation and repatriation are the same.
Reality: Medical evacuation typically means moving a patient from one location where the local care is inadequate to another nearby location that better meets the patient's needs. This does not necessarily refer to moving from the patient’s initial emergency medical transport to the first care setting. Repatriation means transport, usually medically-supervised, back to the patient’s country of residence. There are situations where a medical evacuation is also a repatriation. There are situations where a patient is medically evacuated only to a nearby Center of Excellence (CoE) to receive care and recover, and then the patient continues with their journey. More commonly, the patient has both – evacuated first to a nearby CoE and then repatriated back home for longer term care/convalescence.
- MYTH: For a repatriation to be covered, the patient must first have a covered emergency medical evacuation.
Reality: While it is common for an emergency medical evacuation to occur first, not all GeoBlue policies require this for the repatriation to be covered. On most individual policies, the GeoBlue Medical Director may determine a medically-supported transport is required to return the patient to their residence, irrespective of whether a covered emergency medical evacuation preceded it. An example is where the traveler is hospitalized and treated in a visiting CoE city,, but still requires medically-supervised transport to safely get home for further treatment or recovery.
- MYTH: Medical evacuation back to the U.S. is always the best course of action
Reality: Based on the situation and treatment needed, the GeoBlue Global Health & Safety (GHS) team works with the treating facility to determine patient stability and the risk and benefits of a move to another facility. These factors dictate whether a member requires evacuation back to the U.S.* In most emergency cases, the patient will first be stabilized then a plan arranged for medical evacuation to the closest Center of Excellence or repatriation. Should transport be recommended, the GHS team then coordinates and arranges direct payment for the best method of transportation – for example, ambulance, helicopter, fixed wing air ambulance – which may require a few days to complete. Uber™ and taxis do not count as ground medical transportation.
- MYTH: Evacuation membership programs offer better value than a true travel health insurance plan.
Reality: While there are benefits to having a medical evacuation plan in place, these programs do not typically offer the comprehensive coverage and specialty service that travel health insurance plans provide, meaning that any care not associated with a medical evacuation – such as inpatient or outpatient care – may not be covered. Prompt settlement of medical expenses at each care setting is essential to secure the cooperation of the medical providers in discharging and handing the patient over to the medical transport vendor’s team.
- MYTH: Evacuations happen within minutes; after all, it is an emergency situation.
Reality: While emergency medical evacuations involve very serious medical conditions, the patient is usually hospitalized in a setting that can meet their immediate, short-term treatment requirements. In fact, it is critical that the patient be stable enough before an evacuation is undertaken (a determination that is usually jointly made by the treating doctor, the GeoBlue medical team, and the transport vendor’s medical authority). While GeoBlue maintains a global network of medical transport resources, there are also several factors that affect the timeframe for transport, including: arrangements with a receiving care facility, transit time for the transport resources to get to the patient, crew rest, landing permits, seat availability, weather, etc. GHS works to keep the patient and family informed of the timeframes throughout the course of the transport.
- MYTH: Emergency medical evacuation by air ambulance is the best method for transport.
Reality: Emergency transportation vehicles have one goal: provide life-sustaining care to patients who need to get from point A to point B. Similar to ground ambulances, air ambulances are packed with life-saving equipment and provide minimal space for travelers. Aside from the necessary travelers – the emergency responder, the patient and possibly one other travel companion – there is usually no extra room for luggage, no extra seats, nor in-flight catering or other amenities. The cabin environment can be loud. Additionally, because of size and range, air ambulances can often only go short distances in comparison to a commercial jet. In some situations, transport by air ambulance is the right course. In others, evacuation by commercial airline is also appropriate. The latter provides significantly more comfort and typically shorter transit times; however, they may not provide sufficient support for the patient’s condition. GeoBlue’s GHS team has experienced medical staff who can make these determinations based on the patient’s condition, needs during transport, distance to the nearest CoE, among other factors.
- FACT: GeoBlue simplifies the healthcare process for members in crisis.
In a medical emergency, GeoBlue is available 24/7/365 to support members with concierge-level service through direct contact with healthcare facilities to identify best treatment and care required, coordination of appropriate medical transportation, arrangement of direct pay to healthcare providers and services with a goal to simplify and streamline a challenging, stressful event.
*NOTE: Even if the evacuation route is not to the U.S., we fulfill member requests to repatriate home post evacuation, when they are stable. 4.2.2019 Agent Email from Geo Blue