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Anthem Blue Cross In California Plans To Reinstate Out-of-State Coverage In 2016


People on the California side of the Sierra say they have a long-standing practice of going across the Nevada state line for health care. Many told Capital Public Radio - as part of a series on health insurance problems in Northern California - that driving to Reno is often closer or more convenient than seeking care in California, especially in bad weather.

Individual Anthem Blue Cross plans in California currently cover emergencies out-of-state, but not routine care.

But the company says if all goes according to plan, that will change next year.

“In 2016, members would be able to see in-network doctors, out-of-state as part of their benefits," says Darrel Ng, spokesperson for Anthem.

"So if you lived in South Lake Tahoe but on the California side, as long as a doctor was in-network on the Nevada side they’d be able to see them as part of their benefit,” says Ng.

Ng says the health insurance company eliminated routine out-of-state coverage in January 2014 in an effort to keep health premiums as affordable as possible. The company says it designed its plans to meet the 10 essential health benefits mandated under the Affordable Care Act, which do not require out-of-state coverage.

The in-state restrictions became a problem for Northern California enrollees who live along the border of Nevada and Oregon, in an area where Anthem Blue Cross has over 90% of the Covered California enrollment.

"After hearing from our members, and seeing the marketplace response, we decided to add that benefit to our next cycle," Ng says.

That's a relief to people like Dennie Wright, who lives in a small community north of Quincy. Wright had several heart-related emergencies over the past year and was flown to Reno. He has a device in his chest that connects him to a hospital there.

"Now that's going to allow me to stay with these guys, which makes me really happy. because they're doing a great job. I'm doing really, really well," he says.

Anthem says the plan to reinstate out-of-state coverage is subject to change during its negotiations with Covered California and regulators over next year's health plan prices and products. He says a final announcement about next year's rates and plans is expected in late July or early August.

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