Industry News

Health Insurers Turn to Medical Tourism Strategies to Bypass Obamacare

Industry News

After miraculously dropping 170 pounds, Sarah Keenan could see for herself she might have bitten off more than she could chew. Her abdomen hung almost a half-foot below her waist; so much so that she tucked napkins into her excessive skin folds to avoid infection. Health insurance would cover some of the costs, but Keenan needed much more than a tummy tuck.

Sarah Keenan (Santa Cruz Sentinel Photo) dropped 170 pounds and then saved more than $30,000 when she underwent a medical tourism procedure in Mexico.

The California resident's decision to bypass Palo Alto Medical Foundation and take the last of the money she inherited from her father to travel to Mexico for cosmetic surgery continues to turn a few heads in more ways than her newly transformed shape.

I paid $16,000, and that includes 10 days in a private recovery hospital, said Keenan, who shared the news about her medical tourism surgery at Cosmed, in Tijuana, with the Santa Cruz Sentinel. It would have cost me $45,000 or $50,000 at PAMF and I would have had to go home the next day.

Certainly, some Americans especially the uninsured or those with limited coverage — have been exposed to medical tourism and taken advantage of the bargain prices often discovered abroad for elective procedures and treatments. Considering Lowe's allows employees and dependents from across the United States access to Cleveland Clinic, where they receive domestic medical tourism procedures; and Walmart contracts for healthcare coverage with centers of excellence across the country that perform heart, spine and transplant surgeries, medical tourism at least on the domestic front is as American as apple pie.

The Affordable Care Act has enabled some Americans to purchase health insurance for the first time, but providing fair-priced employee benefits remains a challenging prospect for U.S. employers, said Jonathan Edelheit, CEO of the Medical Tourism Association. Even though the increased cost for insurance has been shifted on the shoulders of working Americans, U.S. employers are beginning to identify self-funding strategies like medical tourism — that reconcile healthcare offerings with
financial goals of the business attracting and retaining healthy employees while maintaining the bottom line.

CLICK HERE: Self-Funding Passport

U.S. employers and the insurers that provide benefit plans to them are turning to medical tourism strategies to confront challenges from Obamacare.

But, not until recently — in part due to cost challenges stemming from the Affordable Care Act — have insurance companies devoted to American healthcare consumers begun to catch on to medical tourism.

Even though healthcare spending for American consumers dropped in May 2014 — the first time in almost four decades — Obamacare hasn't necessarily lowered costs for U.S. employers and the insurers that provide benefit plans to them, many of whom don't predict the inflationary dip to continue very long anyway.

In the meantime, some insurance companies have cut staff, tightened salaries or shifted the way in which they design healthcare benefit plans. UnitedHealth Group, WellPoint and Humana are examining cross-border plans aimed exclusively at reducing expenses by encouraging U.S. patients to seek medical tourism procedures abroad. Blue Cross Blue Shield of South Carolina already offers access to overseas procedures through a subsidiary, Companion Global Healthcare, Inc., which has medical tourism contracts with hospitals in Singapore, Thailand, Ireland, Turkey, and Costa Rica.

A few years ago, Aetna beat most everyone to the game by introducing a benefits plan that allows for members and their eligible dependents to access healthcare in the Mexican cities of Mexicali, Tecate, and Tijuana. Dubbed Vitalidad Plus, the benefit option offers 100 percent coverage for qualified preventative care including immunizations and child and adult wellness exams.

CLICK HERE: The Americans are coming!

Aetna has introduced a medical tourism option that allows for members and their eligible dependents to cross the border for healthcare in the Mexican cities of Mexicali, Tecate, and Tijuana.

Expect cost to continue to drive healthcare, putting patients at the wheel to find alternatives abroad that compensate for the elevated high deductible plans that more businesses intend to offer employees 23 percent according to a Kaiser Family Foundation survey.

While it won't take much for Americans to jump at the chance to save on insurance premiums and reduce their out-of-pocket costs  certainly lower wage earners — insurers can move beyond price to add incentives by contracting with only the best accredited international providers.

MediExcel, a small startup H.M.O, offers member Southern California employers access to routine doctor visits on a 24/7 basis. The Mexican-based company, licensed by California regulators to offer group healthcare coverage to U.S. employers in the San Diego area, enables Cesar Flores, a 40 year-old retail chain employee, to cross the border by car to Tijuana and undergo lab tests at a local hospital. By 7 a.m., after blood has been drawn a routine follow-up to a kidney stone procedure — Flores is in his car, where he will soon be at his home in Chula Vista by 10 a.m.

For patients shopping for cross-border or cross-country healthcare, pursuing quality and understanding the costs involved can be an arduous task. If nothing else except for expanding coverage to those previously uninsured, the Affordable Care Act has brought attention to the disparity among what different providers can charge for the same procedure based on factors such as geographic location, types of coverage and who performs the care. That should be transparent to all Obamacare or not.

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