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Insurance for Overseas Surgery

Who will pay the bill when you seek medical care out of the country?

Health-insurance companies have been slow to accept the idea of medical tourism, but several now allow their members to travel outside the U.S. to receive care.

For example, two providers based in Southern California, Health Net of California and Blue Shield of California, offer cross-border coverage that saves roughly 40% in insurance premiums for policyholders who agree to seek routine treatment in Mexico. "There's always been a pattern of travel to Tijuana for medical care," says Ana Andrade, vice-president of Latino programs for Health Net. "Many Latinos are more comfortable with doctors who speak Spanish and understand their culture, and with this program we're able to fill a need that has existed for some time."

Two insurers have plans that include access to care at Bumrungrad International Hospital, in Bangkok, Thailand. Bumrungrad is accredited by the Joint Commission International and has more than 150 doctors who are U.S. board-certified. Insurance group OptiMed Health/United Group Programs offers Bumrungrad in its PPO network and estimates that the savings for some procedures can add up to tens of thousands of dollars. For example, a kidney transplant in the U.S. could cost as much as $65,000. With the overseas option, a patient might pay less than $20,000. Blue Cross Blue Shield of South Carolina also offers care at Bumrungrad.

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More insurers may cover overseas care in the future, says Greg Scandlen, president of Consumers for Health Care Choices. But Jonathan Edelheit, of OptiMed Health, doesn't see the trend growing among most major insurance carriers.

One exception is Aetna, which is receptive to the idea. Under Aetna-sponsored plans that offer out-of-network benefits, elective surgery performed overseas is eligible for coverage unless the procedure is not a covered benefit or is specifically excluded. "Our position is one of cautious exploration," says Aetna's Roni Grossman.

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