Domestic Medical Tourism

Friday, January 27, 2012

Domestic Medical Tourism: It seems counter intutive to pay for an employee or covered family member to travel to another locale in order to have a less expensive medical treatment. This travel often includes the transportation and lodging costs of a companion caregiver, such as a spouse or other adult relative to accompany the member. However, many large companies often include a domestic medical tourism option within their health care plans. While financial savings is one of the objectives, in other cases those procedures which are most likely to have the highest positive outcomes may only be available in another city or state. Furthermore, it is often the case were both financial savings and positive outcomes come together for the benefit of the plan sponsor as well as the member.

Domestic medical travel is frequently associated with medical centers of excellence which specialize in a limited range of disease conditions, yet employ leading edge treatment modalities. These centers are generally located in metropolitan areas throughout the nation, sometimes in conjunction with research and teaching hospitals. Facilities such as the Cleveland Clinic, Mayo Clinic, Johns Hopkins, and MD Anderson Cancer Center are among the several institutions touted as being recognized for their frontline treatment procedures for diagnosing and treating especially difficult medical conditions.

While expenses associated with travel, transportation, and lodging do not make financial sense for routine and uncomplicated medical conditions; treatment for unusual and rarely seen illnesses may confound local providers, even if they are a specialist. Misdiagnoses, unnecessary care, repeated or incorrect procedures may only exasperate the medical situation, resulting in lost productivity, wasted dollars, time, as well as ageist on the part of the member and family. Negative outcomes could result in long term or permanent disability and/or even untimely and avoidable death.

Organizational policies connected to domestic medical travel must be clearly and comprehensively documented within carrier contracts, Schedule of Benefits, Summary Plan Descriptions, as well as general and specific documents and policies addressing paid, unpaid, and FMLA leaves. Unless the organization retains internal or external medical expertise, it is best to rely on the recommendations of the member’s specialty care provider(s) in consult with the carrier as to whether or not domestic medical travel is warranted.
                  

Special attention should be paid as to who is permitted to travel with the member as a companion caregiver; this could include a spouse, domestic partner or an adult relative. Non-adult children should be excluded. In the absence of a related or domestic partner companion, an organization may want to consider the use of a medical or home health aide to assist the member before, during, and after the travel period. Again, it is best to rely on the recommendations of the member’s specialty care provider(s) when it comes to what type of companion would be required.

If the organization retains an EAP, it may be appropriate to make the member aware of and provide information about such services as requested. The EAP is in the proper entity to provide assistance with legal and other services to address issues dealing with durable power of attorney, advanced living directives, wills, and living wills.