Tag Archives: ICW

Cross-Border Health Care – Insurance Industry Finally Takes Notice

Readers of this blog have no doubt read my first post on cross-border health care, Cross-Border Health Care a Reality in California, among others. Many of them dealt with getting medical care under workers’ compensation, and the others were confined to the health care space.

Thanks to fellow blogger, Joe Paduda, who sent me a copy of the following Quick Take from the GB Journal, a publication of Gallagher Bassett, the issue of cross-border health care, especially in workers’ comp (my idea originally) is finally getting traction in the industry.

Not that I am blowing my horn, mind you, but it would have been nice to get some recognition a few years back when I started writing.

Well, anyway, here is the item from GB Journal:

Quick Take 2:
Cross Border Health Care

Employers in Arizona and California’s huge agriculture business figured this out a long time ago. For many employees who are either Mexican nationals or who have extensive family connections in northern Mexico, getting needed medical treatment in Mexico can be both more convenient and much more cost effective than treatment north of the border. Your humble correspondent set up group health PPO networks in Mexicali and Tijuana for seasonal farm workers back in the 80s. They worked remarkably well and provided this generally underserved group with excellent care at affordable rates. A recent article in Risk & Insurance’s online service describes how the same concept is now being used for treatment under workers’ compensation. 

Yes, this is legal under California law. (The R&I article does not mention Arizona comp law.) The author makes specific reference to the Mexican HMO Sistemas Medicos Nacionales, S.A. de C.V. (SIMNSA), which is – an important point – licensed by the State of California. In addition to lower costs and convenience, treating in Mexico can have additional advantages for injured workers who are not fluent in English and who feel more comfortable in a familiar cultural setting. Getting medical treatment in Mexico is not suitable for all claims or all employees, obviously, but if you have a significant comp exposure close to our southern border, you might want to check this out with your comp carrier or TPA, if you have not already.

If you want any additional information, or would like to explore this option for your workers’ comp needs, contact me and I will work with you to put together a plan for you.

Cross-border Workers’ Compensation a Reality in California

I received an email Friday from one of my LinkedIn connections, Joe Burgess, Senior Executive Vice President for CHSI in Las Vegas. Joe and I had connected back in January, and he mentioned at that time the name of a company called SIMNSA. He informed me that SIMNSA had started a project in regard to cross-border health care for workers’ comp into Mexico. This was in response to my inquiry into any work his company may have been doing with cross-border health care for workers’ comp, since his company is based in the Southwest.

So on Friday, Joe was kind enough to send me a link to a website called Workers’ Comp Executive. The link was a video on that website hosted by the publisher of Workers’ Comp Executive, Dale Debber. Joe told me that this was a program that his company was pushing for the WC self-insured group they used to manage.  He indicated that the self-insured group did not go with it at the time (and may have since) but a company called Insurance Company of the West (ICW) did, which is the subject of the video.

Without going into great length about what is on the video, since it is thirty minutes long, I will just give you a brief description of what came about from the first few minutes of the video, and I will let you decide if you want to watch the video in its entirety.

Dale, the publisher of Workers’ Comp Executive interviews Paul Zamora, Senior V.P. for Workers’ Comp for ICW, and as Paul explains, the idea to explore cross-border health care for the employees of ICW’s San Diego area insured clients came from an agent for Alliant Insurance, Larry Osborne. As Paul tells Dale, SIMNSA is providing many of the businesses in the San Diego area that have employees who live in Mexico, but commute to work in CA, as their HMO, since SIMNSA is the first and only Mexican HMO licensed in CA to offer an HMO product.

The employees are given the option of choosing SIMNSA or any other company for their employee health care plan. And it was Larry Osborne who said to Paul, why can’t they do that for workers’ comp. ICW was a little sceptical at first, but their legal team said that they did not give up their right to control medical, if they were using a non-CA domiciled company. They were told no, they do have the right to have their primary care doctor in CA, and outsource services elsewhere.

At this point, Dale interrupts Paul to ask a very good question. “Does that mean that the utilization review is being conducted here in CA under the control of ICW, but the treatment is on-going in Mexico for those who choose that?” Paul replies that that is correct, and then explains that if an employee is injured, first he will see a primary treating physician in CA who is familiar with SIMNSA, then all future treatment if there is any, is via SIMNSA, with follow-up visits on a routine basis with their primary care physician here.Paul goes on to say that it is the employee’s choice, and that at no time do they tell an insured that they have to have their employees treated by SIMNSA. It is always the employee’s choice to use SIMNSA.

Currently, this program is only in the San Diego/Imperial County area, as Paul tells Dale, because companies in other areas do not have employees that commute for work to CA from Mexico. Paul goes on to say that the quality of care is very good, and there are excellent doctors in Mexico, and that it is very convenient for the worker to be treated in Mexico.

Dale then asks Paul about the fee schedule and he wanted to know if it was an advantage for the employer, and as Paul explains, they were able to negotiate with SIMNSA a better fee schedule because their costs were lower.

I am going to stop here and let you watch the video yourself, so that you can decide if this is something your company would like to do, whether you are an insurance carrier, employer, self-insured employer, etc. But it appears to me that as the workforce in the US grows more Latino and Caribbean, these kinds of programs will be more common, and in many cases, for lower cost surgical care than what is available currently here in the US. It’s up to you…higher cost surgery with not so good outcomes here, or lower cost surgery with better outcomes in a medical tourism destination facility in the region.



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