Health insurance and medical tourism

Medical tourism is for boob jobs, liposuction and poor people without insurance

Many people think medical tourism is only for people without health insurance.. Or people seeking treatments or procedures that aren’t covered by the typical health insurance policy (like some types of plastic surgery.)

But that’s not true.

While medical tourism is often a ‘saving grace’ for the uninsured and underinsured patients in the United States, other medical tourists are often referred to overseas practices by their insurance companies.

Insurance companies want to save money too..

Insurance companies collect premiums from their subscribers.  When subscribers need care, the companies pay out claims at pre-set rates for services.  Companies negotiate for ‘volume discounts’ for many services but use several other strategies to make a profit while meeting their commitments to subscribers.

Paying for services while balancing the bottom line

They balance claim payout with profit-making several ways;

1. Deny claims.   One of the ways insurance companies can save money on claims – is to not pay them… So companies may deny certain claims or by limit access to care for subscribers with expensive pre-existing conditions.  (The New ‘Obamacare’ legislation is aimed at preventing this practice, but we won’t know how effective it is for a couple of years).

2.  Promote health ..Many insurance companies also offer incentives to their subscribers for health promotion activities.  Quit smoking?  Lose weight?  Exercising daily?  Then the insurance company might even lower your premium a bit – since these activities may reduce their future payouts.

3.  Use less costly services.   Another way insurance companies can reduce their payouts is through medical tourism.  Since surgery is significantly less expensive outside of the United States, it benefits the insurance company to have patients travel for services.  So – even if your insurance company doesn’t advertise (loudly) its medical tourism division, it probably has one.

If you aren’t sure – do a little on-line research and call your insurer. Sometimes the insurer will even offer subscribers an incentive for traveling.

and even if your insurance wants to send you to India – they will probably pay for you to go to Mexico, Colombia, Costa Rica or wherever you chose.

But, if you are like me, you still have some questions.. How difficult is it to file a claim internationally?  Is it more difficult for Americans to have their claims processed in other countries?  How long does it take for claims to be processed and paid? Do patients need to start researching and preparing their claim ahead of time?

Meet Myriam

While I was in Mexicali – I took advantage of the opportunity to interview someone who negotiates with American insurance companies every day.  Myriam is an insurance billing specialist for a bariatric surgeon in Puerto Vallarta, Mexico.

Meet Myriam.

Meet Myriam.

The bilingual Myriam has been processing international health insurance claims for over 12 years now.  She laughs out loud when I ask about processing claims for American patients.  “Those are the easiest,” she said.  “The companies are happy to pay.  They never give us any problems.”

As part of her job, Myriam helps patients with information and files their insurance claims.  Myriam explains that as part of the claims process for bariatric surgery, for example, claims must be filed when the patient is actually in the hospital.   “The insurance company requires us to submit the claim at the time of service, not before.”

[So in this practice],” we have the patient provide us with a credit card prior to the procedure.  We don’t bill it without speaking to the patient but that way we can use the credit card for the deductible or co-pay.   Insurance usually pays within 60 days of the procedure, Myriam explains.  If you aren’t sure if your insurance carrier will cover the claim, call them ahead of time.