We’re meeting with a health insurance navigator on Monday, but I wanted to get the community’s input about a specific concern/scenario before meeting with her.
My situation: We’re a family of 3. My wife and I have always had individual health insurance (mine is pre-ACA/grandfathered and hers if BC/BS from the exchange) and own a small business together. We had a daughter this year and are now looking at getting a single plan for the whole family.
We live in the Triangle (Raleigh/Durham/Chapel Hill) area of NC. Each city is dominated by a particular health system (Wake Med/Duke/UNC, respectively) and since we live in Durham, every hospital close to us is a Duke hospital. They have very good doctors but are also very expensive.
My wife had her prenatal care and gave birth within the UNC health system and our daughter has been seeing a UNC pediatrician since. So far, we’ve been very happy with the quality and cost of care both of them have received. It’s a little bit of an extra drive to get to UNC doctors and hospital (~20-30 min.) but it’s not a big deal for any visit we’re able to schedule. In general, we’re both pretty healthy and don’t have any specific health issues beyond generally wanting to stay alive and use our organs (e.g. other than our pediatrician, neither of us require access to any specific providers, but we have been seeing local doctors for basic checkups).
Of the health plans that are available to us on the exchange, it appears as though they either cover UNC (BC/BS) or Duke (Aetna) health systems, but not both. Like the basketball teams, they seem to be rivals. We would like to get the best BC/BS plan we can afford and to continue using the UNC health system for every visit that we can schedule in advance. However…
My specific concern is: If my infant daughter (or us too, I guess) needs to go to an ER in a jiffy (or are taken there by an ambulance), it will almost certainly be to a Duke hospital. While the quality of care will likely be good, my concern is that—since it would be an out-of-network hospital and an emergency—they could bill us out of existence because no one is safe from the American health system.
My wife mentioned to me the other day in the annual document where your health insurance raises your premium/deductible/OOP max and pokes more holes in your coverage, there was a note that out-of-network hospital costs would no longer apply to the annual out-of-pocket maximum. So, even if I’m paying coinsurance after meeting our deductible, any percentage of infinity could still be devastating if I’m in a car accident or my daughter has some sort of emergency that requires ambulance/surgery/etc.
SO… with this in mind, do I need to suck it up, change all of our doctors and select a plan that would include the nearest ER? Or could I get Aflac or some other supplemental insurance to cover the gap if a sudden emergency requires expensive hospital care? What are the limits/risks/etc. of sticking with BC/BS even if the hospitals nearest to us aren’t in that network?
If you made it this far, bless you, and thanks for any response/input.