Insurance coverage in U.S. affected by foreign proceedures

[dean]

My brother lives in Puerto Vallarta half the year and the U.S. the other half. He has good insurance in the U.S. (a perk from the company that he left 2 years ago) but has minor things and dental work done in Mexico. Last February, he decided to get the stomach staple surgery done (he is overweight and has breathing problems). He had it done in P.V., as his insurance wouldn't cover it. He has had many bouts with fevers and stomach probems and has seen his doctor in P.V. 3 times and was given anti-botics and told it would clear up. Last Thurday, in Dallas, he felt particularly bad and went to the emergency room. After checking him out, the doctor, in an X-ray, saw a sponge near his stomach. Surgery was performed and the sponge was removed, along with his spleen. The kicker was the day after surgery, when his insurance company told him they would not pay for the medical treatment given in Dallas, as he had elective surgery in a foreign country. He did leave the hospital 2 days early and is going back next Monday to have the U. S. doctor check him. I know that there was a thread a couple of weeks ago about plastic surgery in Thailand. I would assume that if there were complications at a later date, the person's U.S. insurance probably wouldn't cover treatment. I am wondering to what extent insurance companies try to exclude payment. Are they trying to exclude payment on surgeries done in third world countries. If I went to the (hypothetically) top rated clinic in Switzerland for electicive surgery, came back to the U.S., and months later had to have treatment done here, would it be denied. I guess the bottom line for americans that use medical services outside of the U.S., check with your insurance companies coverage and exclusions before having the proceedure done overseas.

[teddy]

I don't blame the insurance company at all in this case. Do you?

[dean]

I think if I have to get a list of approved foreign hospitals in the country that I plan on viiting before I leave the country, I'd do it. To tell a policy holder that, tuff luck, he are not covering you for mistakes done at reputable, accredited hospitals, is BS.

[teddy]

Forget where he had the procedure done, if the insurance company doesn't cover the procedure that he had. Why should they cover the consequences of the procedure?

 

Seems an easy get-out for the insurance company, nevermind the fact that he had it done in Mexico. If he had gone to a top US clinic and it had gone wrong they still wouldn't have covered the consequences.

[dean]

With U.S.insurance companies looking for any out that they can, I'm not surprised. Without looking at the policy, I don't know if the exclusion was based on strickly the proceedure or that the proceedure was performed out of the country. If the same thing had happened in a country with univeral health coverage, would he have been charged to have the sponge removed/spleen removed? If he had a high deductable and, while the insurance would cover the surgery but he would have to pay more of his own money for the surgery (and he could still get the treatment for far less abroad), would the insurance company be liable for any screw ups in that case? I have a fairly low opinion of U.S. health insurance companies and really don't care about the consequences to them when the health insurance industry is re-organised. All I'm saying in connection to one's policy is "buyer beware." Check it before going to another country for cheaper treatment/surgery.

[cavanami]

Good info to think about.

 

Yes, the insurance companies are trying to squeeze all they can to maximize their profits, sometimes to the detriment of the insured person (insured person dies because of coverage being denied).

 

Still waiting (six months) for my 65% premium reduction as Prez. O said the insurance companies must give out...reorganized, I'm not holding my breath!!!

[Faustian]

Saw Michael Moore's "Sicko" the other day. Very scary stuff.

 

It is amazing that in the richest nation people get denied healthcare. Forgetting everything else, this one thing is just startling.

 

In the richest nation on earth, people get denied healthcare.

[cavanami]

Go to Cuba to get world class health care at very affordable cost!

 

All my US tax dollars go to pay the farkin useless politicians! Have a nice day...

[Hugh_Hoy]

You say he has minor things done in Mexico and then a gastric bypass in Mexico? That's hardly a "minor" procedure !

 

FWIW, just read an article today that a lot of U.S. insurance companies actually encourage their policy holders to have some operations overseas. Like in India and South Korea. Interviews with a few who had the experience marvel over the attention they get and the accomodations; but aren't really happy with the language barrier which can really screw things up.

 

HH

[rchapstick]

My carrier has agreements with several overseas hospitals, including Bumrungrad. But for any surgery you need to get pre-approved.

 

Agreed that gastric bypass is hardly minor ... pretty major surgery from what I gather. Non-inconsequential risks of serious complications. This is, of course, a problem with having surgery done overseas. The surgery itself may (or may not) be ok, but the follow up is critical to a good outcome. Not easy to do on a "drive-thru" basis.