Well if you live in a state as big as Texas you may have to fly out of the state.
If you have to have a consultation before the actual procedure that'll be 2 flights (2 there and 2 back). Tack on a hotel stay which will probably require having to pay for 4 nights (you know how hotel check-ins and checkouts were) and the tab runs up pretty fast.
Combine that with the fact that half of Americans can't pay $1000 for an emergency
If a $1,000 financial emergency hit your household tomorrow, would you be prepared? The answer for about half of Americans is no.
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And you'll quickly see that just going out of state isn't really a viable option.