Medical tourism satire reveals important lessons for uninsured/self-pay patients

Freelance writer Justin Matis had what was mostly intended (I think) as a satirical piece in Slate on the subject of medical tourism and getting major medical needs met as an uninsured American. Satire or not, though, for self-pay patients his article does raise some important points and illustrate some of the opportunities and significant healthcare savings that medical tourism or just being a savvy self-pay patient can offer, as well as problems with the current system of bureaucratic medicine.

Matis’ article begins by noting the plight of an uninsured self-pay patient and the stark difference in prices for when comparing U.S. hospitals and overseas facilities:

How to solve the American health care crisis: with a little help from some Indians

When I worked in finance, I had a generous health plan. Now I can’t afford to pay the state-subsidized annual insurance premium of $6,924 (six months’ rent) myself. Despite my good health, my appendix could become inflamed at any time. Appendix removal surgery costs an average of $33,000 (house down payment). Any medical problem that can’t be fixed with a pill could bankrupt me. 

My friend Tikka exposed me to a more frugal solution. Tikka spends his days and limited money traveling Asia by foot or bicycle, and when he got a hernia, he flew to India to have it repaired. There he paid $300 (groceries for a month) for a surgery that would cost $29,880 (six acres of farmland) here. He was a medical tourist—a patient who travels abroad for cost-effective treatment for cancer, cosmetic surgery, or any large yet time-insensitive medical need…

For starters, Matis is quoting what appear to be “chargemaster” prices for appendix removal or hernia repair at a U.S. hospital. “Chargemaster” prices are typically anywhere from three to five times more than what insurers actually pay for any given procedure, and a self-pay patient needs to understand that a “chargemaster” price is what they will get if they don’t shop around and negotiate.

For example, the Health Care Blue Book shows that nationally, insurers pay an average of around $13,100 for removal of an appendix including hospital, surgeon, and anesthesiologist, while hernia repair averages about $10,500.

The lesson for self-pay patients is clear – DON’T accept that a price quoted by a hospital for a specific procedure is the ‘real’ price.  Before talking with the hospital about prices find out, using a service like Health Care Blue Book or another source, what insurance companies typically pay for that same procedure. If a hospital continues to quote you a  “chargemaster” price that is well above what insurers pay, find a different hospital.

Remember, as a self-pay patient, you should pay LESS than an insurance company because their billing department doesn’t have to deal with all the paperwork and bureaucracy the insurance reimbursement involves (although don’t expect to get a break from what the insurance company pays if you aren’t going to pay the full amount up front).

I’d also guess that Matis also missed a zero regarding his friend Tikka’s experience. A little online searching of overseas medical tourism facilities found that a hernia repair can typically be done for anywhere from $3,000 to $8,000, depending on the exact procedure and the location of the hospital (appendix removal generally doesn’t lend itself to hopping on a plane and flying somewhere to have it taken out, so I didn’t look for that).

But more importantly, he misses that there is a domestic medical tourism industry as well, where hospitals here in the U.S. offer self-pay patients real, ‘all inclusive’ prices for surgery. For example, the Surgery Center of Oklahoma lists dozens of surgeries it performs, often at prices that are well below what insurers pay and even competitive with overseas hospitals. Several types of hernia repair are listed for example, ranging from about $3,000 to $4,500.

Other options for domestic medical tourism include MediBid and North American Surgery, two web sites that can also be used to find hospitals in the U.S. that will provide services to self-pay patients at prices that are often well below what insurers pay, never mind the outrageous “chargemaster” prices many hospitals try to force the uninsured to pay.

The rest of Matis’ piece is entertaining, but not particularly informative. He does suggest that the U.S. allow foreign doctors to set up shop on American Indian reservations as a way of bringing the benefits of lower overseas costs to the masses, taking advantage of reservations’ legal status as semi-sovereign nations that may be exempt from many of the mandates and regulations that can drive up costs of healthcare provided in the U.S.

The idea actually isn’t as far-fetched as it seems, as I know a few people that have tossed around the idea of bringing medical facilities onto Indian reservations as a way of circumventing certain burdens imposed on healthcare providers by what they believe to be excess government regulations.

But the real value of Matis’ piece is in bringing to wider attention, even satirically, the notion that medical tourism has a role to play in making health care services more affordable for America’s uninsured and high-deductible self-pay patients. Where he misses the mark, hopefully I’ve managed to provide helpful information here.

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