I work for a major hospital system and our PPO insurance only covers non-emergency procedures within that hospital system (outside office visits are covered with copay). Normally this is no issue as the hospital system is world class. However, my wife has recently been diagnosed with a very rare and serious condition that seems to be best handled by other hospitals. Obviously we want to get the best care but would also want to know what would be covered. Do such plans generally allow for coverage at different systems if the patient is referred/transferred? Has anyone had experience with a similar situation? Would this at least be counted against our OOP max (which is very low in our case)? We are having a hard time determining if our plan allows this and what conditions must be met. We’re having a hard time getting straight answers from the insurance company.
submitted by /u/acvdk
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I work for a major hospital system and our PPO insurance only covers non-emergency procedures within that hospital system (outside office visits are covered with copay). Normally this is no issue as the hospital system is world class. However, my wife has recently been diagnosed with a very rare and serious condition that seems to be best handled by other hospitals. Obviously we want to get the best care but would also want to know what would be covered. Do such plans generally allow for coverage at different systems if the patient is referred/transferred? Has anyone had experience with a similar situation? Would this at least be counted against our OOP max (which is very low in our case)? We are having a hard time determining if our plan allows this and what conditions must be met. We’re having a hard time getting straight answers from the insurance company.
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