M Managing Overseas i O Medical Care Medical Care By Dr. Kevin - - PowerPoint PPT Presentation

M i O Managing Overseas Medical Care Medical Care

By

• Dr. Kevin T. Bowe

D t Di t / VP M di l S i & Deputy Director/ VP-Medical Services & Claims The National Insurance Board of the Bahamas

• Regulations/ Policies

d t b i l need to be in place. 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

L l id ll f ti t Local provider usually refers patient

• verseas for continued care.

Or, the patient may request this service. I n all cases, m edical necessity b bli h d m ust be established. Care available locally is not usually Care available locally is not usually accessed overseas.

All All

• verseas
• verseas

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 th ti Al i l MRI’

• prosthetics. Also, special MRI’s.

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

• t

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 ll d h / h patient will need upon his/ her return home must be carefully l d i h planned prior to that return. Also, excellent customer service k i f takes into account any future follow-up visits that may be h d l d scheduled.