Presented by
Tracy H. Simons, CISR, President, Custom Assurance Placements
www.medicaltourisminsurance.com
4 Key Topics
- Importance of Insurance in expanding industries
- Patients, Facilitators and Provider Risks
- Products Available
Accident Insurance – Travel and complications coverage
Liability Insurance for stakeholders
Professional Insurance
Medical Malpractice Insurance
Data Breach Coverage
Other Risk Mitigation Tools
- Real life claim scenarios
Taking Risks
Importance of Insurance
- Protection of Assets
- Allowing for Industry Growth
- Reducing Financial Risks
WHAT IF SOMETHING GOES WRONG?
Importance of Insurance and Common Concerns
The Benefits Accident Insurance
- PatientPeace of mind
- Professionalism to the industry
- mitigates YOUR Liability
- expert Assistance and claim services – repatriation benefits
- Dealing with Worst case scenarios
- ◦Reduces medical Receivables
- ◦Can be paid by patient and not aCost item orIncluded in the cost of Services
What is included in Medical Tourism Accident Insurance?
- Accidental Death and Dismemberment and Repatriation of Mortal Remains
- Costs of Additional Medical or Surgical Treatment as a result of a complication
- A Complication is a separate medical diagnosis as a result of the approved procedure.
- Additional costs of travel meals and accommodations due to a complication
- For the patient and the travel companion
- Stay in the country of treatment or return to the country of treatment
- Unsuccessful or unfavorable outcomes as a result of a complication
- Emergency Medical Transport
- 24/7 International Emergency Medical Assistance Service
- Accident and Illness – While Traveling
Misunderstandings Travel Insurance Versus Medical Tourism Insurance
What is covered by typical Travel Insurance
Sudden Illness and Unexpected Accidents, Trip Cancellation, Trip Interruption, Baggage, Death, Repatriation, Emergency Medical Transport, Assistance Services
Medical Tourism Insurance covers:
A planned procedure that increases the exposure and intent of travel
Includes Travel insurance but has specialized coverage for a planned procedure
Medical Tourism Insurance Is Not Health Insurance
Self pay and elective procedures – trends for inclusion in primary health insurance
Exclusions
Travel Insurance Versus Medical Tourism Insurance
What is NOT covered by typical Travel Insurance
Traveling for the purposes of receiving medical care and complications from that care.
Medical Tourism Insurance DOES NOT covers:
Costs of the planned procedure or related follow-up care or treatment
Pre-existing conditions, workmanship, failed outcomes
Medical Tourism Insurance Covers
Many benefits related to a “Complication” of an approved medical procedure.
WHAT IF SOMETHING GOES WRONG?
Claim Examples
CASE SCENARIO 1 – blood clot or thrombosis
Patient having Bariatric Surgery in Mexico with Daughter – experienced a post procedure blood clot and patient passed away.
- Assistance and Repatriation Service activated
- Death Benefit Paid
- Medical Bills Paid up to limit provided
- Travel, Meals and Accommodations of Daughter paid
WHAT IF SOMETHING GOES WRONG?
Claim Examples
CASE SCENARIO 2 – failed or unfavorable outcomes
Patient having breast augmentation in Thailand– 2 months post op diagnosed with capsular contracture
Additional Medical Expense paid to explant the implant (medically necessary care covered)
Once healed, the patient needs a revision (not medically necessary)
- The revision is required as a result of a covered complication
- Unfavorable Outcome benefit paid
WHAT IF SOMETHING GOES WRONG?
Claim Examples
CASE SCENARIO 3 – pre-existing conditions
Patient having Bariatric Surgery in Mexico – during surgery surgeon found hernia and repaired resulting in additional expenses
Cost of hernia repair is considered treatment for pre-existing condition.
WHAT IF SOMETHING GOES WRONG?
Claim Examples
CASE SCENARIO 4 & 5 – Pre- and post op instructions
Patient had bariatric surgery in Mexico. Pre- and Post surgery, they were advised not use tobacco. In the recovery suite they were discovered chewing tobacco. They had ordered delivery of a bottle of vodka to their hospital room and checked out of the hospital before discharged.
Patient had a hemorrhage and was taken to the hospital on the travel home. The bleeding and subsequent hospital stay costs were significant.
______________________________________________________________________________
Cosmetic patient went swimming in public pool while recovering and got an infection. The infection was severe and resulted in the eventual explant of breast implants.
Patient has medical expenses related the infection and then had an unfavourable outcome requiring a revision.
How does Medical Tourism Insurance
Accident Coverage reduces liability?
How does accident coverage reduce liability for stakeholders and provide value to the patient?
- The claimant is the insured and owner of the policy. If they have a loss, they collect the claim payment themselves.
- No need for the patient to file a lawsuit or claim against a third party (Hospital/Facilitator)
- Adds a benefit typically not afforded to a patient in a local setting.
- Adds reputational value to the receiving medical provider and facilitator
- Reduces receivables for the medical provider
Legal Action
- In what country would the patient file a lawsuit? Home Country of Traveler? Destination Country?
- What countries legal system will preside – determination of fault? Application of local law?
- How costly would it be to hire legal representation for the patient, the medical provider or the facilitator?
- How would a providers medical malpractice insurance apply?
- Standards of care are higher when a patient travels for medical needs
Waivers and
Opt-Out forms
Just like the standard disclosures used by providers, medical tourists also need an informed consent form or waiver, so they take personal responsibility for the exposure of travelling for medical care.
Providers around the world who offer or include a basic coverage for medical complications, typically require a signed “Opt-Out” form when coverage is declined.
- Opt-Out forms set expectations for the patient.
- They also protect the provider by allowing the patient to decide who is paying for an unforeseen complication
After-Care
Complications coverage options for patient satisfaction includes the possible need for medical care after the procedure.
- Coverage for a complication up to 6 months past the procedure date.
- Travel meals and accommodations costs for the patient and companion to return to the original provider to receive medical care or the patient can have care locally.
- Continuity of care issue – follow-up care is not included.
Professional Liability Insurance – E&O
Another form of risk management is liability insurance.
Who needs professional liability coverage?
- Travel Agents, Facilitators and Employers, Providers
- Anyone who manages a person’s healthcare or provides them with healthcare travel options or advice
- Suggest minimal requirements when dealing with referral sources.
Patient Privacy Protection
Patient privacy expectations
Government regulations – Application to your patients
GPPR https://gdpr.eu/checklist/
HIPAA (Americans)
PHIPA (Canadians)
Sending of personal data and medical recordsWhat will patient need? To file a claim? To have follow-up care?
Breach Notifications and Rights
Data Breach insurance provides a benefit to cover the expenses related to a data breach. Breaches can include notification costs and remedies.
HIPAA requires a breach be disclosed regardless of the number of people affected.
◦Exposure not only includes the healthcare provider but their associates who may aid healthcare entities and their subcontractors.
Can a solution be developed that meets the minimal requirements and allows patients access to needed records?
****Recent claim where records would not be released. Minimum standard of care when dealing with private and protected information is required.
In conclusion…
1. “Specialty” Travel Accident Insurance – meant for the medical traveler/tourist
a form of risk management
2. Opt-Out and Waivers – get legal assistance
3. Professional Liability Insurance – for sending organizations and employers
4. Medical Providers – Medical Malpractice insurance requirements?
5. Privacy Guidelines and Permissions – DATA BREACH
Questions?
Tracy Simons, CISR
+1 (803) 799-1770