Does my insurance have to cover out of network, if there is no in networks?

Mar 29, 2012 at 09:30 AM

I was just wondering if anyone knew the answer to this. Okay I have dissociative identity disorder. It requires specialized care. My insurance company, medicare/medicaid covers no hospitals that specialize in it. There is none in my state, so we have to go out of state. Last time we did a out of network single case agreement. My DID specialist is recommending I go back there, as parts are severely harming the body. And appear suicidal.

General psychiatric wards just restrain and seclude me anytime I switch, which ends up traumatizing me more. I am worried and she is worried that somebody will end up permanently hurting me. Would it be a legal thing for them to have to cover a out of network hospital?

Perna · Mar 29, 2012 at 02:18 PM

"Network" is an insurance company word only. In/out of network is their own network, has nothing directly to do with what is/is not covered or with specific geographic location.

It sounds like your specialist will have to try for another out of network single case agreement (doesn't necessarily mean you can only do it once, could just mean "this" case) if you want to go to that hospital again. But, your insurance may/may not cover it. There's no requirement that they do.

dmight · Apr 07, 2012 at 05:37 PM

Quote:

Originally Posted by LydiaB

I was just wondering if anyone knew the answer to this. Okay I have dissociative identity disorder. It requires specialized care. My insurance company, medicare/medicaid covers no hospitals that specialize in it. There is none in my state, so we have to go out of state. Last time we did a out of network single case agreement. My DID specialist is recommending I go back there, as parts are severely harming the body. And appear suicidal.

General psychiatric wards just restrain and seclude me anytime I switch, which ends up traumatizing me more. I am worried and she is worried that somebody will end up permanently hurting me. Would it be a legal thing for them to have to cover a out of network hospital?

That is very disturbing

Amazonmom · Apr 08, 2012 at 07:52 PM

depends on what state you are in. In washington state they do have to pay at the in network rate if you need a treatment not available in network.

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Does my insurance have to cover out of network, if there is no in networks?

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Amazonmom Grand Poohbah Member Since Feb 2009 Location: usa Posts: 1,730 15 183 hugs given	Apr 08, 2012 at 07:52 PM #4 depends on what state you are in. In washington state they do have to pay at the in network rate if you need a treatment not available in network. __________________ "Unipolar is boring! Go Bipolar!" Amazonmom is not putting up with bad behavior any more.
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