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Asked: Apr 24, 2010

HMO Insurance Plan Coverage for Medical Emergenies Out-of-Network…

Will my HMO insurance plan cover for a medical emergency even if I was brought to a hospital that is not in my network?

Categories: In California

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Answers

Ideally, your HMO insurance is supposed to cover all emergencies such as first aid and hospital admission. However, health insurance companies have varied definitions of what is an emergency. A “medical emergency” is often  defined by the admitting diagnosis record which later on will support any medical claim. Some HMO insurance plans will consider a pregnant woman going into labor an emergency case while others may not. For some health care providers, going into labor is a natural process and is not a real emergency. In the event that you get unconscious, the ambulance would usually bring you to the nearest hospital for first aid. You or your family can transfer you to an HMO insurance in-network hospital once you are stable. State laws on emergencies and insurance claims vary. In most states, insurance companies cover life-threatening emergencies without asking any questions. You will be rushed to the nearest hospital or health care provider for first aid. Some HMO insurance companies pay for the cost of your medical emergency regardless of where you were brought while others don’t even pay for the ambulance ride. If going into labor is not considered a medical emergency in your HMO insurance, then better prepare a list of in-network providers and carry it with you wherever you go. When you go into labor, you can choose a service provider from the list and then ask whoever will be taking you to bring you to your preferred hospital. Review your HMO insurance plan for your peace of mind. You can also call your carrier or insurance agent and ask them to eplain their provisions on emergencies. Answer by IndianaHealthCare -- June 19.2009 @ 1:06 pm

Answered: May 02, 2010

 

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