Health Plans Adding Foreign Providers to Their Networks

Published July 1, 2007

Though increasing numbers of uninsured patients are traveling abroad for low-cost medical care, few insurers over the past few years have included foreign providers in health plan networks.

That trend, however, is beginning to change.

For the past seven years, BlueShield of California has offered an HMO plan, Access Baja, in which enrollees access physicians across the border in Mexico.

“BlueShield of California has been a pioneer in cross-border health coverage,” said company spokeswoman Elise Anderson, “and continues to expand and enhance the products and services that are designed to support the needs of the community.”

Open Borders

Access Baja was designed for people who want to get their care in Mexico.

“The BlueShield of California Access Baja plan has been helping employers in Southern California provide a level of health coverage to a Latino population who previously had not had access to this extensive coverage in Mexico and the United States,” Anderson explained.

Medical care costs less in Mexico than in California; thus, premiums are substantially lower for Access Baja than the alternative BlueShield of California plans. Hispanic enrollees also like having a doctor who is fluent in Spanish and understands their culture.

Although many enrollees are Mexican nationals who cross the United States border each day for work, employers on both sides of the border are free to offer the plan to their workers. BlueShield of California requires enrollees to live within 50 miles of the border. Southern California is unique in this regard because San Diego is so close to the Mexican border town of Tijuana.

Overseas Visits

In the future, it may become common for insured patients to travel abroad for low-cost surgery.

In February, for example, BlueCross BlueShield of South Carolina announced its health plan enrollees now have access to Bumrungrad International Hospital in Thailand.

South Carolina BlueCross does not plan to force patients to go abroad for lower-cost care, nor is it actively considering using financial incentives to encourage patients to travel abroad. Instead, the option is a value-added service available to members who request it, said David Boucher, assistant vice president for health care services.

Though “no patients have taken advantage of this service to date,” Boucher speculated the type of patient who might be interested in it is likely to be underinsured and facing steep out-of-pocket payments.

Excellent Reputation

Bumrungrad Hospital has an international reputation and is accredited through Joint Commission International, the foreign arm of the organization that accredits American hospitals. In fact, more than 200 members of Bumrungrad’s medical staff are U.S. board-certified.

“Folks may go initially for the price,” Boucher said, “and then be pleasantly surprised at the level of hospitality and perceived level of quality they experience.”

Approximately 400,000 foreigners were treated at Bumrungrad last year, Boucher said–including 80,000 Americans.

Insurance Arrangement

Rudy Rupak, president and co-founder of PlanetHospital, a Web site that helps arrange international medical visits, is working with a major insurer to design a low-cost health plan with foreign hospitals in its network.

The plan would include limited benefits, sometimes referred to as a “mini-med” plan, based on the casualty model. Though details of the PlanetHospital deal were still being worked out at press time, mini-med plans generally cover a limited number of physician visits each year, with an annual cap on benefits of about $25,000.

Another common feature is that medical conditions are subject to coverage limits, with specific allowances spelled out in the policy. The allowances are relatively low, and patients can expect to face significant cost-sharing when seeking care.

Usable Anywhere

The unique part of Rupak’s plan is that the allowances can be used anywhere, including domestic hospitals and clinics or low-cost foreign providers.

“A mini-med by itself is not very good coverage,” Rupak explained. “But when taken to an overseas facility, you have something meaningful.”

For instance, an enrollee needing a heart procedure could easily spend more than $50,000 at a hospital in the United States, and a mini-med policy might have an allowance of only $10,000 to use towards the cost. A patient entering a domestic hospital would face out-of-pocket cost-sharing of $40,000.

But PlanetHospital will help enrollees interested in traveling abroad obtain care from highly qualified providers, where the allowances will likely cover the entire cost of a procedure.

Devon M. Herrick, Ph.D. ([email protected]) is a health economist and senior fellow for the National Center for Policy Analysis in Dallas.