Some Calif. Residents Face Coverage Barriers to Out-of-State Care

Thousands of California residents who live along the state's borders seek routine out-of-state care out of necessity and convenience, but many of the state's largest insurers do not cover such care, Capital Public Radio's "KXJZ News" reports.

Lack of Out-of-State Coverage

According to "KXJZ News," at least 9,600 Northern California residents who live in border counties have health plans that do not cover routine care outside of the state. However, for many of them, it is more convenient to seek care in Oregon or Nevada.

This year, Anthem Blue Cross stopped covering out-of-state care for individuals. Darrel Ng, public relations director at Anthem, in a statement said, "These are California plans for California residents with California providers," adding, "Anthem's policies fully comply with state law and our contract with Covered California."

Ng noted that Anthem does cover out-of-state care for small group policyholders.

Meanwhile, Blue Shield of California also does not cover out-of-state, non-emergency care. Coverage is confined to within California's borders for plans purchased on and off of the state's exchange.

According to "KXJZ News," Northern California residents who want individual health policies that cover out-of-state care can purchase a plan from Assurant Health, but those plans are not offered through Covered California.

Meanwhile, the out-of-state care restrictions also have changed the way physicians operate, according to "KXJZ News." For example, some doctors have to form new relationships with specialists as they refer patients for care at locations farther away.

Reasons for Coverage Restrictions

According to Dylan Roby, an assistant professor at UCLA's Fielding School of Public Health, the Affordable Care Act likely spurred the restriction of certain out-of-state care.

He noted that under the ACA's consumer protections, insurers that used to have large provider networks had to find new ways to cut costs.

Roby said that the because of "negotiated contract[s] with lower cost providers," some "coverage is no longer as portable as it used to be" (Bartolone, "KXJZ News," Capital Public Radio, 12/16).