Insurance

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August 12, 2008

The debate over U.S. health-care reform rages on. But why wait for someone else to dictate your future? You have many options -- if you're willing to take a vacation. If recovering from a medical procedure while lying on a palm-swept beach, relaxing by the hotel pool, or shopping for terrific bargains sounds good, then medical vacations may be exactly the right solution for you.

From hip replacement to heart surgery, more people are discovering the advantages of traveling abroad for their medical needs.

A big growth industry
In just the past few years, medical vacations have gone from a tiny niche market to an impressive growth story with substantial market-share gains. From Mexico to India, Costa Rica to Thailand, hospitals are taking advantage of this global trend. And U.S. companies are taking note as well. Aetna (NYSE: AET) and Blue Cross Blue Shield of South Carolina are among the health-care companies tailoring their corporate health insurance plans to give employees the opportunity to head to India or elsewhere for surgeries such as knee replacements and the more modern, less invasive approach to hip replacement, hip resurfacing...

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June 2008

Link http://www.nbc11.com/msnbchealth/16748813/detail.html

Timmi Ryerson, a San Diego stock market analyst, says her left hip actually works again, thanks to an orthopedic specialist in India.

...What's new about these procedures is not the exotic locales the three chose, but the way they paid for their far-flung surgeries.

While at least 150,000 Americans travel abroad for medical care every year, according to the American Medical Association, Ryerson, Mason and Davies represent a small but growing category of medical tourist: patients whose insurance companies have agreed to foot at least part of the bill.

"I think that's the solution to our health care crisis," said Davies, 53, whose company plan, Delta Dental, maxed out his dental benefit, about $2,500, toward the $30,000 he spent to repair damage caused by years of grinding his teeth, a procedure that would have cost an estimated $80,000 in the United States.

Increasingly, some of the nation's larger employers and leading health insurers agree.

Once the province of the poor and uninsured, medical tourism is gaining attention of industry giants such as CIGNA, Aetna and Blue Cross/Blue Shield, who say they either have begun or are considering pilot programs that provide limited coverage for foreign care. One Montana firm, Employee Benefit Management Services Inc., recently began offering medial tourism plans to its 120 self-insured clients in the Northwest...
 

"I just think that others need to be aware that they are able to have a safe procedure done out of the country for a price at a third the cost," she said.

Ryerson, 61, said her private Blue Cross plan paid 80 percent of a $7,000 hip resurfacing surgery in Chennai, India, that would have been about $55,000 in the U.S. - if she could get it at all.

In 2006, the hip resurfacing device necessary for her surgery had just been approved for U.S. use by the federal Food and Drug Administration and not many domestic doctors had experience with it. Dr. Vijay Bose, her U.K.-certified surgeon in India, had performed the surgery more than 1,100 times.

"Doctors here didn't know what they didn't know and I didn't want to be a guinea pig," she said.

While she was there, Ryerson also had cosmetic surgery and dental work done at her own expense...
 

Need health insurance? Better get to work
Do research to find the best individual plan

Link  http://www.kentucky.com/147/story/279530.html

By Jane Glenn Haas
THE ORANGE COUNTY REGISTER
If you are too young for Medicare but considering leaving a job that offers group health insurance, it pays to do some research.

After a yearlong investigation, Consumer Reports has concluded that 89 percent of the people younger than 65 who look for individual health insurance do not buy it because it is too costly, because they are turned down for health reasons or because benefits are inadequate.

"Private insurance is virtually out of the question for 76 percent of uninsured Americans -- and those who do have insurance told us wrenching stories about the high costs and poor coverage they receive," says Nancy Metcalf, health editor at Consumer Reports.

She calls searching for private insurance "daunting" and a challenge to any adult who hopes to retire early, loses a job, is self-employed or has an adult child leaving a group plan.

"The nature of health insurance is that the only people profitably to insure are those who are healthy," Metcalf says.

Question: Why can a person get coverage in one state but not in another?

Answer: The insurance industry is regulated on a state-by-state basis. There is no uniformity. There are enormous differences in disqualifying medical conditions.

Q: You cite PacificCare, which might exclude anyone who takes prescription medications for high blood pressure, acid reflux, asthma, migraines, arthritis. Aetna won't insure anyone who has had a hip or knee replacement. Other insurers have equally onerous health hurdles. Some of those conditions are tough to avoid after 50. What alternatives do we have?

A: It is very shocking to a lot of people. There is no good answer for the way the individual insurance system works today. People just don't realize they are only paying 25 percent or 30 percent of the premium when they have group insurance. Consumer Reports found that the median out-of-pocket medical expenses for the last 12 months were $2,264 for those with individual insurance vs. $973 for those with employer-based plans.

Q: You have many tales of insurance woe in your article. What's a person to do?

A: Start by going to www. healthinsuranceinfo.net to check out coverage in your state. You really need to be careful leaving a group plan. There is a little window for coverage.

The federal Health Insurance Portability and Accountability Act provides some protection if you are switching from job-based group coverage to an individual plan even if you have a medical condition that could preclude insurance.

But to exercise your HIPAA rights, you first have to exhaust all job-based coverage available, including COBRA, which allows you to continue in your employer's plan for 18 months by paying the full cost plus 2 percent.

HIPAA is like a get-out-of-jail-free card for people with pre-existing conditions. But you must apply for individual coverage within 63 days after your old coverage ends.

Every state has to make sure there is at least one policy available to you if you meet these conditions.

Q: Other suggestions?

A: Know your state laws.

Q: What are other ways people can educate themselves?

A: Go to www. consumerreports.org/health for unbiased comparisons and www.eHealthInsurance.com for links to hundreds of insurance plans across the country.

By Alan Ray  LBHR with Dr. De Smet  12/15/2004 

THE APPEAL LETTER TO CIGNA (NAU IS "national appeals unit") 
 Dear CIGNA NAU: 
 I have received your written notice, dated Aug. 27, 2004, denying my initial request for pre-authorization for left hip surface arthroplasty. With this letter and attachments, the request is being re-submitted for further consideration as an appeal of the initial denial.
 
 I am a 55-year-old male diagnosed in March of this year with end-stage osteoarthritis of the left hip, with “some component of dysplasia”.  The result of the condition is that I am unable to engage in the athletic activities that have helped me control hypertension and maintain extremely low blood cholesterol levels (as demonstrated in my past two annual
 physicals). Despite a high-stress professional position and extremely demanding work schedules, I have managed to maintain my health…with the help of competitive handball, three to four times a week, and a rigorous regime of weight-resistance training, and aerobic conditioning. Now the activities that helped keep me healthy are closed to me.
 
 The physician who provided the initial diagnosis also made clear that, with a Total Hip Replacement, these activities would be closed to me for as long as I live. With that word from him, I set out to find an alternative.
 
 It is clear, from what I have read in the professional literature that, with a Total Hip Replacement, in addition to a high level of surgical and post-operative complications, there is an exceedingly high likelihood of dislocation in even basic activities...
 
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