The passage of PPACA has caused many agents to consider alternative health care products for self-insured clients. Among those products is an international provider network through a medical travel facilitator — a medical travel health care benefit.
Medical travel is the practice of traveling across international borders to receive high-quality health care at a fraction of its U.S. price. A medical travel facilitator oversees the medical travel process, from managing the international provider network to coordinating the procedure and travel arrangements for the patient and companion. Many U.S.-based medical travel facilitators provide an international network of hospitals and providers that can be easily added to an employer's existing self-insured health plan. Typically, adding a medical travel health care benefit to an existing health plan costs nothing with no compromise on the quality of care, and the medical procedure savings range from 50 to 80 percent of U.S. prices.
Among the options offered by U.S.-based medical travel facilitators is stop loss coverage, which can help answer the client's question, "What if there is a complication, or I need additional medical treatment?"
What is stop loss?
Stop loss insurance in the medical travel industry provides significant financial protection for the client in the event that the patient requires additional medical treatment stemming from the medical procedure they received when abroad. This type of coverage does not cover a patient's decision to receive voluntary additional treatment in another country; it only will cover additional treatment that is medically necessary. The amount of stop loss coverage available depends upon the specific policy, but regardless of what you use, your goal is to limit the employer's financial responsibility.
For example, a medical travel facilitator's stop loss policy may limit a client's maximum responsibility to $50,000 in total medical travel expenses. Total medical travel expenses include:
- The initial approved medical procedure and travel expenses for the patient and companion
- Any additional required medical treatment and the expenses for the modified travel arrangements for the companion and patient.
In this scenario, once the total medical travel expenses exceed $50,000, the stop loss insurance that the facilitator provides will kick in for the next $100,000 worth of expenses. Therefore, the client will potentially be responsible for a maximum of $50,000 in total medical travel expenses — still far less than the average U.S. cost of $75,000 for a lumbar laminectomy with fusion alone, without additional medical treatment.
Kristen Montez is the director of legal and regulatory services at Satori World Medical.
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