All’s Well that Ends Well

It’s kinda quiet in the work comp blogosphere, and I’ve written enough about the pain medication abuse problem, that I thought I’d write another little scenario in which medical tourism can be implemented into workers’ compensation.

Here it goes:

“Juan Herrero”, not his real name, is a hard worker. He moved to the US as a small boy and got married, found a job and raised three kids as an employee of a large utility company in the Southeastern US.

Juan is the kind of guy you often see on a cherry-picker, high in the air, fixing electrical lines and cables. One day, while Juan was working in the cherry-picker, the door to the cab opened, and Juan fell to the ground. Luckily, the cherry-picker had not reached all the way to the top, so Juan’s fall was not that far.

However, Juan did injure his back, his shoulder, and suffered some bumps and bruises when he landed on the ground.

Juan was immediately taken to a local hospital and was seen by an emergency room doctor, and a specialist in orthopedics and spinal injuries. As his injuries were not life-threatening, and it appeared that Juan had not needed emergency surgery, he was released and allowed to go home.

Over the next two weeks, Juan complained of pain as he rested at home under doctors’ orders and having already missed time from work. His employer filed a workers’ comp claim with their insurance carrier, and Juan began to receive his indemnity payments.

But as the insurance company’s adjuster was beginning to handle Juan’s claim, the adjuster realized that it may be necessary for Juan to have surgery on his back and his shoulder after all, because of medical reports the adjuster received subsequent to his release from the hospital.

The adjuster, who worked for a Third Party Administrator, realized that for their company to pay for Juan’s treatment, it would be a considerable cost that they were not willing to spend on this case.

As it happened, the adjuster had the foresight to remember an article he read about medical tourism to Latin American countries, where surgery was far less costly than what is charged in the U.S.

One of the responsibilities of the adjuster was to find the best care for the injured worker at the lowest possible cost, and when he realized that surgery could be thousands of dollars less than here in the U.S., plus the cost of airfare and accommodation for the patient and his spouse, the adjuster decided to approach his superiors and the insurance company, and the employer to see if they were willing to try this. They agreed, provided that Juan and his wife agreed to go abroad.

As Juan had come to the U.S. from Chile, the adjuster learned that there was a hospital in Santiago, Chile, that specialized in trauma and rehabilitation. The name of the hospital was Hospital del Trabajador. Trabajador is the Spanish word for working man.

Juan and his wife agreed it would be a good idea to go back to Chile and see old friends and relatives they have not seen in years. As their three children were old enough to be left with friends nearby, the opportunity to have a vacation was enticing.

Juan and his wife flew to Santiago, and were met at the airport by the hospital’s staff, who escorted them to transportation that would take Juan directly to the hospital. His room was waiting for him, and the nursing staff got him into bed as soon as possible.

Juan’s wife was very pleased with the hospital room, and with the accommodations, and his surgery went exceedingly well, as the doctors had planned. He had an uneventful recovery, and his Chilean friends and family came to visit him and his wife while he was recuperating from surgery and throughout his rehabilitation.

Juan returned home to the U.S. grateful that his employer, their insurance carrier, and the TPA had suggested medical tourism as a treatment option, and his wife and friends and family were glad that Juan received such wonderful treatment.

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This entry was posted in Medical Tourism, Workers' Compensation and tagged , , , on by .

About Transforming Workers' Comp

Have worked in the Insurance and Risk Management industry for more than thirty years in New York, Florida and Texas in the Claims and Risk Management spheres, primarily in Workers’ Compensation Claims, Auto No-Fault and Property & Casualty Claims Administration and Claims Management. Have experience in Risk and Insurance Business Analysis, Risk Management Information Systems, and Insurance Data Processing and Data Management. Received my Master’s in Health Administration (MHA) degree from Florida Atlantic University in Boca Raton, Florida in December 2011. Received my Master of Arts (MA) degree in American History from New York University, and received my Bachelor of Arts (BA) degree in Liberal Arts (Political Science/History/Social Sciences) from SUNY Brockport. I have studied World History, Global Politics, and have a strong interest in the future of human civilization in all aspects; economic, political and social. I am looking for new opportunities that will utilize my previous experience and MHA degree. I am available for speaking engagements and am willing to travel. LinkedIn Profile: http://www.linkedin.com/in/richardkrasner Resume: https://www.box.com/s/z8rxcks6ix41m3ocvvep

2 thoughts on “All’s Well that Ends Well

  1. Mike

    That is exactly as it should be.
    A positive outcome, a satisfied employee, no absurd astronomical costs paid for treatment, etc.
    Everyone was a “winner” in this “Win”, “Win”, “Win” situation……
    Definitely something to look into…….

    “The times….they are a’ changing…..”

    Mike Benishek, Pd.T.F.

    Like

    Reply

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