Tag Archives: Costa Rica

An Old Story Resurfaces

My loyal readers may recall that in two separate occasions, I discussed a company in North Carolina called HSM that chose to send its employees to India and Costa Rica for medical care under their self-insured health care plan.

The two previous articles, US Companies Look to ‘Medical Tourism’ To Cut Costs and Self-Insured Employers and Medical Travel: One Company’s Experience came out of an interview in Business Insurance.com that was conducted by the author and the Director of Benefits for HSM, Tim Isenhower.

This morning, my good friend Laura Carabello of US Domestic Medical Travel.com published another interview with Tim, adding two more locations to their medical travel portfolio, Cancun and the Cayman Islands.

The interview is reproduced verbatim below, and pay attention to one point Tim makes about his company’s workers’ comp costs, a point I mentioned previously and cite as a basis for considering implementing medical travel into workers’ comp.

Here is the interview:

SPOTLIGHT: Tim Isenhower, Director of Benefits, HSM
Spotlight U.S. Domestic by Editor – March 20, 2018

About Tim Isenhower

Tim Isenhower, Director of Benefits – has worked with HSM and their self-insured health insurance for the past 25 years. Managing a self-insured health plan through the 90’s to today has provided him the opportunity to think out of the box for reduced healthcare cost programs including direct contracting, on site clinics, chronic disease management, and medical tourism. With IndUShealth, Tim and HSM were pioneers in self-insured companies offering medical tourism, as was presented on ABC News and Nightline.

About HSM

HSM is a privately-owned holding company based in Hickory, North Carolina, that specializes through its subsidiaries, in the manufacture of components for the furniture, bedding, transportation, packaging and healthcare industries, and the design and construction of automated production machinery for the bedding, apparel, aerospace and other industries.

Medical Travel Today (MTT): As a pioneer in the medical travel phenomenon, your story and your company’s role is so intriguing.

Tim Isenhower (TI): We are a manufacturing company and have had facilities coast to coast, as well as technologies in small towns and big cities. We were negotiating discount rates with hospitals across the country, where prices varied based on location.

I went to a human resource seminar in Raleigh in 2007 and Rajesh Rao’s company, Indus Health, was presenting medical travel to India as an option for employers. I went to India with Raj and his team, and got a physical exam which took less than six hours. In the U.S., this type of physical would have taken a month, from schedule to results.

So, we began offering medical travel to India for our employees during our annual enrollment process. We told them that if they chose to have a medical procedure done in India we would pay 100 percent, including travel with a companion.

We got no takers in the beginning. But at one of our final meetings, a fork lift driver from one our plants volunteered to have a knee replacement done in India – he simply couldn’t afford to have it done in the U.S.

He had never even been inside an airport, so I went with him and his travel companion. I was a little nervous because he had no experience traveling. But we got to India, and he actually did very well. He was impressed by the level of treatment he received.

When he returned home, he wrote a testimonial for our company newsletter. After that, more of our employees started traveling to India.

Soon word-of-mouth inspired more of them to get their surgeries in India because they saw what a positive experience it was.

MTT: So why did you shift your destination away from India?

TI: The cultural differences and distance resulted in many of our employees becoming homesick.

So, we started looking closer to home for medical care options. We have a large Hispanic population and Costa Rica had a history of high quality healthcare. We chose that area as the new medical travel destination.

Mostly, we send people for gastric procedures, joint replacements, back surgeries, hernia surgeries – a wide gamut of procedures.

Positive word-of-mouth has kept up the level of interest, and we also visit every location each year to promote the medical travel offering so more employees can understand its benefits.

MTT: And now you have expanded to Cancun. Do you find that there are other opportunities?

TI: We have. We had a patient go to Cancun just a couple of months ago. She did very well and that was a little different concept because it was an American doctor who flew down to Cancun to do her hip replacement. She was very happy with the services, pricing and results. We also send people to the Cayman Islands for various surgeries.

MTT: What has this experience meant to you, as an employer, beyond the cost savings?

TI: It’s really benefitted employee morale, to have a chance to travel to a place like Costa Rica, Cancun or the Cayman Islands. They come back and tell everyone about what a positive experience it was.

We’ve also been able to use our medical travel option as a recruitment tool.

What’s more, we saw our worker’s comp costs decline. [Emphasis mine]

I get thank-you notes from our medical travelers all the time, and we publicize these positive experiences within the company.

There’s no charge to the employee, and we give them a bonus when they return of 20 percent of what they saved the company.

MTT: Wow! That’s very generous.

TI: Up to $10,000. We are just trying to be a good employer, and this is just one way of doing that.

MTT: Do you know how many of your employees travel for surgery every year?

TI: I have lost count. We have roughly 2,500 employees now, and we’ve probably sent about 500 of them during the period of time that we have been doing this.

MTT: Did you ever have any unexpected outcomes?

TI: We’ve had people who had issues with back surgery, and they weren’t allowed to come home until the issue was resolved. But it was resolved.

They got better, came home and are doing very well.

That doesn’t always happen in a U.S. hospital. Here if a patient has issues down the road, they are on their own.

MTT: No legal issues?

TI: Fortunately, no. And the program is growing.

We’ve had everybody from executives to line workers utilize the program. Not everyone qualifies. A few have been eliminated because they have comorbidities that makes traveling for surgery unsafe, so these few were turned away.

MTT: And if you had to improve the program in any way, what would you suggest?

TI: I don’t know how I’d improve it.

Everybody that comes back is ecstatic about the program. The folks at Indus Health make it work. I know other administrators who couldn’t make it work. But Indus Health’s nurse case managers and screening process make it a no-brainer.

Rajesh Rao: We work very hard to make sure our patients are happy with our services. We don’t promise what we can’t deliver.

We work hard with our destinations to make sure we can provide assistance and high quality outcomes because that is what sells the program.

Jim Polsfut: I would like to add that it is a pleasure to work with Indus Health for all the reasons that Tim mentions. Their expertise and thoroughness have worked out very well with us.
We focus on three main objectives.

First, the quality outcomes.

Second, the satisfaction that we get from helping patients save money. In the U.S., it is so expensive to receive medical care even when you have a health plan. In that regard, the patient benefits in a significant way.

Finally, the cost benefit to the employer. For self-insured employers, this is important because of the hyperinflation of medical costs in the U.S. It’s difficult for employers to avoid the impact of healthcare expenses.

All of these factors motivate us, and give us a lot of satisfaction to provide a quality medical travel option.

Here is the link to the original: http://medicaltraveltoday.com/spotlight-tim-isenhower-director-of-benefits-hsm/


Medical Travel for Americans is Alive and Well

Many of you have probably thought that going abroad for medical care after passage of ACA was a thing of the past, or that the idea that workers injured on the job would go abroad was a “stupid, ridiculous idea and a non-starter”, have forgotten that medical care in the US is the most expensive in the world.

But the simple, undeniable fact is that we spend too much on medical care and get very poor results and outcomes, while other countries spend far less and get better outcomes.

Why are we so stubborn? And why hasn’t the workers’ comp world realized that they are fighting an uphill battle to lower costs every time they come out with some new strategy or cost containment measure that never lives up to its promise industry-wide?

Sure, there are individual cases where these companies save money for a particular client, but overall, the cost of medical care for workers’ comp still rises, even if that rise is slow at times, or appears to have shrunk, only to rise once again the next year, as seen in the NCCI State of the Line reports.

An article yesterday in Salon.com said that traveling abroad for medical care simply makes more sense — even regular teeth cleaning is four times more expensive in the US than it is in Mexico.

One of the first procedures mentioned in the article involves a Minnesota couple who went out of the country for an in-vitro fertilization (IVF) procedure. On her fourth trip to the Czech Republic, it finally worked, and she got pregnant. The procedure in the US would have cost them between $12,000 and $15,000.

While IVF is not something that workers’ comp would cover, the fact remains that procedures cost far too much in the US, and in the case of IVF, only have a 29% success rate, according to a CNBC report cited in the article.

An estimated 1.7 million Americans traveled abroad for care in 2017, according the Josef Woodman, CEO of Patients Beyond Borders, and author of the same titled book. In my seven years of studying medical travel, Josef Woodman’s name has figured prominently in many articles and forums of discussion on the subject.

The article goes on to say that that is 10 times more than the 2008 estimate from Time magazine.

Some of the top destinations for medical care are: India, Israel (always go to a Jewish doctor first), Malaysia, Thailand, Taiwan, South Korea (unless that little twerp up north gets an itchy trigger finger), and Turkey.

However, there are other, more accessible destinations closer to home like Mexico, Costa Rica, Panama, etc.

Typical operations are orthopedic or spine surgery (are you listening work comp world?), reproductive operations, cardiovascular and eye surgery.

For example, a coronary artery bypass graft (CABG) in the US costs an estimated $92,000 (you could buy a couple of nice cars for that amount), whereas in India, the same operation would cost $9,800.

A total knee replacement (are you still listening ,workers’ compsters?) cost around $31,000 in the good ole US of A, but in Thailand, costs around $13,000. Tell me how you can save that much on a knee replacement using any of your so-called cost saving schemes?

These same operations in Costa Rica would cost 45 to 65% less than in the US, and would not require such long flights from most parts of the US. What are you waiting for? Save some money, I guarantee your insureds will love you for it.

Malaysia would be 60 to 80% less, but why go there when you can go to Costa Rica?

According to Woodman, medical tourism (travel) is a Band-Aid for the country’s dysfunctional health care system.

Woodman told Salon, “I don’t think you can penetrate this with philanthropy. It’s gonna be baby steps all the way. But in the meantime, medical tourism is a really important option.”

Woodman also said he did not like the term “medical tourism” because it is not a vacation. You may have noticed that I use the term “medical travel” instead. It is travel for medical purposes, and if there is tourism component to it, it is incidental to the reason for going in the first place.

Patients who cannot afford dental work, IVF or orthopedic surgery in the US, Woodman said, should consider travelling abroad. If their operation or treatment is expected to cost them $6,000 out of pocket, they will save money — even with the plane ticket.

Oh, by the way, that Minnesota couple spent, get this, only $235 for the IVF, not including flights. With such reasonable cost savings, it would be a no-brainer for workers’ comp to do the same.

But some people are stupid, ridiculous, and non-starters in my book.

S**thole Countries and Medical Travel

The comment yesterday that the current occupant of 1600 Pennsylvania Avenue said, is not only revolting, disgusting, sick and racist. It is also a threat to the national security of the United States, and to the economic health of the nation, and of the medical travel industry.

A host on the Fox News network defended what was said Thursday by saying that this is how forgotten men and women talk. If by “forgotten men and women” he means the men and women who lost their jobs because their wealthy bosses sent their jobs overseas or they were lost due to automation, then they only have to blame themselves for voting against their economic interests, and not the immigrants they blame for losing their jobs.

As to what this means for medical travel, think carefully about who travels from the US to other countries like India, Thailand, Singapore, Costa Rica, Mexico, and others, and not to mention those countries he did mention as “s**tholes”, especially in Africa, the Caribbean, and the Middle East (a region he did not mention yesterday, but has singled out for a Muslim ban).

And consider also what this means for inbound medical travel from those continents and countries that American hospitals might want to attract. Would you, as a citizen of those countries, travel to the US if that was what the leader of the US thought about you and your country? I don’t think so.

The notion that we should take in people from Norway (not that there is anything wrong with Norwegians, in fact, I am watching a series on early Norwegian history, Vikings on the cable channel History) is proof that he is a racist and a white supremacist.

Comments on social media have even gone so far as to indicate that Norwegians would never consider moving to the US because they have a better standard of living and have free education, health care, and rank higher on all social metrics.

So, those of you in the medical travel industry should be aware that some of the resistance to medical travel from America, and from the very people who would benefit greatly from it, are the forgotten men and women the Fox host mentioned. If so, it will be a tough sell to get them over there.

Ashley Furniture and Medical Travel, part 1

From the One Hand Washes the Other department comes the following Spotlight article from Medical Travel Today.com.

Ashley Furniture, based in Wisconsin, is one of the largest manufacturers of home furnishings in the world.

I met Rajesh Rao in 2014 when I attended the Costa Rican Medical Travel Summit in Miami Beach. Rajesh’s company was also instrumental in convincing another furniture manufacturer, HSM in North Carolina, to first send patients to India, then to Costa Rica for medical care. I have written about this in previous posts.

This article is part one, and part two will run next month.

How Employers (and Medical Travel Facilitators) Can Deal With Zika

Teresa Bartlett, wrote last Friday in Insurance Thought Leadership.com about the precautions employers can take to avoid the Zika virus, and how to think about it.

She raises the following questions, and gives insightful answers:

  •  Where Is Zika Spreading?
  • What Are the Symptoms?
  • How Is Zika Treated?
  • What Special Precautions Should Be Taken by Pregnant Women?
  • What Should Employers Do?

The entire article can be read here.

Now that summer is almost upon us in the US, employers and those in other industries, like health care and medical travel, as well as the travel industry itself, should be fully aware of these facts.

Only time will tell before we have native cases of Zika here. You must be prepared.

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.

Ask me any questions you may have on how to save money on expensive surgeries under workers’ comp.

I am also looking for a partner who shares my vision of global health care for injured workers.

I am also willing to work with any health care provider, medical tourism facilitator or facility to help you take advantage of a market segment treating workers injured on the job. Workers’ compensation is going through dramatic changes, and may one day be folded into general health care. Injured workers needing surgery for compensable injuries will need to seek alternatives that provide quality medical care at lower cost to their employers. Caribbean and Latin America region preferred.

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.

Will accept invitations to speak or attend conferences.

Connect with me on LinkedIn, check out my website, FutureComp Consulting, and follow my blog at: richardkrasner.wordpress.com.

Transforming Workers’ Comp Blog is now viewed all over the world in over 250 countries and political entities. I have published nearly 300 articles, many of them re-published in newsletters and other blogs.

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Zika More Dangerous than First Thought

According to two reports on NBCNews.com, the Zika virus is more dangerous than health officials first thought.

The first report from last week can be found here. The second report says that Zika goes to the brain, and causes nerve damage similar to that caused by multiple sclerosis. Zika destroys developing nerve cells.

What does this mean to you, the medical travel facilitators working in Central and South America?

It means that maybe, money spent to attract patients to your countries, might first be better spent cleaning up your slums and cities that have standing water and debris that can be a breeding ground for the mosquitoes that carry the disease.

It also means that you must work closely with your government agencies to assure that medical travel facilities are clean and prepared to deal with the disease, should there be patients who come down with the disease while getting medical care there.

More on Zika and Medical Travel

Ian Youngman posted the following article on IMTJ.com last Friday.


This is in addition to the posts I wrote last month, “Will Zika Impact Medical Travel to Latin America?“, “Insurers’ Have Zika on Radar“, “OSHA To Weigh In On Interim Guidelines for Zika this Spring“, and “Zika to Cost Latin America and Caribbean $3.5B“.