Question:
Can you have surgery in another state

I grew up In NJ but I live in NY now. I am on Adult Health Plus (a fancy new name for medicaid) Has anyone been covered by NY medicaid but seen a Dr and had surgery done in another state? I want to be by family and Westchester Medical sounds like a zoo. Hope some can help me. Thanks Nikki    — Losing I. (posted on November 9, 2003)

November 9, 2003
Not sure of the geography you are speaking of, but I do know that most states will accept medicaid from a bordering state. Some are bordering states, some are counties. I live in Kansas City and part of the metro area is in Kansas and some in Missouri. I know that Kansas hospitals will accept Mo medicaid and the other way around. Cant hurt to call the hospital and surgeon and ask.
   — RebeccaP

November 11, 2003
Well, I have Aetna HMO not medicaid, but I live in PA and had surgery in NJ without a problem
   — emilyfink

November 11, 2003
In answer to your question, I worked with the medicade HMO population in Okla for many years, In the State of Okla the only way they would pay another state was if the member was in a emergency situation and had to be admitted, But the rate that they pay differs from state to state, So the amount that Okla. pays the hospitals and Dr's were not necessarly the same amount that say Texas was getting from the Texas medicade and the Hospital would demand payment from the patient for the balance of the account in full. Or if the patient would call us and let us know they were being billed we would try to intervene for them and work out a deal where we paid the difference from one state to another, but if the person was to go out of area and have a surgery that was not pre-authorized and it was not an emergency, the surgery was ALWAYS denied, A state wont deny admission of another states recipent as long as they are on a emergency basis, how ever to schedule a Elective surgery, I think you would be hard pressed to find this assistance. Good Luck to you. Sue
   — LS F.

November 15, 2003
Hi Nikki, I live in NJ and had surgery in NY. I didn't have Medicaid but I would think that as long as their requirements are met that it shouldn't be an issue.
   — Linda M.

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