Things are not always what they seem. The percentage of surgeries or health treatments resulting in complications can vary significantly and is most often based on type of surgery, as well as individual health conditions, and the primary cause for treatment. Regardless of the provider’s conduct, the result of unexpected complications during treatment is most always higher cost than originally anticipated or planned for by either the patient or the provider.
Traveling abroad to receive medical treatment or healthcare services continues to gain popularity. Reasons for this treatment abroad are often derived from two key factors – expertise and cost. The recent increase in momentum to this global industry equates to elevated risk and loss to providers when trying to recover payment for these services.
Unforeseen events often change an expected outcome, especially for international travelers who need unexpected medical care. It is not uncommon for international travelers to fall ill or sustain an injury during the stay abroad resulting in required need for urgent medical care. This can affect a single traveler or their co-travelers as well. While on the topic, let us not forget the vacationers sustaining an injury or illness likely did not plan to spend a day (or more) in your Emergency Department or facility. Therefore, on top of having to treat these patients, providers are having to explain how medical reimbursement works in their country to patients who are unfamiliar with the system.
Ensuring patient satisfaction when being treated for a surprising illness or injury under a health system that is foreign is not an easy task for providers. Recent studies conclude, depending on destination and length of stay, up to 50% of travelers will experience an episode of illness or injury during international travels.
Access to resources and timing of tasks will contribute to providers' financial success as well as patient satisfaction in the unfortunate event additional or unexpected costs are incurred resulting from any of the above-mentioned scenarios.
There are fundamental principles which serve as the groundwork for maximizing revenue and obtaining it quickly. Those principals begin at registration when both provider and patient can obtain the necessary information to ensure reimbursement. Being able to talk patients through information needed when dealing with a travel policy at the start will ensure that delays are lessened and claims are resolved as quickly as possible for the satisfaction of both the provider and the patient.
Communication is key. From the providers perspective, contacting the insurance company as soon as possible to notify them of their member’s situation, to define the coverage limits, to be notified of any policy or plan exclusions, to outline documentation submission requirements, and to know the level of reimbursement expected including knowing the patient’s out of pocket responsibility sets the provider up for the meaningful and educated conversation to be had with the patient.
Obtaining in real-time a guarantee of payment (GOP) from an insurance company can ease initial concern over unpredicted costs. Obtaining as much documentation around the coverage in writing is key. Written verification of benefits will help to outline coverage information. Providers should also be prepared to communicate in an alternative language when reaching out to foreign insurance companies to have these conversations. Documentation received may also be in a foreign language. The home plan or travel policy company may not always have the necessary translation options needed by providers so having your own options to overcome these language barriers are key to communicating not only with insurance companies but also with patients.
Some key things you should have readily available before making the phone call to any insurance company or third-party administrator for a travel policy include:
- Patient Full Name and Date of Birth
- Insured’s Name and Date of Birth, if it varies from patient
- Diagnosis
- Insurance Card with Member Identification number and Plan or Group number located
- Patient health history
- Provider Tax ID number, if appropriable
- National Provider Identification number, if appropriable
- Date of admission or treatment
- If patient is being admitted and any initial recommendations on how long patient will be treated
It is recommended you keep the insurer apprised of the patient’s condition and services throughout the course of treatment, especially if there is a change in patient’s status or the level of care being provided. Document each exchange of information to include source of contact (including whether it’s by email, phone call, etc.), email address, phone number, or fax number used to make the communication, name of individual at insurer being communicated with as well as a reference number when possible, and a thorough summary of the information exchanged. Access to legal and clinical resources to provide further support of the provider’s position is a bonus.
Patient or next of kin advocacy during this stressful treatment time is invaluable. Having open dialogue in a professional yet kind way will reap a multitude of benefits. One of the most important areas to discuss and coordinate on is participation in the claims adjudication process.
Often, patient involvement may be beneficial in getting paid for services you have already provided. Including the insured in the account resolution discussion creates an equilibrium of power sufficient to encourage payers to avoid imposing ill will on its’ member and to take a stance of customer service rather than of process interference. We can all attest to the difference in demeanor when contacting the insurance company as a subscriber versus as a creditor.
Hosting a 3-way call which includes the insured and the payer is often beneficial as well as informational for both the provider and the patient. Forming an alliance with the patient can come back to be of value particularly if you have a residual balance due from the patient at the end of insurance processing.
There are some critical pieces of information that are integral to recovery success post patient discharge. Often these are missed or not documented correctly in a provider’s patient accounting system. Many systems have limitations around characters, symbols, and general field space to accurately capture foreign information.
Having the ability to document a patient’s address exactly as it would appear if they were receiving mail or a delivery to their home is first and foremost. In today’s era of electronic communication, obtaining patient approval to receive and exchange information via email and/or text and subsequently noting the full cellphone number with country code and their personal email address should also be a patient registration required element.
One thing healthcare providers have in common with payers is the desire to avoid bad public relations. Negative public relations can result in patient decrease and thus financial losses. New healthcare law in the United States ties future reimbursement to patient satisfaction. Communication with both the payer and the patient throughout the process will help the patient see the provider as an advocate. Having the patient as an added voice when dealing with the payer will help the provider reach resolution faster. When working towards the best outcome for patients treated abroad, both financially and physically, collaborating amongst the various parties involved is most fruitful and reduces revenue cycle challenges.
