A Few Answers to ‘More Questions, Questions’

My article, “More Questions, Questions: A Call for Answers from the Medical Tourism Industry”, asked members of the medical tourism industry to provide me with answers to several questions posed to me by an individual I had a running discussion with that week.

I posted the questions in the article, and divided the questions into the following four areas of concern:

Legal Liability and Medical Malpractice

HIPAA

Physical Therapy and Rehabilitation

After-care and follow-up

One individual did respond to my call for answers, and here is his reply: (Note: this individual is a specialty lines broker)

Legal Liability and Medical Malpractice:

Legal Liability and Medical Malpractice are concerns of course; however, one can mitigate their exposure by doing several things. 1. Obtain professional liability cover that includes managed care liability for overseas medical treatment. 2. Obtain specialized medical complication and medical travel insurance – Global Protective Solutions can assist with both. In the event of a medical complication (no fault or fault) arising from the procedure in which someone travelled, this specialty insurance would provide first party cover for the medical traveler. By attempting to make the injured party whole again there is little reason for them to place blame on an employer, facilitator or medical provider.

HIPAA:

Whilst HIPPA concerns are warranted there are various programs that can assist in keeping medical records /data private. These range from the very complicated to simple formats. Global Protective Solutions also provides services from their partner Swiss MedBank, that allows the patient/medical traveler to be in charge of his/her own medical records thus not leaving it up to a third party such as an employer or facilitator. Swiss MedBank is a leading provider of secure, safe medical information storage and retrieval services, the program acts as a type of “medical passport”.

Physical Therapy and Rehabilitation:

Physical Therapy and rehab will need to occur no matter if the surgery was performed in the home city, another state or in a foreign country. This should be a non-issue. If a PT/rehab provider declines treatment because the surgery was provided out of the country I would be wary to use their services no matter what.

After-care and follow-up:

Same as above. Certainly theses services would be needed, and pre-arranged before treatment is every given. In every situation the medical traveler would have received their initial follow-up and rehab before returning to the US. If there is a need for medical follow-up or further treatment due to a complication (fault or no-fault) it should be given be any licensed physician in the US. There could be some major laws being broken if treatment is denied, such as EMTALA as well as their Hippocratic Oath.

No difference between surgeries covered under group health care and workers’ comp

In my article, “Surgical Shenanigans: How Workers’ Compensation is being ripped off”, and in my article, “Clearing the Air: My Defense of Implementing Medical Tourism into Workers’ Compensation”, I asked the following questions:

Is there something different about patients who can afford to pay for medical treatment abroad or who have private health plans that do, from those who get injured on the job and have their treatment paid for by an employer or insurance carrier under workers’ comp?

What difference is there if a person injures their hip or knee by engaging in some sort of physical activity outside of their employment, or if the person gets hurt on the job? Are the surgical procedures for these types of surgeries different for a working person than those for a middle-class or upper-middle-class person?

Of course, the answer to both of these questions is no, there is no difference. And there should not be any difference when we consider the areas of concern I discussed above; namely, that if a patient has surgery that is covered by their group health plan or through their own insurance, they will require the same physical therapy and rehabilitation that would be required of a patient covered under workers’ compensation.

After-care and follow-up, as well as a return-to-work program, normally a part of the claims process for workers’ comp, would apply for the group health care or private pay patient. For example, in the second question, a knee operation would require a certain amount of after-care and follow-up, and a plan for the patient’s return to work, even if the patient injured their knee outside of their employment.

The problem is, and this was perfectly discussed in John Connell’s article that I cited in “Betting the Farm”, that we have separated the medical care received in general health care from the medical care received in workers’ comp, thereby placing them into two different silos of care.

There is a name for this way of thinking. It’s called “tunnel vision”, and in this case, there is no light at the end of the tunnel, only continued darkness. And until we all realize that medical care is really on one track, and one track only, there will continue to be darkness. The only difference between the types of care is how the care is paid for, and that too can be solved. It just requires the will to do so.

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I am willing to work with any broker, carrier, or employer interested in saving money on expensive surgeries, and to provide the best care for their injured workers or their client’s employees.

Call me for more information, next steps, or connection strategies at (561) 738-0458 or (561) 603-1685, cell. Email me at: richard_krasner@hotmail.com. Ask me any questions you may have on how to save money on expensive surgeries under workers’ comp. Connect with me on LinkedIn and follow my blog at: richardkrasner.wordpress.com. Share this article, or leave a comment below.

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This entry was posted in Group Health Plans, Health Care, Knee Replacement, Medical Tourism, Medical Travel, Surgery, Workers' Comp, 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

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