Implementing Medical Travel in a Fully Insured or Self Funded Health Plan

We are starting to see US health insurance carriers, Stop Loss Carriers and Self Funded Employers implementing medical tourism in their health plans in 2008, and some planning to implement medical tourism starting in 2009. What is surprising is the lack of organization or due diligence these organizations are performing to choose hospitals or to choose what company they partner with to send their employees or insureds overseas. Some are not only not asking key important questions, they are simply not asking any questions at all.

If not done properly, a poorly implemented Medical Tourism program will only result in disaster for an employer, while a properly and well thought out medical tourism program will be a huge success.

First, we are finding Employers and insurance companies partnering with organizations to coordinate care overseas which have little to no experience in international healthcare, have no medical training background, little to no financial funding or stability, and even more so, a staff of one or two employees.

Some insurance companies and employers are smart. Before they make a choice they contact the Medical Tourism Association for advice and guidance. They easily find out if the company they are working with has a good reputation in the industry and can handle their business. The Medical Tourism Association can verify the information an employer or insurance company have received. Our association has seen companies stating they have 50 employees worldwide, when in reality they only have 2. How successful do you think your company’s medical tourism program will be when you find out the organization you are dealing with does not have enough infrastructure, staff or financing to support your employees going overseas?

What are some good “starter” questions should you ask before implementing a Medical Tourism Program?

1. Which hospitals have you partnered with?
2. Why did you partner with those hospitals?
3. Is the hospital accredited and by which organization?
4. Who will coordinate the care overseas?
5. Is the hospital or medical tourism company you are working with a member of the Medical Tourism Association? By joining the association the organization agrees to transparency and providing detailed information on their quality and their organization?
6. How many employees does the organization have coordinating your travel overseas? How have you verified what they have told you?
7. What is the financial stability of the organization you are partnering with?
8. How have you addressed the Quality of Care issue?
9. What steps have you taken to limit your liability, from patient waivers, disclosures, to how you present information in a brochure to employees?
10. How are you convincing employees to go overseas for care? Simply providing them with a brochure on savings isn’t going to cut it?
11. What procedures are in place if a complication happens when your employee is overseas?
12. Have you chosen hospitals based upon that hospital having the highest quality of care and outcomes?
13. Or, are you choosing a hospital simply because it was in the news or someone recommended it to you?
14. What Errors and Omissions insurance coverage does any company you are dealing with have?
15. What indemnity agreement do you have to protect your organization from liability?

Recently we have encountered Medical Tourism Companies, and other companies trying to sell international networks to employers and insurance companies. Some of these organizations have no background or even understand the US health insurance marketplace and how it works. What is not being disclosed by these organizations when marketing to US health insurance carriers and employers is that this information they are providing on hospital outcomes and quality of care are not “credible,” and employers and insurance companies could be liable by utilizing this information and passing it on to employees. This is because each hospital has their own methodology on how they determine outcomes and statistics. This means you cannot compare or consider credible quality of care information and outcomes if you try to compare with multiple hospitals in the world. The Medical Tourism Association is resolving this issue as we have gotten the top hospitals in the world to agree to a single methodology so US employers and insurance companies can compare the top hospitals. Is your insurance company or you as the employer participating in this program?

Employer Workgroup Launched –

The Medical Tourism Association has launched an employer workgroup, made up of Insurance companies, Stop Loss Carriers, TPA’s, Employers and insurance agents. This workgroup is helping to teach all of these organizations how to properly implement medical tourism and allowing them access to confidential information on quality of care and legal issues. The response we have had is amazing, as some of the largest insurance companies and employers have joined our workgroup, which is free to join.

Contact Jonathan Edelheit if you are interested in participating in this workgroup at Jon@medicaltourismassociation.com