M Managing Overseas i O Medical Care Medical Care By Dr. Kevin T. Bowe Deputy Director/ VP-Medical Services & D t Di t / VP M di l S i & Claims The National Insurance Board of the Bahamas
• Regulations/ Policies need to be in place. d t b i l • All staff must be familiar All staff must be familiar with the same. • Ensure that your public- y p relations, with regards to these policies, is effectively these policies, is effectively managed.
Case Managem ent � Local provider usually refers patient L l id ll f ti t overseas for continued care. � Or, the patient may request this service. � I n all cases, m edical necessity m ust be established . b bli h d � Care available locally is not usually � Care available locally is not usually accessed overseas.
All All overseas overseas care care requires requires pre-approval ! pre-approval !
• NIB uses a contracted Third Party NIB uses a contracted Third Party Administrator (TPA), to negotiate the rates paid for services. • Most care outside of the Bahamas is referred to Florida, USA • Types of cases: Various orthopaedic cases, especially spinal care serious burn victims especially spinal care, serious burn victims, extensive rehabilitation cases, and specific eye injuries and patients requiring certain prosthetics. Also, special MRI’s. th ti Al i l MRI’
Overseas Expenses I nclude: • Air and ground transportation • Provider fees (consultation & procedures) • Facility fees Facility fees • Accommodations and meals • Escort travel costs (when indicated)
Challenges… • Travel documents which may not be valid • Travel documents which may not be valid. • Provider & facility needed, who are willing to accept the case. • Patient develops complications, or even dies. • Services required which may not have Se ces equ ed c ay ot a e been initially planned. • Patient’s length of stay goes far beyond what was expected what was expected. • Language barriers. • Be aware of potential FRAUD !! Be aware of potential FRAUD !!
Finally Finally… Continued care which the patient will need ll d upon h his/ her / h return home must be carefully planned l d prior i to that h return. Also, excellent customer service takes k into i account any f future follow-up visits that may be scheduled. h d l d
Recommend
More recommend
