Hi, everyone, I live in Texas and I plan to get another round of proton radiotherapy in Mass General Hospital, but I am having a hard time finding an insurance that covers out-of-state networks. I got my first round of treatment in MGH five years ago through a PPO plan in my previous job, but not anymore. Now I’m getting my healthcare coverage through healthcare.gov, because my new job only offers coverage through healthcare reimbursement arrangement. All the plans I’ve seen are HMO plans with only in-state coverage. Is it possible for individuals to get PPO or PPO-like plans?
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Hello. I always hesitate responding to people because I never feel like I could help anyone. But here goes… I also have to use the Marketplace for an insurance plan. You are correct, they almost all are HMO’s, and you can not go out of state for care. I have an AVM that’s being treated by stereotactic radio surgery. I’m 2 years since treatment, and am still awaiting final results in another year. I live in AZ. I was able to go to MD Anderson, affiliated with the Banner Network here in Phoenix area, and I was covered. I do pay for the highest level of membership, Gold Elite. I can’t say if that makes a difference, but it could. I often think it’s how your doctor explains why you need this, and completes the proper coding to your insurance. I looked at Texas, and there is MD Anderson in the Houston area. They certainly have Radiation Oncologists. I sincerely wish you the best with your treatment and wish your search for Insurance that covers.
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Fegleyc,
What you have to say is true regarding the documentation skills of one’s physician, and in our cases, neurosurgeon. Although my AVM and craniotomy were MANY years ago, my neurosurgeon volunteered to write detailed information to the Social Security Administration in behalf of my petition for permanent disability. He knew what types of measurements they were looking for and how to describe my abilities/disabilities. I would strongly agree that the same skills would be necessary in requesting insurance coverage.
Congratulations on recovery from your AVM. I am sure your efforts have made a great impact on how you live your life today. As time goes on, you may make small but significant progress!
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Does anyone have experience with moving to a different state just to use their insurance coverage, and then quickly move away after the procedure was done? Would I get in trouble for that?
I dont see why you would people move all the time-
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We have been caregivers of a granddaughter who had an AVM rupture and subsequent bleed at age 9. She is now 33 years old. We live in California which has fully implemented MedicAid and the Affordable Care Act, as have many other states. She has 100% coverage for all her medical needs through Medi-Cal, of which there have been many over the years. A resident of California is eligible for Covered California or Medi-Cal just being a resident, with no waiting period. For more information go to Who can get a health plan through Covered California? | Covered California™
Our largest frustration is educating service providers, primarily non-neurologically trained medical people to understand the nuances of brain-related injury and disease. It is very common for those impacted from brain injury to have issues with depression, memory, emotional control, epilepsy, cognitive and executive functions, and communicating effectively.
She lives in her own apartment but does receive services through Supported Living Services. There are other services such as In-Home Support Services through the county and state. People who have a disability have a right to live as independent a life as they can and want.
To have a procedure or other medical care covered would require establishing a relationship with medical providers before and after any procedures. That would come after establishing residency. It is not simply moving temporarily for just a procedure to be covered.
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