Medical Tourism Risks, Benefits, and Trends
When Cynthia Losen was looking for a doctor to treat her pain, she decided to go to Florida — so her husband could play golf at a local resort while she relaxed and recovered.
Cynthia’s not alone, either. Across the country and around the world, patients are opting for cushy, comfy, or financially-attractive venues. It’s not out of the question to combine a sight-seeing venture with an elective surgery, or a family vacation with Mom’s research study enrollment visit.
What Is Medical Tourism?
The CDC defines medical tourism as, “traveling to another country for medical care.” Under the umbrella of medical tourism, prospective patients are packing their bags and heading out in hopes of getting better, less expensive, or more immediate care than they may receive at home.
Beyond the CDC’s restriction of traveling internationally, medical tourism may occur domestically as well. Within the United States it is not uncommon to see patients traveling in order to visit research centers, be enrolled in clinical trials, or get a second opinion from field experts.
Where Do Medical Tourists Go?
Destinations range greatly depending on a patient’s country of origin and goal in medical tourism. Patients seeking care from expert specialists will end up in a different locale than someone seeking sunny skies to recover under.
The United States is a popular destination for medical tourists seeking advanced care. Almost half of the patients entering the US for care are from the Caribbean, with the next largest group coming from Europe. The Mayo Clinic and similar institutions actively advertise in overseas markets to woo potential clients.
For those leaving the United States, popular destinations include South and Central America, followed by the Caribbean. Traveling abroad for care is typically motivated by seeking lower costs outside an increasingly expensive domestic market.
Domestic medical tourism primarily revolves around receiving better care than a patient might find in their home state or region. By crossing state lines, an individual is usually seeking access to either a clinical trial or a specific medical expert. In some cases, they may be traveling to research institutions with programs relevant to their condition.
In some instances, medical tourism is encouraged by employers seeking to lower healthcare costs. Third-party companies work with treatment facilities and insurance reps to negotiate lower cost treatment for employees of participating businesses.
Medical Tourism Benefits
For patients, the obvious benefit is saving money. Many people, especially the uninsured, stand to save thousands of dollars on healthcare by travelling for procedures. Even after travel expenses are factored in, jetting to another continent can still prove to be the fiscally responsible decision.
For those concerned with quality of care over cost of care, travel offers the opportunity to be picky about practitioners. By cherry-picking doctors and facilities, patients may be able to access care not available at home, or elective treatments their regular provider refused.
Practitioners and facilities stand to gain financially from the estimated 500,000 patients that travel to the US for treatment every year. Patients will spend money on vacation stops, hotel stays and eating out during their time traveling, and the economic boost that provides inspired Florida to allocate part of its state budget specifically to medical tourism.
Medical Tourism Risks
Jumping on a plane and flying to a cheaper, more efficient tummy tuck isn’t all sunshine and roses, though. Medical tourism blurs the lines of accreditation, follow up care, and balance of responsibility.
Quality of Care
In the interest of cost, patients may seek out care centers that cut corners or don’t have an up-to-date facility. Medical standards vary from location to location, so it’s important that patients do their homework before committing to a travel plan. International accreditation standards have grown with the industry and can provide guidance in selecting a destination.
Beyond tangible factors, quality of care may arise from cultural or linguistic barriers creating misunderstandings between patient and practitioner. Medical details can be lost in translation, including prescriptions and doses, personal history that might impact the procedure, and, frighteningly, what’s actually being performed.
Meetings between practitioner and patient prior to the treatment date are essential to make sure all the necessary information is exchanged. Health history and treatment electives are important for physical health, but establishing an understanding of payment means and expectations is just as essential.
Understanding where the fiscal responsibility lies is perhaps the biggest headache in medical tourism.
Internationally, things are the most cut-and-dry. Generally speaking, insurance doesn’t cover overseas care unless it’s an emergency, and sometimes not even then. If treatment is sought in another country, it’s likely an out of pocket expense for the patient due at the time of service.
Domestically, payment gets a little stickier. Seeking treatment across state lines, or even in different counties, can result in patients being charged higher, out of network copay and coinsurance amounts. In some cases, a patient may think they’re receiving care at an in-network facility, only to receive the bill and find out the doctor was out of network.
Facilities are left with a tangle of complicated paperwork — if providers and facilities aren’t enrolled with a network, they risk being denied payment, getting involved in litigation with health plans, or having reimbursement recouped. Insurance payment to out of network facilities is lower than to those in network, leaving a greater financial responsibility to be collected from the patient.
Billing Medical Tourists
Patients may be responsible for more than they anticipate when opting to travel for care. Beyond the cost of the treatment itself, surgical procedures will require follow up care. Most patients do not opt to stay abroad for the duration of their recovery and seek postprocedural check-ups at home.
For offices, this poses several problems. Primarily, many doctors don’t want to follow up on work from a facility they’re not familiar with, especially when medical records need to be translated to be understood. Secondarily, billing an insurance company for follow up care without a preceding bill for the procedure frequently results in a denial.
When health plans deny insurance claims for coding reasons, offices must choose whether to appeal the denial or balance bill the patient. In either instance, financial resources are expended in pursuing reimbursement. To ensure accurate responsibility of balances, it is important that patients and providers sign legal documents outlining who the balance falls to in the event that insurance denies payment.