Category Archives: Monopoly

Washington State Workers’ Comp Accepts Foreign Medical Providers

Seven years ago, when I was working on my MHA degree, I wrote a paper which has become the basis of this blog.

During that time, I found the website of the Department of Labor & Industries for Washington State, and was surprised to find landing pages that listed physicians in Canada, Mexico, and other countries. These countries were mentioned in my paper, and I have referred to it in subsequent posts from time to time.

However, in the period since, I have noticed that the landing page for other countries was removed. I contacted WA state a while back and was told they were updating it. Yet, as of recently, it is still not been replaced, so I contacted them again yesterday.

I received a reply from Cheryl D’Angelo-Gary, Health Services Analyst at the WA Department of Labor & Industries. She indicated in her response that she is the business owner of the Find a Doctor application (FAD).

According to Ms. D’Angelo-Gary, “our experience showed that most of Washington’s injured workers who leave the country travel to one of these adjacent nations. Workers who travel further afield are advised to work with their claim manager to locate (or likely recruit) a provider. All worker comp claims with overseas mailing addresses are handled by a team of claim managers who have some extra training to help the worker find a qualified provider.”

I asked her to clarify this statement further in my next email by asking if this means that any claimant who travels outside of North America will have to ask the claims manager to find them a doctor.

She replied, “interesting questions!” She also differentiated between an injured worker who is traveling versus one who has relocated out of country.

She went on to say that, “a worker who is traveling and needs claim-related care would be instructed to seek treatment at an ER or urgent care clinic, where the providers do not need to be part of our network and would not be providing ongoing treatment. To be paid, the provider would have to send us a bill and a completed non-network application (available online). Under no circumstances should the provider bill the worker.”

However, she continued, “a worker who has relocated overseas must send in a change of address (required whenever a worker moves). That allows us to transfer management of the claim to a unit that specializes in out-of-country claims. The claim manager would work with the injured worker to help the worker find somebody in their new location. It’s critical (per state law) that the worker choose their own provider, though the provider must meet our requirements and standards of care. Proactive workers tend to handle this well, and find a provider in very little time; less proactive workers can find this challenging. We’re currently looking at this process to see how we can do this better.”

And in final emails to her last night, I tied the first scenario to medical travel, and the second scenario to ex-pats living abroad, but needing medical care. I also asked about workers who wanted to travel back to their home country for medical care, and said that I write about medical travel for workers’ comp.

As of today, I have not heard back, but it is early, and there is a three-hour difference between us.

It must be pointed out that WA state is what is termed a ‘monopolistic state’ in that the state does all the work of handling workers’ comp insurance and claims. Thus, when Ms. D’Angelo-Gary says that worker must work with the claim manager, the claim manager in question is a state employee, and not an employee of a commercial insurance company.

It may be possible, therefore, for medical travel to be implemented in workers’ comp, and it should be something that the medical travel industry and the state should explore together. Ms. D’Angelo-Gary did say they were looking at this process to do better. What better way to improve the process then by utilizing medical travel?

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Satori Files For Bankruptcy: What that Means for Medical Travel

As reported last month by US Domestic Medical Travel.com, Satori World Medical, Inc., a company based in San Diego, filed for bankruptcy.

When news of this story broke, I inquired with my contact at US Domestic Medical Travel.com to learn what this meant for the patent Satori had taken out that had a chokehold on the growth and development of the medical travel sector, both domestic and international.

Her reply was that she was not sure, so I looked up what happens when a company goes bankrupt. Most of the information concerned companies who manufactured products and what happens to the patents to those products after a bankruptcy. The gist of what I found was that they transfer to the receivers/liquidators.

But since Satori’s patent is for an idea, and not a tangible asset like manufactured goods or inventory, I doubt the receivers/liquidators for this action would be willing to take this asset. What would they do with it?

So, instead of wondering, because that may be a fruitless exercise, let’s look at what the patent was all about, what it allowed and did not allow, and then you can decide how best to model your business plan going forward.

The Satori patent, trademarked as the “Health & Shared Wealth Program”, is actually two patents; the first, U.S. Patent 8160897, titled the “Satori Integrated Health & Financial Benefits System and Method” and U.S. Patent 8224668, a Continuation-in-Part to Patent No. 8162897.

They are part of a portfolio of other patents of intellectual property that regard the calculating and sharing of the dollar savings from a medical travel health benefit. The patents provided Satori with exclusive rights to the only permissible medical shared savings model in the medical travel industry.

I know what you all are thinking, how can anyone patent an idea such as this? Isn’t this restraint of trade, you may wonder?

Well, as I am not a patent attorney, nor an intellectual property expert either, I would think not, except that was the case before the bankruptcy.

As Satori’s own website states, the Health & Shared Wealth Program supports organizations by lowering their cost structure for health benefits by providing plan members with a highly-valued benefit option at no cost to the plan sponsor or members.

The parent patent, they continue, is a system and method that calculates the savings generated when a patient selects medical care outside the US.

It waves all co-pays, deductibles, and/or co-insurance, making the selection of outbound medical care a 100% medical benefit for the patient. In addition, it shares the savings between the patient and the insurer/employer.

I want to stop here in the explanation of the patent to tell you my idea, and why this patent seems to me to be a restraint of trade issue and a virtual monopoly.

My idea was to implement medical travel into workers’ compensation in the US, and along the way, after writing my paper on the subject, and this blog, I learned from other individuals that the best way to do so was to offer an financial incentive from the savings to the claimant/patient from either his employer or insurance carrier.

At the same time, I learned from one individual, that in order for this to be advantageous, the savings had to be greater than $5,000 for medical care received outside the US. So for example, if a knee surgery in the US cost $30,000, in order to convince an employer or insurance company of the efficacy of outbound medical travel, the cost of that knee surgery would have to be $25,000 or less.

How much the claimant/patient would receive and when and how they would receive it is a matter of discussion. It could be a percentage of the savings, a flat-rate of say, $2,000 or $2,500, or come from the overall settlement of the claim, but that could take years to realize.

Returning to the patent, the Health & Shared Wealth Program, Satori states, precludes certain entities such as medical travel/medical tourism facilitators (I bet you are hoping mad at this point; I sympathize), health plans, self-funded and fully insured employers, Taft-Hartley trusts (labor unions), unions, workers’ compensation carriers (this got me mad), municipalities, pension plans, etc., from offering any shared savings model similar to the one described above to their clients and/or plan members without written permission from Satori (now you must be steaming!!!!).

So, what does this mean? If Satori is out of business, we can all take a sigh of relief that now the wicked witch of the west (Satori) is dead. What comes next is up to you. Prior to the announcement, there were ways to get around the patent’s restriction. Now, that may not be necessary.

My suggestion is get yourselves some good IP attorneys to see if you are good to go, and if you are given the green light, adjust your business model and plan accordingly. You will only benefit from the fall of the house of Satori.