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Group Employee Benefit Plans/Health Care in Different State


I work in the state of Mississippi but live in the state of Georgia.  My work has health coverage, but because I live so far away from the state, all options I have here are out of network.  The nearest in network doctor is, in fact, over 175 miles away.  Because of this, I am also put into a high deductible plan that has a deductible of $2000 at first and then $4000 out of pocket after with them covering 75% of the allowable charge.

Up till now the doctors I have been seeing have been writing off the difference between what the insurance will cover and what they charge.  However, on my recent bill, I noted that they have stopped this and are now billing me for the full amount regardless of what the insurance says are the allowable charges.  Apparently, it was a mistake for them to have been crediting me up till now, but they said they would not go back and charge me.  From this point on, however, I will have to pay the higher amount, which amounts to double or triple the bill in some cases.  I am in a fix, now, because I have to come up with money to cover the bills at a higher rate.

My question is this: what are my options?  Do I try to find an insurance plan here in the state on my own and pay out of pocket for it?  Do I tell my work that I won't be using their insurance anymore (they are paying the premium every month).  Is there such thing as a secondary insurance plan that I could buy in this state to cover what the insurance won't cover for normal doctor visits since it is out of network?  I'm rolling in debt and this is getting stressful.

You do not want to cancel the insurance you have as the company is paying the premium. The premium I pay for one employee is substantial.  You can buy a supplemental policy. You want to be careful because sometimes they fight over who will pay the bill when you have two policies.

Another option would be to find out how much the company is paying and find an insurance coverage in your state for the same amount and have them pay that premium and take you off the current coverage. They may or may not be able to do this, it would depend on how their policy is written.

Do not allow them to give you money to pay the premium as it will be taxable wages and will show on the W-2 form. If they pay your insurance it must be paid to the insurance company.

If your company has an HSA or FSA saving plan you may be able to put pretax money in there to use for medical expenses.

In the near future insurance exchanges will be set up in each state into which you can buy to keep your insurance costs down.

You are very fortunate to have your insurance paid many companies only pay a portion most 50% at the most.


I might add that another option would be to use a doctor close to your work and just get your treatment where the network exists. If it is close enough to to to work  than you could probably find a doctor in network there.


Group Employee Benefit Plans

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Shirley McAllister, CPP, PHR


I can answer questions about Benefits plans, Health and Retirement, Erisa, Hippa, Cafeteria 125, Cobra and 401K. I cannot answer questions about stock option plans or other retirement plans.


I have been 25 years with my current International company. I am the Health Plan benefit administrator and I am also the Retirement Plan Trustee. I am the Human Resource Director.


I.O.M.A. B.N.A.

PHR in Human Resources CPP in Payroll

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