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Planning Surgery in a Foreign Country? Make
Sure Your Finances Are Safe Too
Getting surgery overseas used to be the territory of the rich
and secretive the heiress running outside the country for a
little plastic surgery and some R&R. But today, the rising
number of underinsured Americans (over 61 million at last count)
in the United States have made overseas healthcare a much more
popular option for its often considerable discount to the price
of American procedures.
The so-called medical tourism industry has grown up around
such procedures in countries like India, Thailand and many
countries in Europe and Latin America. News stories describe
hospitals that are the match of any in America many quite
luxurious with doctors trained in the United States and prices
for major surgery that are a mere fraction of what one would pay
in America. In 2006, an estimated 500,000 Americans went
overseas for procedures priced anywhere from 30 to 80 percent
less than what's charged at American hospitals.
Some estimates have medical tourism becoming a $40 billion
business by 2010.
Increasingly, U.S. insurance companies and medical
accreditation organizations are starting to recognize quality
providers of such services though they're not quite at the point
of insuring stateside customers for overseas procedures.
Published reports, however, indicate that may change. Joint
Commission International (JCI), a division of the leading U.S.
organization that reviews hospitals for quality, now provides
similar services to hospitals abroad. JCI provides an online
reference (http://www.jointcommissioninternational.com),
listing accredited hospitals worldwide.
If you are considering going overseas for a medical
procedure, start by checking those accreditation records, and
add the following to your list:
Involve your doctors here in the discussion. Don't
assume that your stateside physicians will automatically be
opposed to your decision to have a procedure done overseas
they might be enormous help in getting you to the right program.
But if they balk and can provide solid medical reasons for you
staying here, ask them whether they or their hospital might
consider repricing their fees so you might be able to afford the
procedure here. Of course, if you can afford the procedure here
but are simply looking to save a few bucks, don't expect much
sympathy financial need will likely be a factor in their
decision. You need to give full disclosure to your doctors here
for another important reason: They need to be fully informed
about your medical history at all times.
Check your insurance coverage. Check with your health
insurer to get their position on overseas treatments. Even if
they don't cover such procedures, ask whether they recommend you
get treatment at specific hospitals and clinics abroad with
credentials they trust. Most insurers won't be terribly happy
about covering problems that crop up domestically after overseas
treatment, so ask them how they would deal with such
post-surgical complications. Also, if you have long-term care
insurance, check in with them on these issues as well. It's best
to be upfront because you might risk your coverage otherwise.
Also, find out if you can get a travel insurance package that
not only covers the healthy part of your trip, but the
possibility of specialized medical transport if something goes
wrong.
Get some money advice. If you are planning a
non-emergency procedure that won't be covered by insurance, take
the opportunity to see how such a move will affect your overall
finances. It makes sense to talk to a financial advisor such as
a Certified Financial Planner professional to weigh this
expenditure which may still be in the tens of thousands even
at a sizable discount against your other financial needs and
concerns.
Designate a family member as your primary contact.
This person may or may not be your health power of attorney
(more on this below), but you should have one person designated
to keep in touch with the family, friends and employers you
designate they call. This person could also see that your bills
get paid if you're out of commission longer than you anticipate.
It also makes sense to get specific advice for this person on
how to deal with the unthinkable if you suffer complications
or die outside the United States.
Make sure your health care directives work where you're
going. A health care directive also called an advance
directive specifies your medical wishes in case you're
incapacitated. They come in two forms: the living will and the
power of attorney for health care. The living will indicates
specific wishes about medication and life-support treatment if
you're incapacitated, and you need to refer to your own state
laws on how these documents need to be written. The power of
attorney for health care also called a durable power of
attorney for health care also specifies your wishes for
treatment but allows you to designate a specific person to act
in your stead if you are incapacitated. You should check with
the hospital where you'll be doing the procedure as well as your
attorney about what documentation will be effective where you're
going.
Set up accounts properly. Your health care power of
attorney may or may not be the person with the power to disburse
your assets if you're incapacitated, but that person should have
their name on a joint checking account in case bills need to be
paid. Also, make sure you have a line of credit established that
your designated representative can access in case of emergency.
Make sure all these sources of cash can flow easily to the
foreign country where you're recovering.
Make sure your will is current. No one expects they'll
die in the hospital, but it's necessary that your will be up to
date so your spouse or designated executor can step in
immediately to handle your affairs. Again, it makes sense to see
whether anything needs to be amended based on your
out-of-country care.
Have an up-to-date disaster plan. If you are
incapacitated or die, it makes sense to have all critical papers
and data in one place so either your health care power of
attorney, your executor or a trusted friend or family member can
access them. Include the following with an index:
- Full details on
administrative contacts and physicians at the hospital where
you're undergoing treatment (and money set aside for your
health power of attorney if they have to travel to you);
- Birth, death,
marriage certificates (with 10 copies apiece in case they're
needed for estate purposes);
- Your passport
information in case they have to contact the U.S. Embassy
for any reason;
- List and location
of all household bills that must be paid with due dates;
- Divorce decrees
with all relevant settlement information;
- Location of
wills, trusts and any power of attorney information;
- Advanced
healthcare directives;
- Adoption papers,
if applicable;
- Key
identification numbers, including driver's license, Social
Security, passport and employee identification data;
- Recent bank and
brokerage statements;
- Detailed funeral
and burial wishes;
- Location of cash
that may be used to handle other emergency expenses;
- Copies of recent
medical records in case you're incapacitated;
- Copies of deeds
for primary home, vacation and investment properties;
- Car title, lease,
loan information and license plate data;
- All insurance policies (health, disability, life, auto and long-term care)
with agent contact information;
- Photocopies of
credit and debit cards, front and back (displaying the
individual's signature);
- A current copy of
the individual's home financial software program reflecting
up-to-date financial data;
- All password
information necessary to get inside any computers, PDAs, and
cell phones you own;
- The locations for
all investment documents;
- Notes on house
maintenance and service providers;
- Where safe
deposit, lockbox and filing cabinet keys are;
- The name and
number of your human resources department at work;
- Location of tax
returns for the last three years;
- All relevant
contact numbers for executors, financial advisors, trustees,
guardians, attorneys and any other individuals who will need
to step in if you are dead or incapacitated;
- All user IDs and
passwords for online accounts;
- Guidelines on
what to do about orphaned pets, including set plans for who
will adopt them and pay for their care;
- A general
statement of family origins, values, and hopes for future
generations, including what you want for children in the way
of day-to-day parental guidance as well as aspirations.
February 2008 This column is produced by the Financial
Planning Association, the membership organization for the
financial planning community, and is provided by Don McCarty of
Financial Decision Partners, a local member of the FPA.
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