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Employer sponsored medical tourism: Kevin’s new knee

Kevin's new knee

Many medical tourism destinations and international hospitals are pursuing the “American dream” and see the USA as a lucrative market for their medical tourism services. Companion Global Healthcare is one of the few businesses that has understood the opportunity in US employer sponsored medical tourism. Phil Midden from Companion Global Healthcare provides the background to “Kevin’s new knee”.

Companion Global Healthcare facilitates medical tourism options by providing concierge travel, case management services and assisting patients with accessing select hospitals. CGH has built extensive relationships with hospitals worldwide and contracts with a highly select network of facilities. CGH also assists employers with modifying their benefit plans to create significant savings by incenting employees to consider surgery abroad for medically necessary, episodic procedures.

The story of Kevin, an employer sponsored patient from the USA, is told in the patient’s personal blog: Kevin's New Knee Why in the world would I go around the world for a knee?

Companion Global Healthcare assisted Kevin in traveling to Kuala Lumpur, Malaysia to receive a total knee replacement. By choosing Ramsay Sime Darby over a typical US hospital, he saved his employer approximately $15,000 to $20,000, including travel costs. The savings factor in his employer covering the entire cost of business class airfare for the patient and his wife, as well as their hotel stay for the entire 12 day period. His wife stayed at the hotel the entire time.  He stayed at the hotel for the first two days of the trip before being admitted to the hospital for surgery. Once discharged after five days in the hospital he re-joined his wife in the hotel while he continued his recovery and continued his daily physical therapy.

How are the savings calculated?

The savings made are approximate for two reasons:

  • First, US hospitals generally do not provide all-inclusive case rates as non-US facilities do. It is necessary to estimate an episode of care in the US and compare it to a non-US facility. In this case Ramsay Sime Darby.
  • Second, the comparison between the facility in Malaysia, where he had surgery, to where he could have had surgery in the US, varies depending on exactly which facility in the US is compared. The patient is from Columbia, South Carolina. Based on our knowledge of all related insurance negotiated hospital prices and allowable costs for total knee replacement in the Columbia area, we can reasonably expect his employer saved $15,000 - $20,000 assuming he would have had the procedure in South Carolina.

There are hospitals in the US that are significantly more expensive than others regardless of how charges are bundled; insurance companies pay some hospitals substantially more than other facilities. However the savings above are reasonable.

His employer also waived the out-of-pocket costs he would have been subject to, if Kevin had undergone the surgery in the US. This is according to the self-insured plan document his employer put together.

Medical travel insurance (Complications Coverage)

The patient, although advised of the coverage option, did not purchase medical travel/complications coverage, nor did his employer.

CGH requires individuals, (e.g. uninsured and not affiliated with an employer group that CGH serves), to purchase $50,000 worth of coverage from Global Protective Solutions. In this case, Kevin was a member of his employer’s self-insured medical plan and CGH provides services for Kevin’s employer. In this case risk is being shared and accepted by the employer.

We do recommend most people travelling for surgery purchase a policy which may provide additional piece of mind. However, it should be noted that there is risk of something going wrong abroad just as there is in the United States. Proper due diligence, including first vetting the hospital/staff and then transferring of pre-operative blood, cardiac and related test results from the US to Ramsay Sime Darby all help play a role to mitigate risk and ensure the patient is a good candidate for surgery abroad.

He returned to the USA approximately one week following his discharge from the hospital. As is the case for all CGH patients, the hospital and surgeon provided the clearance to return to the US not CGH. As is normally the case, our company and the hospital estimated what the departure date for his flight should be, barring complications. This helps in booking flights. But if the patient needed additional recovery time due to an unforeseen circumstance, he would be recommended to stay additional days and change his departure flight.

Managing the risk of DVT and resulting liability

Ara Damansara Medical Centre

A number of steps were taken to mitigate risk. First, as noted in the previous section, before the hospital will accept the patient, a number of pre-operative tests were requested to ensure the patient could have surgery and be a good candidate for travel. After arrival, the patient had additional preoperative tests at Ramsay Sime Darby.

Ramsay Sime Darby provides the patient with an informed consent noting the risks of surgery. After hospital discharge, the patient was provided instructions as a part of the required discharge steps.

In terms of bearing risk, it should be noted that no entity is immune from pursuit of legal action regardless of any coverage. The employer and CGH do both have a liability policy. However, risk must be looked at in its totality. That is, when you consider a relatively healthy individual who has provided the appropriate medical information, it is reasonable to suggest that the risk of an undesirable outcome is not much different that if the patient had care in the US and had travelled from Columbia, SC, to Cleveland, OH, for example.


Profile of the author

Phil Midden

Since 2007, Phil Midden has facilitated individual patients to hospitals worldwide. He has also helped many employers and agents implement a medical tourism benefit. Mr. Midden is a licensed life and health insurance producer in South Carolina who holds the Fellow, Academy for Healthcare Management designation (FAHM). He has also completed training with The Joint Commission on hospital accreditation standards. Mr. Midden earned a BS in Atmospheric Science from Creighton University and an MBA from Clemson University. On Twitter @PhilMidden

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