What You NEED To Know About Your Medical Coverage Before Going On Vacation

The following post is by MPFJ staff writer Travis.  Travis is a customer blogger for Care One Debt Relief Services, and also appears weekly at Enemy of Debt.  Travis candidly shares his personal journey to pay off $109,000 of credit card debt and the tips he’s learned along the way. As a father and husband he provides a unique perspective on balancing debt, finances, and family.

Admission time, I have generally walked through my adult life without knowing the specifics of what my health care covers and what it does not.  I’ve taken on the perspective of, “I’ll figure it out when I need to.”  But last month, for the purpose of a post on this website, I explored my current health care plan in a level of detail I’ve never reached before.

Little did I know how soon I would use this information.

Midway through our vacation in Florida, my wife woke up at 1:30am in pain with a rash above her left eye.

The rash had developed a few days prior, but was only a slight annoyance until now.  She immediately called our insurance provider’s help line which connected us with medical personal able to answer basic questions.  After a few minutes of discussion, she was advised to seek medical attention within 24 hours.

I remembered reading about the differences in coverage between going to the ER, urgent care, and a doctor’s office visit, but I couldn’t recall the specifics.  Luckily for me, I bookmarked the web page with my plan’s information so I could quickly recall what each of the options would cost.

• Emergency Room Visit:  Subject to my deductible, of which I had not had any expense for yet in 2014.  Thus, we would pay the full price.
• Urgent Care:  We would pay 15% of the bill.
• Diagnostic Office Visit: 100% covered.

I would never suggest my wife delay care if she felt she needed immediate relief, however after reviewing our options she suggested she would try taking some ibuprofen and wait until morning to decide our next action.

When we woke up, I immediately began searching for nearby medical facilities.   I knew that there would be a difference in what we would pay dependent upon whether the facility was in our plan’s network or not, so I again pulled up our plan’s details.

• Emergency Room:  Patient responsibility is the same in network vs. out of network.
• Urgent Care:  Patient responsibility is the same in network vs. out of network.
• Diagnostic Office Visit: 100% covered in network, subject to deductible if out of network

Using a list of in network providers, I was able to find one within 5 miles of where we were staying.  Amazingly we were able to get an appointment almost immediately that morning.

My wife was diagnosed with an infected bug bite.  The physician’s assistant who was handling my wife’s appointment prescribed the following treatment plan:

• An antibiotic shot was given in the office
• A prescription was given for a 10 day cycle of antibiotics
• A prescription was given for a steroid to help reduce the symptoms and pain

We passed a Walmart on our way to the appointment, which I knew was in our provider’s pharmacy network.   I instructed them to send the prescription there, to minimize the cost of the drugs.

As we were checking out of the facility after the appointment was complete, the woman behind the desk asked if we would be paying that day, or if we would like them to send the bill to our home.  Given that we thought the appointment was an in network diagnostic office visit, we had thought the fee would be covered by insurance.

During the phone conversation that followed with our insurance provider, we learned the following:

• It was covered 100% if my wife had been seen by a doctor
• If my wife had been seen by a physician’s assistance or a nurse practitioner, the fee is subject to our deductible because they are considered specialists.

Going back to the reception desk, we were told that she had indeed been seen by a physician’s assistant.  However, they submit all bills under the name of the physician on call for just these kinds of situations.

We breathed a sigh of relief, and asked them to submit the bill to our insurance.

When we got back to our vacation rental house, we did a little side by side comparison to determine what the cost of our medical excursion would have been had we made different choices:

In Network Cost

• Diagnostic Office Visit:  Because we found an in network provider the cost was zero out of our pocket.
• Prescription Drugs: Because we found an in network pharmacy, the cost was about $8.

Total Cost:  $8

Out Of Network Cost

• Diagnostic Office Visit:  Subject to deductible, which we have not  accumulated any medical bills.  We would have paid the full price of the office visit:  $150.
• Prescription Drugs: Out of network pharmacy cost would have been about $25.

Total Cost:  $175

What I learned

This was the first time I had ever had to seek medical services while far away from home, and it taught me some very valuable lessons for things I need to do each time we go on vacation, or are a significant distance from home:

1. Know at least the basics of your medical coverage.
2. Know how to access more detailed information just in case you need it.
3. Have your insurance card and the phone number to their help line to  answer questions about your medical plan if needed.
4. Know where the nearest in network provider is for your medical coverage.
5. Know where the nearest in network pharmacy is located.

Having this information can mean the difference between a small out of pocket fee, and a significant medical bill should you have a medical condition that requires attention while you are away from home.

How about you all? Have you ever had to seek medical attention while on vacation?  Did you make the right choices given your medical coverage?

Share your experiences by commenting below! 

Image courtesy of Stuart Miles / FreeDigitalPhotos.net