Opt-out as a way in: Implementing Medical Tourism into Workers’ Compensation



Last December, in my post, The Stars Aligned, I mentioned a study released at that time that looked at the Texas model of an opt-out program for workers’ compensation, and the proposal that failed in the Oklahoma legislature last year.  My LinkedIn connection, Peter Rousmaniere recently released a new study on the Oklahoma opt-out program that was recently enacted by the Oklahoma legislature and signed by the governor, and what he reported about it has significant implications for implementing medical tourism into workers’ compensation.

The report was published today by Sedgwick CMS, and in his email on RiskList, a group I belong to on Yahoo Groups, Peter stated that opt-out right now is rapidly transitioning from a marginal, obscure concept to a viable, legitimate product in the employee benefits family with a compelling value proposition for every state.

Peter further defined the value proposition as follows:  The value proposition is that it by conforming work injury benefits to established employee benefit practices, and thus releasing it from the traditional statutory model, worker benefits can increase and employer premiums can significantly decline.

When I contacted Peter earlier today to clarify what this means, and whether this means that medical tourism could be implemented into workers’ comp as an employee benefit, his response to me was that it makes medical tourism viable for work injury benefits, as employer has largely unfettered discretion over selection of medical provider.

What this means for medical tourism and workers’ comp is this, as more states enact opt-out programs for employers in their states, the likelihood that an employer would chose to send their employees abroad for medical treatment increases. Considering what I have already said in earlier posts about the changing demographics of the US labor force and the rise of medical tourism destinations in Latin America and the Caribbean, this possibility is closer to becoming a reality because more states will have given their employers a choice to stay in the statutory system with its complexity and its legal barriers to implementing medical tourism, or to allow them to add workers’ compensation medical care as another employee benefit which they control and for which they can offer medical tourism as an option since they would no longer be subjected to state rules and regulations concerning medical care for injured workers.

This entry was posted in Employee Benefits, 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

5 thoughts on “Opt-out as a way in: Implementing Medical Tourism into Workers’ Compensation

  1. MercuryHealthcareCEO

    For an employer to “send” an injured worker abroad sounds easier than it really is. First, the tort lawyers would drool at the potential to state that the patient never reached their full recovery potential because the care was substandard. True or false, it would tie up the employer for years in the courts system unless tort law changes in the USA to complement this approach. Second, who would be doing the “sending”. Most human resources specialists that tend to the workers’ compensation matters are clerical at best, and not medically trained. How will they discern which case is appropriate for referral on a long flight, given the altitude physiology implications that could actually create increased risk of DVT / Pulmonary embolism, and exacerbate the claim further to a lifelong journey of blood thinners and expensive medications, and a larger PPD.

    I am sorry Richard, but I can’t stand when you post these simplistic solutions of workers compensation and medical tourism without addressing all the moving parts. It gives the readers who don’t have the medical wherewithal an impression that it as simple as a plane ticket and a lower surgery price. and that they are crazy not to. Much of the complexity lies within the Employees Retiree Income Security Act of 1974, as amended. [29 USC]. Your article provokes readers who are our network providers at Mercury Healthcare International and our employer clients to send me questions from all over the world to ask “why is he saying this?” “is it really that simple”, to which I have to answer “no” and then follow with a 45 minute explanation.

    As a professionally trained case manager, a health law paralegal, former nurse and a workers’ compensation specialist who understands this and has consulted in it since 1984, no way, can I allow this simplistic suggestion to stand without objection and caveat. There’s so much more to the story. If you want to address the topic, drill down to the strengths, weaknesses, opportunities and threats, but don’t pixie dust it.


  2. Ravindranath vs

    Yes, we too agree. However, i have a different opinion here. When we affix the word “tourism” with medical, people normally tend to believe that such ‘medical cases’ are not very critical which need emergency attention; and, a tooth implant, laser surgery, orthopedic cases, vision correction or even some other surgery which can be efficiently carried out in a foreign country of their choice, at a lesser cost, interspersed with sightseeing trips come under the category “medical tourism”. In fact this is true.
    I personally feel workers across countries of the world should be given this choice and facility to pick and choose their health program within certain budgetary limit.
    All necessary protocols should be carried out by the service provider.


  3. Healthcare Executive tired of the lack of substance

    RICHARD: Look to the source of whom is commenting. If you are familiar with the term “SHAM” then that describes the opinion of several folks and companies that say they are in the know and truly are not. When someone is an author, who sells a few books an not hitting the best sellers list, and has mirrored or copied another person’s work and does little or no work on an ongoing basis, I wouldn’t put much credence into anything Maria Todd says. She’s all mirrors with no substance. Granted she talks a good game and gets invited to speak, as she is a good presenter, but post the verbiage there lacks substance.


    1. richardkrasner Post author

      I don’t want to get personal, but I do think it is unfair to criticize someone who is doing their level best to get his ideas out there, and even going beyond their comfort zone. Yeah, I can shut down my blog and give up writing, but then the things I have to say would not be said. And I certainly don’t want to make enemies, as I am in no position to defend myself adequately through my work experience, but that may change. I won’t go into that at this point, but will say I am exploring a possibility that will provide me with more credibility. Rome was not built in a day, and neither will this opportunity, if it comes at all.

      I thank you for your comment and support.



Leave a Reply to MercuryHealthcareCEO Cancel reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out /  Change )

Google photo

You are commenting using your Google account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s

This site uses Akismet to reduce spam. Learn how your comment data is processed.