Archive for the ‘Health Insurance’ Category

Toothless Healthcare Reforms May Boost Prospects for Medical Tourism

Tuesday, March 16th, 2010 by Frank Gillingham, MD

For many reasons, health insurers in the U.S. have been reluctant to jump on the medical tourism bandwagon.  They are concerned about taking business away from doctors and hospitals already resentful of payment rates virtually dictated by the plans.  Insurers realize that promoting medical treatment abroad would be perceived as a cost control measure at a time when politics is making cost containment an ever “dirtier word” with the public.  Finally, patients would likely hold insurance companies responsible for malpractice committed in the course of medical tourism. But overriding these serious concerns is the prospect of backbreaking costs brought on by the healthcare reforms now poised to become law.

We now understand that the proposed legislation would require health insurance companies to change the way they do business (by covering pre-existing conditions, accepting all applicants for coverage, e.g.), thereby eliminating avoidance of adverse risk and potentially increasing premiums dramatically. According to the Cato Institute, federal legislation that is working its way through Congress strongly resembles the reforms enacted in Massachusetts in 2006, which have accelerated costs significantly. As a result, despite the imposition of fines for non-compliance, many individuals and small employers may not be able to afford health insurance.  This outcome could, in the long run, actually increase the number of uninsureds, who must pay medical bills themselves and thus may seek less expensive care outside the U.S.

Unfortunately, current healthcare reform proposals do little to address the underlying reasons why healthcare costs are so high: defensive medicine, overutilization of specialists, the shortage of primary care physicians, excessive drug costs and patients’ expectations of heroic measures at the end of life, for example. These relentless price pressures bode well for the medical tourism industry, which will continue to represent a lower cost alternative to double digit annual increases in medical costs in the U.S.

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The Lure of Easy Living

Wednesday, December 16th, 2009 by Brendan Sharkey

Island lifeIn my days of lecturing about global health care services to prospective expatriates, it was never a surprise to see scores of retirees stationed up front. They showed a high level of interest by nodding and taking copious notes. They had come to hear about health care services available around the globe.

Although many retirees love the idea of a personal maid, a driver, endless summer days, cheap eats and all around easy living, they also fear the limitations of health care in far-away places.  Their fear is not unfounded. It is a big world and the quality of healthcare can vary greatly from one city to the next.

Some of the most attractive retirement destinations lack the kind of health care infrastructure that someone chronically ill, or even someone perfectly healthy, needs access to. Is it reasonable to hope you can be airlifted from your island sanctuary anytime illness or injury comes calling? This may be impractical and could land you in a perilous situation.

A host of issues need to be considered when deciding what kind of insurance coverage you need for you and your family:  routine services, finding dependable medications, locating well trained English speaking doctors. For major surgeries there are even more concerns to address.  And whether you are healthier than you’ve ever been or have a chronic illness, there are other important questions. How will Medicare cover me overseas? Can I drop out of Medicare and purchase a local health plan and what are the pros and cons of doing so? 

Forbes recently covered several of the issues that a potential expat should consider including Insurance: Don’t Leave Home Without It, The 10 Best Retirement Havens, and The Globe’s Best Hospitals.  These articles provide you with a lot of things to think about and to help you make a sound decision.  Do your research, talk to the experts and remember this:  easy living requires peace of mind.

Photo by Just.looking http://www.flickr.com/photos/jonathanhercock/ / CC BY-ND 2.0
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Trip Cancellation Coverage and H1N1 – A Clarification

Thursday, October 8th, 2009 by Brendan Sharkey

globe2Recent articles, like the one that ran last Friday in USA Today, explore trip cancellation insurance benefits in relation to the H1N1 flu and along the way create the potential for some misunderstandings. To sort out the subtleties, HTB takes a look at a typical product — TripProtector from HTH Worldwide.

The pandemic exclusion clause contained in the TripProtector plan applies strictly to trip cancellation, trip interruption or travel delay benefits. If a member feels threatened by pandemic flu and decides to cancel her trip prior to departure or to cut her trip short, the policy does not cover the associated travel expenses. Or, if a member’s travel is delayed because of circumstances arising from the pandemic, the policy does not cover the associated travel expenses. But if that person becomes ill while traveling, with H1N1 or any other pandemic infectious agent, TripProtector covers the associated medical costs, including evacuation for medical treatment, if necessary.

By definition, pandemics affect a large swathe of the population, so many trip cancellation carriers anticipate a potential avalanche of claims related to H1N1. Some carriers have decided to take this risk; others have not. We are not aware of any policies that exclude medical treatment for pandemic flu while you are traveling.

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Travel Medical Plans: Why Smart Travelers are Buying Them

Wednesday, June 24th, 2009 by Brendan Sharkey

globe-and-scope1Scores of Americans are traveling the globe for leisure, business, study and missionary travel.  Because of the recent travel concerns raised by the H1N1 pandemic and terrorist threats like the Mumbai attacks, many of these smart travelers are better planning and preparing to avoid potential hazards. 

Greater consumer awareness has led to an increase in the popularity of travel medical insurance.  The simple fact is that existing health insurance plans are inadequate when taken across U.S. borders because they strictly limit overseas benefits. In addition, most health insurers will refuse to pay to get you to a higher standard of care should you need to be evacuated due to a medical emergency. Savvy travelers are aware of these limitations and are not leaving anything to chance.

Travel medical insurance policies are designed to pick up where your primary health plan leaves off. If you do not have health coverage, these plans act as primary insurance while abroad. The best designed plans offer more than emergency benefits. They cover big ticket items such hospitalization and surgeries but will also pick up the tab on physician office visits, ambulance services, prescription medications and more. The premier plans make it a point to cover sickness or injury due to a terrorist event or a pre-existing medical condition. Critically, some policies will pay medical providers overseas on a direct basis so you can avoid hassles and red tape.   

Also, remember that there can be big differences in coverage rights when you buy travel medical insurance. Some plans are licensed and regulated in the U.S. while others sit offshore: beyond the reach of your local Department of Insurance. U.S. licensed and approved plans are called Admitted Insurance and should be given first consideration when choosing your plan.

Do your homework. Shop around. Compare the plans.  Always ensure that you read the fine print rather than just scanning a benefit schedule. Ask your broker or insurance company to send you a sample policy so you can get a complete picture of what you’re buying.

Enjoy peace of mind when you travel with a well built travel medical plan.

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International Health Plans: Why Buyers Need to Beware

Monday, May 18th, 2009 by Brendan Sharkey

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Given the choice, would you rather buy an international health plan that is secure and subject to state regulators’ standards, or one that is not?

When it comes to international health plans, consumers often encounter products from “non-admitted” insurers that operate beyond the reach of U.S. state insurance regulations. These offshore plans–also referred to as surplus lines policies-are cheap but should be purchased only after very careful consideration.

  • What is a non-admitted health plan? Any plan that has not been approved by the state insurance department as health insurance is considered non-admitted even if the administrator or marketing company is located in the U.S.,
  • By law, buyers typically must acknowledge in writing that they are aware that they are buying a plan that does not conform to health insurance regulations. This is a kind of “buyer beware” warning.
  • Non-admitted insurers are not bound by state financial solvency requirements. To draw an analogy, buying a non-admitted plan can be likened to opening a bank account that is not FDIC protected. .
  • The “rock bottom price” on a non-admitted plan can be a warning of troubles ahead. The cheapest health plan at time of purchase often turns out to be the most expensive in the long run.

When plans from admitted carriers, such as those offered by HTH Worldwide, are an option, consumers are fully protected under the law

  • If a consumer files a complaint with the Department of Insurance, the state has direct recourse to the Admitted insurer to demand fair claims payment.
  • State regulations are designed to protect consumers, making it less likely that buyers will have to confront hidden gotcha’s on waiting periods, harsh exclusions, inside limits, penalties or unusual claims payment procedures.
  • Policy definitions must be stated in plain English. For example, admitted plans define a pre-existing condition as one that was treated or diagnosed prior to the effective date of the policy. In contrast, non-admitted plans often define it as a condition that was treated, diagnosed, or “could have manifested itself (whether symptoms existed or not)” prior to the effective date. This broad, ambiguous wording often backfires at time of claim.
  • Those returning from a stint abroad in need of a new health plan have peace of mind knowing that U.S. health insurers will recognize an admitted plan as creditable coverage. Additionally, members returning home are entitled to keep coverage in place for the long haul on certain HTH products such as the Global Citizen plan.

What is the bottom line? Avoid the financial risk and potential headaches that come with non-admitted health plans. Purchase admitted plans protected by U.S. state insurance regulations. You will sleep safe and sound at night.

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Get Hip to HIPAA before heading overseas

Thursday, March 26th, 2009 by Brendan Sharkey
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Employee Benefits Security Administration

Navigating your health plan to get the most out of your benefits can be a challenge -the administrative hurdles alone can sometimes be daunting.

But for international travelers there’s a little known trapdoor that can open large gaps in healthcare coverage that quickly spiral beyond your control, exposing world travelers to significant financial risk.

Traveling or residing outside the U.S. for six months or more often means that one of the key benefits of a health insurance plan-coverage of pre-existing conditions-is in jeopardy when you return home. How so? If you’re not hip to HIPAA, you wouldn’t know – the catch is in the fine print of the Health Insurance Portability and Accountability Act of 1996.

Unless you are enrolled in a well-designed international health insurance program, you can be caught up in technicalities that subject you to a 12-month waiting period for a pre-existing condition when you return home and re-enroll in a domestic group health plan. Even if you purchased another plan to fill the gap, HIPAA rules permit the group plan to institute the waiting period. That’s bad news if you have developed a serious medical condition in the meantime.

Doesn’t sound fair? Well, it’s all perfectly legal. The waiting period can be reduced or eliminated if the time you spent in your alternative health plan is viewed as “creditable coverage” and applied as an offset. But that decision is made unilaterally by the health plan.

What’s the answer? Staying healthy certainly helps. But if you want to do more than cross your fingers (and that is what this is all about) do your homework before heading out of the country, like this smart person did (at least we think she’s smart… she chose our product).

If you are employed and posted abroad, ask your employer to enroll you in an international plan that provides seamless eligibility no matter how much time you spend abroad. If group coverage is not an option, choosing the right individual plan can help you avoid similar, even larger gaps in coverage.

Most individual international plans on the market are constructed and administered to minimize coverage for pre-existing conditions. They typically feature exclusions or very low benefit limits for conditions that were treated over the past two years. To your peril, they also define pre-existing conditions much more broadly than U.S. plans, and they don’t recognize the group plan you may be leaving as “creditable coverage.” Check to see if the individual plan you are considering is filed with U.S. state insurance regulators as an “admitted” plan (HTH products are).

Lastly, ask about what happens to your eligibility when you return home. Will the plan continue to offer benefits after your assignment ends? Many plans discontinue benefits after six months at home; others will cover you all the way up to age 84. This is a critical issue: you clearly don’t want to be left out in the cold as uninsurable. 

The last thing you need when going abroad or coming home is to trip over technicalities and fall through a trapdoor . Be a savvy health insurance buyer. Ask the right questions and don’t leave anything to chance.

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Medical Tourism: Hot Topic Meets Cold Facts

Wednesday, March 11th, 2009 by Frank Gillingham, MD

 

42-16163361Ever since pilgrims to Epidaurus sought the healing powers of Asclepius, the Greek God of Medicine, people have traveled to distant destinations to obtain medical care. Today published reports suggest that a new medical migration is taking place. Some estimate that as many as one million patients worldwide leave their home countries to be treated for everything from a toothache, to liposuction to open heart surgery. Does this trend threaten U.S. doctors and hospitals? Not necessarily. According to a recent McKinsey study, the number of medical tourists who travel outside their own country to obtain inpatient medical care is 60,000 to 85,000 per year worldwide, and many of those come to the U.S. for treatment.

The primary motive for people leaving the United States is cost. Surprisingly, it is not the uninsured (43 million), but the underinsured (100 million) of Americans with large deductibles, exclusions or low benefit limits who make up the largest segment of those seeking healthcare outside the U.S. If U.S. healthcare reform efforts produce some form of universal coverage, it will likely include cost-sharing features that could continue to drive the medical tourism trend.

Even so, there are many factors that may ultimately limit the appeal of obtaining healthcare abroad:

1) U.S. hospitals will respond competitively by specializing in procedures to deliver cost- effective care by achieving high volumes

2) Natural limits on the number of procedures that can be performed on an elective basis. For instance, cardiac bypass surgery and the repair of unstable hip fractures must always be performed on a timely basis to avoid further injury

3) Difficulties in obtaining compensation for malpractice committed in a foreign country. Foreign jurisdictions are generally not sympathetic to visitors filing malpractice claims.

4) Loss of an existing physician-patient relationship

5) Perception that health care in other countries remains inferior to the United States

6) Unwillingness on the part of many to travel for healthcare, no matter the cost savings

7) Reluctance on the part of US physicians to handle complications of a surgery performed on a medical tourist. At the October, 2008 meeting of the American College of Surgeons, an overwhelming majority answered “no” to the question: “If a patient returned from surgery abroad with a complication and came to see you, would you agree to care for the patient?”

Nonetheless, the allure of inexpensive care abroad has led WellPoint, the largest health insurer in the United States, to enter into a pilot program to provide access to medical care outside the U.S in a partnership with Healthbase, a Boston-based provider of medical tourism logistics.  Healthbase will assist WellPoint members with coordination of the trip, medical appointment, scheduling, digital medical records transfer, and concierge travel service.

Before embarking on a medical tour, patients should research the proposed facility and surgeon carefully. International accreditation is in its infancy, but there are facilities who have obtained certification from agencies such as Joint Commission International the Trent International Accreditation Scheme or the International Society for Quality in HealthCare.

If American doctors and hospitals respond aggressively, they will compete effectively in the emerging international market. If not, many of today’s perceived obstacles may fade away, and medical tourism could become commonplace.

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