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Work Comp Medical Tourism – Thinking Way Outside The Box

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Work Comp Medical Tourism – A New Frontier?

The subject of Work Comp medical tourism was something that I scoffed at when I first heard about this interesting Risk Management technique.   However, when I started talking with one of the medical tourism bloggers – Richard Krasner – the subject peaked my interest greatly.

Picture of Doctor with Stethoscope Work Comp Medical Tourism Concept
123RF

 This blog always is in search of technology for Workers Comp. The bottom line is that improvement and savings in WC, may not be with a smartphone and an app.

While this is not a techno-innovation, it may be an accepted practice soon as Washington and Oregon already allows this practice to some degree.   An article from Richard’s blog is below used with his permission.    His byline is at the end of the article.

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.

Geo Work Comp Medical Tourism Globe
Wikimedia commons – Kskhh

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.

Map and stethoscope with airplane Work Comp Medical Tourism Around The world
(c) 123RF

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 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.

Picture of Man Doctor Work Comp Medical Tourism with color green background
StockUnlimited

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 work comp medical tourism 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 work comp medical tourism destination facility in the region.

http://www.wcexec.com/Insurance-Company-Innovates-Claims-Savings-video.aspx

By Richard Krasner, MA, MHA, Blogger-in-Chief, Transforming Workers’ Comp blog,

Work Comp Medical Tourism Blog can be found here at Richard Krasner.

©J&L Risk Management Inc Copyright Notice

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Table of Contents

James Moore

Raleigh, NC, United States

About The Author...

James founded a Workers’ Compensation consulting firm, J&L Risk Mgmt Consultants, Inc. in 1996. J&L’s mission is to reduce our clients’ Workers Compensation premiums by using time-tested techniques. J&L’s claims, premium, reserve and Experience Mod reviews have saved employers over $9.8 million in earned premiums over the last three years. J&L has saved numerous companies from bankruptcy proceedings as a result of insurance overpayments.

James has over 27 years of experience in insurance claims, audit, and underwriting, specializing in Workers’ Compensation. He has supervised, and managed the administration of Workers’ Compensation claims, and underwriting in over 45 states. His professional experience includes being the Director of Risk Management for the North Carolina School Boards Association. He created a very successful Workers’ Compensation Injury Rehabilitation Unit for school personnel.

James’s educational background, which centered on computer technology, culminated in earning a Masters of Business Administration (MBA); an Associate in Claims designation (AIC); and an Associate in Risk Management designation (ARM). He is a Chartered Financial Consultant (ChFC) and a licensed financial advisor. The NC Department of Insurance has certified him as an insurance instructor. He also possesses a Bachelors’ Degree in Actuarial Science.

LexisNexis has twice recognized his blog as one of the Top 25 Blogs on Workers’ Compensation. J&L has been listed in AM Best’s Preferred Providers Directory for Insurance Experts – Workers Compensation for over eight years. He recently won the prestigious Baucom Shine Lifetime Achievement Award for his volunteer contributions to the area of risk management and safety. James was recently named as an instructor for the prestigious Insurance Academy.

James is on the Board of Directors and Treasurer of the North Carolina Mid-State Safety Council. He has published two manuals on Workers’ Compensation and three different claims processing manuals. He has also written and has been quoted in numerous articles on reducing Workers’ Compensation costs for public and private employers. James publishes a weekly newsletter with 7,000 readers.

He currently possess press credentials and am invited to various national Workers Compensation conferences as a reporter.

James’s articles or interviews on Workers’ Compensation have appeared in the following publications or websites:

  • Risk and Insurance Management Society (RIMS)
  • Entrepreneur Magazine
  • Bloomberg Business News
  • WorkCompCentral.com
  • Claims Magazine
  • Risk & Insurance Magazine
  • Insurance Journal
  • Workers Compensation.com
  • LinkedIn, Twitter, Facebook and other social media sites
  • Various trade publications

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