WellPoint Provides Coverage For Non-Emergency Procedures

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WellPoint on Wednesday is expected to announce a pilot program that will offer some of its group members the option of traveling to India for non-emergency medical procedures, the Indianapolis Star reports. The medical tourism benefit is set to begin in January and initially would cover about 700 group members and their dependents at Serigraph, a Wisconsin-based specialty printing company, who will be able to travel to India with a companion at no travel or other out-of-pocket cost for procedures like joint-replacement surgeries.

Under the program, WellPoint case managers would collaborate with patients on their travel and medical arrangements with Joint Commission International-accredited hospitals in the Indian cities of Bangalore and New Delhi. WellPoint said the pilot program meets the medical tourism standards of the American Medical Association.

WellPoint spokesperson Kristin Binns said patients who seek legal recourse regarding the outcome of a surgical procedure are "entitled to all rights and remedies available under applicable law." Binns did not indicate which country's laws are applicable, the Star reports.

According to the Star, WellPoint joins a "limited list" of U.S. insurers that offer medical tourism benefits. BlueCross and BlueShield of South Carolina offers medical tourism benefits through a company called Companion Global Healthcare.

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Benefits, Implications

Razia Hashmi, chief medical officer of Anthem National Accounts for WellPoint, said a patient undergoing knee replacement surgery in the U.S. could pay between $60,000 and $70,000 for the procedure, follow-up care and other costs. However, the same procedure in India, which includes a 15-day stay for rehabilitative care, could cost a total of $8,000 to $10,000, he said. "It allows the customers to have choice," Hashmi said, adding, "Certainly the cost difference is striking enough for some procedures."

According to the Star, the proliferation of medical tourism programs like WellPoint's could "create even more friction between insurers and health care providers when it comes to the contentious point of reimbursement rates." The Star reports that hospitals seek profits on "surgical procedures such as joint replacements -- the very surgeries targeted in medical tourism -- and then use those proceeds to help fund money-losing areas of care."

Daniel Evans, CEO of Clarian Health, said, "Medical tourism is a new wrinkle in the complex question of how to provide safe, high-quality and affordable care." However, he added, "One unintended consequence of medical tourism will be to raise the costs of those who must get their care close to home" (Lee, Indianapolis Star, 11/12).

Reprinted with permission from kaisernetwork.org. You can view the entire Kaiser Daily Health Policy Report, search the archives, and sign up for email delivery at kaisernetwork.org/email . The Kaiser Daily Health Policy Report is published for kaisernetwork.org, a free service of The Henry J. Kaiser Family Foundation. © 2007 Advisory Board Company and Kaiser Family Foundation. All rights reserved.

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