Mass evacuations and narrow networks

One of the positive things I’ve seen from Hurricane Matthew has been the targeted state governors’ communication has been very clear:

There has been no dithering, no hoping that a delayed evacuation could save a tourist weekend. Millions of people have been on the move.

Hopefully it will be enough to save a lot of lives. And hopefully there is a last moment wiggle and the eye of Matthew stays out to sea and then it recurves to the north and open water.

But if that hope fails and Matthew grinds the Atlantic coast hard with the full force that we fear, hundreds of thousands of people will be temporarily displaced. So what happens to their health insurance if an Indian River County resident ends up in Alabama for a couple of weeks?

This splits into two types of questions, emergency and non-emergency care. The easy answer is for emergency care. All policies will pay to stabilize an individual in a critical care scenario. The cost sharing will look like the hospital is in-network. So if a person has a heart attack after looking at the damage on TV, the first few days in the hospital are covered without concern. Rehab might not be covered in Alabama.

This leads to the non-emergency care scenario which we will talk about below:

It really depends on what type of insurance that temporary refugee has. If the individual has traditional Medicare or a national carrier employer plan, they can probably get local care 400 miles from home without too much trouble. They would be in network, they would be authorized and they would have nearly seamless care.

If they have Medicare Advantage, they might be going out of network, but the out of network Medicare fees are capped at Traditional Medicare rates. Medicaid in Florida is mainly a managed care state, so the individual is most likely out of network in Alabama. If they received non-emergency care from an out of network provider, the individual would probably be balanced billed. The same would apply to individuals who are on narrow network Exchange plans.

The twist on these scenarios are if the individuals is on a course of treatment that is medically necessary and non-deferablesuch as tri-weekly dialysis or chemotherapy. Insurance companies are obligated to pay for medically necessary treatments. If all in-network providers are in an evacuation zone, the insurance company will need to find some way to pay as their network is temporarily inadequate. The problem will rise if there is an open and accessible in-network provider that can provide the medically necessary care. Then the insurer if they want to evil bastards can plausibly deny the claims and charge full out of network cost sharing/member responsibility. The counter to that is massive negative publicity that EvilCorp Insurance is truly Evil.

In the short run of a mass evacuation, medical insurance and networks are not a major concern as most people will cancel or defer any and all deferrable care. There would only be emergency claims. Insurers know how to handle those easily enough. The policy problem is two, three, four weeks down the line where someone is still being told to stay out of their home area and they need to go see a provider for an infection, or they need to get their shoulder checked out, or their ulcer is flaring up again. Those are the tough policy cases with narrow network plans.