| According to section 76 of the bill passed by the Senate Budget Committee today, you've got a year. And then you have to go before your carrier for an "expedited determination" of whether "such service is otherwise not available through an in-state health care provider."
But that's the generous part. Let's say you need, say, a kidney transplant, and think the best place to get it is in New York. Hope you like the doctors in New Jersey! Because it's not going to happen. Unless you are willing to pay extra. How much extra? The difference between the total charges from the hospital and "the lesser of the contractual rate or a rate equal to 150% of the Medicare fee schedule for the same services." Not being a health care expert, I don't know how much this is, but I sure have had some interesting experiences with my insurance company interpreting contract clauses in, shall we say, interesting ways.
This might be a good way to "improve the economy" for, say, big hospitals that are near a state border in cities such as, say, Camden, as some recent articles have pointed out. Is it fair to do so on the backs of limiting state employees' medical choices though?
I'm no expert on health care and no idea if these kinds of out-of-state clauses are generally common or seen elsewhere in health care. But these are good examples of issues that should be worked out at the bargaining table. |
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