One Community, One Health System
Will My Insurance Cover Services Across State Lines?
Author: Kelly Neiger, CFO
As Barton Health plans for the future of healthcare in South Shore, our patients remain our top priority. By expanding healthcare services on two campuses, South Lake Tahoe and Stateline, we’ll provide more services to meet your needs. And a new hospital ensures you receive excellent health care with a larger emergency department, upgraded operating rooms, modern medical equipment, and the latest in healing design.
Within our diverse community we have many types of insurance plans and insurance payors represented, and many are asking how this will affect insurance coverage. We are here to share accurate information to reassure our community.
Emergency and acute care (inpatient/ when you are hospitalized) services are covered across state lines no matter your insurance type or payor.
This means if you live in California and have Medi-Cal or California-based HMOs, and you need to be seen in the emergency department or be admitted to the hospital located in Nevada, your insurance will cover these services. This is like today, where South Shore residents who live in Nevada are seen and treated in our hospital today.
Insurance plans, including Medi-Cal and Covered California, have ‘border provisions’ where elective, hospital-based procedures (medically necessary procedures not treated in a medical office) can be covered across state lines if a border provision is included in the contract. Examples of these types of procedures may include orthopedic surgeries, hernia repairs, and hysterectomies.
Currently, private insurances and some state insurance contracts already have border provisions, which is why some can receive services across state lines today. In the coming years, as the new hospital is constructed, our teams will focus on negotiating border provisions for all contracts including Medi-Cal and California-based HMO insurance plans.
Outpatient services (primary care, specialty care, and ancillary services) are covered in the state in which you live. Some plans cover specific network providers across multiple states, while others have border provisions to cover care across state lines.
Today, 90% of our patient visits are outpatient visits, meaning appointments within medical offices or ancillary services like lab or x-ray. These types of services will be available at both campuses, so patients can be seen in the state they live in for most services needed.
We know insurance coverage is one of the community’s top concerns related to the hospital replacement project and ensuring you are covered is my team’s top priority — in summary, emergent medical care is covered across state lines and most outpatient services will be available in the state you live via our two campuses.
Kelly Neiger is the Chief Financial Officer of Barton Health. For more information about Barton’s dual-campus strategy or the hospital replacement project, or to provide feedback, visit BartonHealth.org/Dual-Campus.
