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DONUT HOLE IN THE EMERGENCY ROOM
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DONUT HOLE IN THE EMERGENCY ROOM

Hello: Just like there is a "donut hole" in regard to medicare prescription coverage, I have the same type of issue for out-patient emergency room visits. I expect to be treated by non-participating (out-of-network) doctors. I want to bridge the gap by a supplemental coverage policy that will cover the difference between participating and non-participating medical providers specifically related to E.R. (non-elective) expensive operations. I am covered for lab tests, CT's, etc. Otherwise, I am satisfied with my existing coverage. Any specific ideas out there?
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Dear CyscoTheKid,

Most health plans cover a legitimate (non-elective) ER visit subject to in-network charges, regardless of participation of providers in your plan’s PPO network. That means if one of the ER providers decides to charge you an unreasonable amount for their services, it is usually your insurance carrier that has to fight the unreasonable charges, not you.

Your current insurance carrier’s customer service department should be able to verify if your plan works that way.

Sincerely,

Amir Mostafaie
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