Experience with major health insurance providers for semi-expats

Travel
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So, there’s been plenty of talk about what I might call “nomad insurance” - safetywing or N26 or whatever, that are for full nomads looking for crisis cover world-outside-US.

I’m more interested in full-boat policies that do include the US, corporate level insurance policies that cover everything for US and abroad - Allianz Global, Cigna Global, GeoBlue - ones where you can spend a fair bit of time in the US, get access to real PPO networks like BSBC or Aetna and real facilities like Mayo/MassGen/MountSinai/HSS. Yes, I know they’re expensive. That’s not the point.

I’m curious if anyone here uses these kinds of policies and how good they really are. Do you get value for money or do they just swamp you with denials after taking your money, or do they say “we have a wide network” but it’s like 5 doctors per city? Thomas I know you mentioned MSH and they might be interesting, I’m curious what network they use in the US. 90 days is a bit short for us perhaps, but.

We don’t want to live full time abroad. We’d prefer to be half and half or 70/30 US/non-US, we don’t know. We are also spoiled - we’ve lived in NY metro for so long and are used to having access to Langone/HSS/NYP/Mount Sinai and we don’t want to give that up, and let’s face it, Portugal isn’t stocked with world-class facilities. We’ve had UHC via work/COBRA but that’s going to go away, and it’s hard to get good group insurance in the US without a full-time job that, well, keeps you in the US.

I know, why not just pay cash? If you’re not getting some sort of preferred-provider rate, that cash goes real fast, and if you get serious cancer or whatever, it’s too late to get a good plan…

(Our perspective is a little different, perhaps. We’ve had an unexpected very expensive major medical crisis in our lives. It makes you think.)

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I’d be interested in this too. The US network is probably the biggest thing to check with these plans, especially if you want to keep access to major hospitals. It would be useful to hear from people who have actually filed large claims and dealt with the insurer.

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I have been using GeoBlue (now called BlueCross/BlueShield Global) and have had zero issues with using it anywhere in the US, Portugal, and other European countries (I have used it in all those scenarios).

Most of the time I need to go to facilities that are not in their network–particularly in Portugal, and so I have to pay up front and submit claims. Rarely outside of the US have I been able to use an in-network provider, but that has never been a problem. I just have to be prepared to pay up front.

My co-pay is €10 for regular doctor visits and anything that requires payment of deductible is just deducted from the reimbursement they send me. They are quite fast with their review of the claims and with electronically depositing my reimbursement directly into my US Bank account I don’t need to mess with figuring out how to deal with paper checks (they do the currency conversions, because I ask for reimbursement to be in USD, but I have the option to ask for reimbursement in € as well).

On the couple of times when I have had disagreements with their assessment of what is covered and what is not, I receive prompt responses from their claims people and we have had easy and responsive communications, and to date have yet to have anything fully rejected. it has always been resolved quickly. I make sure that what I claim is actually covered, of course).

Yes, it is quite expensive (but honestly no more that what I would be paying under the new premiums being charged for “regular” US coverage), but because I choose to spend about half time in the US and half time in PT/abroad, and I have need for good medical coverage with good Rx coverage, it is worth it to me.

Outside of cost, I honestly have zero complaints so far and I have had this since 2021. I can’t speak for any of the other providers, but I do know when I spoke with my broker in 2021, he said that GeoBlue was the least problematic with claims. Another benefit is that when I signed up, as long as I was able to show that I had creditable coverage at the time I applied for it back in 2021, they waived any pre-existing conditions (I have several). None of the other companies would do this. They either rejected me outright or put a 2-5 year waiting period from the last time I had a claim due to a preexisting condition. That was another reason I went with them.

Another tip: we signed up for one of the very low cost (€6 month!) pre-negotiated plans offered by the myriad of Portuguese organizations that offer these plans (ours is through ACP but most banks, Wells/Continente, Cell companies, etc. offer the same thing). I present that card at the clinic, get my reduced rate for labs, Imaging, etc. and then submit a claim to GB for the rest. This saves me a lot of out of pocket money when it is something that is subject to deductible and stretches my Euros before hitting any coverage limits. I have never even come close to exceeding my GeoBlue deductible because medical costs here are so much cheaper and with the pre-paid “insurance’” programs the costs are even lower. I hope this helps!

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