Skip to content
CapRadio

CapRadio

signal status listen live donate
listen live donate signal status
listen live donate signal status
  • News
    • topics
    • State Government
    • Environment
    • Health Care
    • Race and Equity
    • Business
    • Arts and Lifestyle
    • Food and Sustainability
    • PolitiFact California
  • Music
    • genres
    • Classical
    • Jazz
    • Eclectic
    • Daily Playlist
  • Programs + Podcasts
    • news
    • Morning Edition
    • All Things Considered
    • Marketplace
    • Insight With Vicki Gonzalez
    • music
    • Acid Jazz
    • At the Opera
    • Classical Music
    • Connections
    • Excellence in Jazz
    • Hey, Listen!
    • K-ZAP on CapRadio
    • Mick Martin's Blues Party
    • Programs A-Z
    • Podcast Directory
  • Schedules
    • News
    • Music
    • ClassicalStream
    • JazzStream
    • Weekly Schedule
    • Daily Playlist
  • Community
    • Events Calendar
    • CapRadio Garden
    • CapRadio Reads
    • Ticket Giveaways
  • Support
    • Evergreen Gift
    • One-Time Gift
    • Corporate Support
    • Vehicle Donation
    • Stock Gift
    • Legacy Gift
    • Endowment Gift
    • Benefits
    • Member FAQ
    • e‑Newsletter
    • Drawing Winners
    • Thank You Gifts
  • About Us
  • Contact Us
  • Close Menu
 We Get Support From:
Become a Supporter 
 We Get Support From:
Become a Supporter 
  • Health Care
  •  

California Border Residents Grapple with Out-of-State Health Insurance Restrictions

  •  Pauline Bartolone 
Tuesday, December 16, 2014 | Sacramento, CA
Listen
/
Update RequiredTo play audio, update browser or Flash plugin.
Pauline Bartolone / Capital Public Radio

Stacey and Kory Felker in their Quincy, California home. The Felkers live near the California-Nevada border, and recently learned that their individual insurance does not cover routine out-of-state care.

Pauline Bartolone / Capital Public Radio

Capital Public Radio's Health Reporter Pauline Bartolone traveled to the town of Quincy, California, where major insurers Anthem Blue Cross and Blue Shield of California aren't covering routine out-of-state care. This is the first of a three-part series.

For some people living along California's state border, the closest or most convenient care is out of reach. 

Kory and Stacey Felker experienced this problem for the first time this year, after they signed up for individual insurance with Anthem Blue Cross.

The Felkers live in Quincy, California with their two kids. The small community rests in an alpine valley at 3,500 feet in the Sierra Nevada mountains, a couple of hours northwest of Lake Tahoe. 

"Reno is the closest city," says Stacey Felker. "That’s where we’ve always gone for health care."

Kory Felker says Reno is about 80 miles away. The nearest California city, Chico, is about as many miles away, but requires a longer, more dangerous drive down a windy canyon road. Chico is also smaller than Reno, and its major hospital has more limited facilities.

1215-Quincylumber -p

The town of of Quincy, Calif. has about 1,000 residents. Pauline Bartolone / Capital Public Radio

So when Kory Felker found skin cancer on his neck this year, his doctor sent him over the state line for surgery. But then his health took a scarier turn. Kory Felker's Crohn’s Disease led to a perforated bowel. When his condition became toxic, the hospital called Stacey.

“They said, 'He’s having trouble breathing. He’s pretty much collapsed on the floor. Flight care - which is the helicopter - is on its way.' Ok great, I rush out there,'" Stacey Felker remembers. 

The local hospital sent Kory Felker to Reno for surgery. That week, the Felkers found out their Anthem Blue Cross plan doesn’t cover routine out-of-state care. Anthem does cover emergencies for individual policyholders, but other care must be provided within state borders. That was a problem after Kory Felker's abdominal surgery.

"So then I called Blue Cross and I said he needs wound care, and they told us, "The nearest [provider] we have is Auburn, California' which is like three hours...from us," says Stacey Felker.

"Kory’s just gotten out of surgery. I’m pregnant. We have two little kids," she says about the circumstances under which they were faced with that travel prospect.
 
The Felkers now face a tangle of high medical bills, some which may be covered, some maybe not. Meantime, they started getting care in a California valley town, what requires a longer, more dangerous drive than Reno. 
 
“We pay a lot of money for our health insurance, and to be so restricted, I feel like it’s just not fair," Stacey Felker says. 

Thousands of Border Residents Face New Out-of-State Insurance Obstacles

 

At least 9,600 Northern Californians who live in counties bordering other states have policies through Covered California that don’t cover routine out-of-state care. For many of them, going to Nevada or Oregon may be the closest or most convenient care. 

Anthem Blue Cross stopped covering out-of-state care as a benefit for individuals in 2014. It declined an interview, but sent a written statement about the coverage change in their individual market plans.

"These are California plans for California residents with California providers," wrote Darrel Ng, Public Relations Director with Anthem Blue Cross. "Anthem’s policies fully comply with state law and our contract with Covered California.”

Ng confirmed that small group policyholders with Anthem Blue Cross still have the out-of-state coverage benefit. 

Anthem Blue Cross has over 90 percent of the Covered California market in Northern California - which includes the region from Mendocino to Nevada County, and stretches all the way north to the Oregon state line.

Blue Shield of California, the area's second largest insurer through Covered California sells EPO plans (Exclusive Provider Organization) in the region, which also restrict non-emergency care to within the state. Blue Shield of California offers PPO plans in other regions of California, plans which cover out-of-state care. 

The coverage restrictions are the same for people who bought on or off the exchange, who bought with or without a subsidy. 

Out-of-State Restrictions Part of Limited Provider Network Trend under ACA

 

Dylan Roby, Assistant Professor at the UCLA Fielding School of Public Health, says it's fairly new that individual policyholders have trouble with out-of-state care. 

He says before the Affordable Care Act, some plans offered broad choice in doctors, and they controlled cost in other ways, such as refusing sick people. But Roby says consumer protections under the new health law have limited the ways insurers can cut spending.

“You saw plans having to figure out how to make money in the new world, where benefits were fairly fixed, they couldn’t have really high deductibles anymore, they couldn’t have annual benefit limits," says Roby. 
 
Roby says patients encounter limitations in doctor choice now because insurers are using provider payments as a budget-saving mechanism. 
 
"They basically just negotiated contract with lower cost providers, and so we’ve seen quite a few where the coverage is no longer as portable as it used to be," he says.

Out-of-State Coverage Restrictions Felt by Physicians

 

The new out-of-state restrictions change the way doctors practice, too. Just 25 miles from the Nevada state line, Dr. Dennie Chez has an urgent care practice in Truckee. He says when a patient needs specialty care, he sends them over the border.

“Reno is what we call downhill," says Chez. "You don’t have to go over a summit in the winter."

1215-Dr Chez -p

Dr. Dennie Chez has an urgent care practice in Truckee. He says he's sending his patients far away for care.  Pauline Bartolone / Capital Public Radio News

Now that Nevada doctors aren’t accepting some insurance, Chez must send his patients up to four times as far away for care. And, he must form new relationships with specialists. 
 
“I just don’t understand why one state would accept insurance and another state wouldn’t accept insurance," says Chez.

"I mean insurance should be insurance. I thought it was all backed by Obamacare which is a national program," he says.
 
Nevada’s individual plan holders don’t have the same problems crossing state lines, according to Nevada's Division of Insurance.

There is at least one other option for Northern Californians who want coverage for care across state lines using an individual policy - Assurant Health. But it’s not available through Covered California.


Follow us for more stories like this

CapRadio provides a trusted source of news because of you.  As a nonprofit organization, donations from people like you sustain the journalism that allows us to discover stories that are important to our audience. If you believe in what we do and support our mission, please donate today.

Donate Today  

    More about Few And Far Between

  • Few And Far Between: Health Insurance Choices In Rural Northern California

    In a three-part series, Capital Public Radio explores why rural northern Californians are facing new challenges with individual health insurance.

    Related Stories

  • Emergency Health Insurance Regulation Issued

    Monday, January 5, 2015
    The California Department of Insurance issued an emergency regulation today [Monday] intended to assure improved healthcare access to Californians.
  • When A Marketplace Only Offers One Health Insurer

    Thursday, December 18, 2014
    In 22 Northern California counties, some health insurance customers have only one carrier choice in Covered California. We go to a rural community north of Quincy to find out what that's like.
  • Pauline Bartolone / Capital Public Radio

    After Blue Shield Pulls Out of Zip Codes, Consumers See Limited Insurance Options

    Wednesday, December 17, 2014
    Blue Shield of California stopped selling policies to individuals in 250 zip codes in 2014. The coverage area reduction is especially felt in Northern California, where consumers have few choices through Covered California.

 healthhealthcarecovered californiaAnthem Blue CrossFew And Far Between

Pauline Bartolone

Editor-at-Large

Pauline’s been a journalist for two decades, covering health care, education and the many disparities that exist in California.  Read Full Bio 

Sign up for ReCap and never miss the top stories

Delivered to your inbox every Friday.

 

Check out a sample ReCap newsletter.

Thanks for subscribing!

Thank you for signing up for the ReCap newsletter! We'll send you an email each Friday with the top stories from CapRadio.

Browse all newsletters

More Health Care Stories

Andrew Nixon / CapRadio

New variants, wastewater data, long COVID: What Sacramento region experts are watching

August 5, 2022

KEVIN KWONG

A California man’s ‘painful and terrifying’ road to a monkeypox diagnosis

August 6, 2022

Alain Jocard, Pool via AP

Sacramento County declares monkeypox a local public health emergency in response to rising cases

August 9, 2022

Most Viewed

Parties, stolen cars, a gun: 9 police complaints at Council member Sean Loloee’s disputed North Sacramento residence

California coronavirus updates: Can the monkeypox outbreak be stopped? Experts believe it’s possible

Northern California wildfires: Where to find updates on air quality, evacuations, and official information

Abortion is still legal in California. Here are answers to questions about access in the state.

Trump says he will not oppose the release of documents tied to the Mar-a-Lago search

We Get Support From:
Become a Supporter

Most Viewed

Parties, stolen cars, a gun: 9 police complaints at Council member Sean Loloee’s disputed North Sacramento residence

California coronavirus updates: Can the monkeypox outbreak be stopped? Experts believe it’s possible

Northern California wildfires: Where to find updates on air quality, evacuations, and official information

Abortion is still legal in California. Here are answers to questions about access in the state.

Trump says he will not oppose the release of documents tied to the Mar-a-Lago search

Back to Top

  • CapRadio

    7055 Folsom Boulevard
    Sacramento, CA 95826-2625

    • (916) 278-8900
    • Toll-free (877) 480-5900
    • Email Us
    • Submit a News Tip
  • Contact Us

  • About Us

    • Contact Us / Feedback
    • Coverage
    • Directions
    • Careers & Internships
    • Mission / Vision / Core Values
    • Press
    • Staff Directory
    • Board of Directors
  • Listening Options

    • Mobile App
    • On Air Schedules
    • Smart Speakers
    • Playlist
    • Podcasts
    • RSS
  • Connect With Us

    •  Facebook
    •  Twitter
    •  Instagram
    •  YouTube
  • Donate

  • Listen

  • Newsletters

CapRadio stations are licensed to California State University, Sacramento. © 2022, Capital Public Radio. All Rights Reserved. Privacy Policy | Website Feedback FCC Public Files: KXJZ KKTO KUOP KQNC KXPR KXSR KXJS. For assistance accessing our public files, please call 916-278-8900 or email us.