Empire Blue Cross HMO/POS - do they cover procedures overseas?
Before I call Empire, I'm wondering if anyone else had a similar situation. I'm a self-paying Empire member and the plan is HMO/POS, meaning I can also use services out of network.
I'm considering going to Canada for gallbladder/hernia surgery with Dr. Gagner, and I can't decipher Empire's terms and conditions for out-of-the-country procedures. There seems to be something about some hospitals being in the network (including Sacre Coeur, which is one of the centers where Dr. Gagner operates), but I can't figure out whether that's if you are visitng and get sick by chance, or whether they cover it if you schedule a procedure there to begin with.
Any tips or suggestions how to approach Empire would be greatly appreciated. Many thanks!
I'm considering going to Canada for gallbladder/hernia surgery with Dr. Gagner, and I can't decipher Empire's terms and conditions for out-of-the-country procedures. There seems to be something about some hospitals being in the network (including Sacre Coeur, which is one of the centers where Dr. Gagner operates), but I can't figure out whether that's if you are visitng and get sick by chance, or whether they cover it if you schedule a procedure there to begin with.
Any tips or suggestions how to approach Empire would be greatly appreciated. Many thanks!
Thanks for replying.
Yeah, my first instinct is that they would balk at *scheduled* out-of-country procedures. I know there is accommodation if you need medical care while you are traveling, but that's something different from scheduling a procedure.
But I poked around their website and tried to understand the T&C for my plan benefits. Since I self-pay and don't belong to a group, HMO/POS is the best (i.e., most flexible) plan I can get. It allows for out of network coverage, subject to certain conditions, and it turns out the question of *planned* or pre-scheduled health care outside the U.S. isn't so so clear cut.
There is something called "world" coverage, and something called "expat" coverage (but that's where you actually sign onto a plan knowing you are permanently situated overseas). The "world" coverage was more encouraging. To get the info, I had to enter my specific member number on one of their satellite websites, so apparently the details are different for different plans. I'm not sure I understood it correctly - and certainly not completely - but it appears that there are overseas hospitals where one can apply for advance authorization for procedures and coverage might be possible. Sacre Coeur in Montreal was on the list, which makes me feel a tiny bit optimistic that at least some coverage may be possible.
I think maybe I will try to find someone to talk to at Sacre Coeur who handles such issues.
Thanks anyway.
Yeah, my first instinct is that they would balk at *scheduled* out-of-country procedures. I know there is accommodation if you need medical care while you are traveling, but that's something different from scheduling a procedure.
But I poked around their website and tried to understand the T&C for my plan benefits. Since I self-pay and don't belong to a group, HMO/POS is the best (i.e., most flexible) plan I can get. It allows for out of network coverage, subject to certain conditions, and it turns out the question of *planned* or pre-scheduled health care outside the U.S. isn't so so clear cut.
There is something called "world" coverage, and something called "expat" coverage (but that's where you actually sign onto a plan knowing you are permanently situated overseas). The "world" coverage was more encouraging. To get the info, I had to enter my specific member number on one of their satellite websites, so apparently the details are different for different plans. I'm not sure I understood it correctly - and certainly not completely - but it appears that there are overseas hospitals where one can apply for advance authorization for procedures and coverage might be possible. Sacre Coeur in Montreal was on the list, which makes me feel a tiny bit optimistic that at least some coverage may be possible.
I think maybe I will try to find someone to talk to at Sacre Coeur who handles such issues.
Thanks anyway.
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