Medical treatment in US for non US citizen

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sam101
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Medical treatment in US for non US citizen

Post by sam101 » Thu Mar 16, 2017 9:58 pm

Hi All,
I am based in US and my niece is living outside US. Unfortunately she has been diagnosed with rare type of disease and can be treated most likely in US. The total expenses are around $350,000 for someone with no insurance. This amount is something I can't pay off entire my life. I would appreciate if someone can let me know what are the options for treating her in USA. Additionally, how do i get her here. Will appreciate your help

Thanks,
Sam

mhalley
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Re: Medical treatment in US for non US citizen

Post by mhalley » Thu Mar 16, 2017 10:13 pm

Sorry about your niece. You might look into one of the major medical centers that specialize in her illness. For example, say the Mayo Clinic was a major center involved in treating her illness, you might look here
http://www.mayoclinic.org/patient-visit ... assistance
If the illness is cancer, you might look here
http://ramoslink.info/treatcancerusa.html
A rare illness might increase the likelihood of her being accepted into a clinical trial.
https://clinicaltrials.gov/
https://clinicalcenter.nih.gov/participate1.html

sam101
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Re: Medical treatment in US for non US citizen

Post by sam101 » Thu Mar 16, 2017 10:36 pm

Thank you so much for your quick reply. Though I am US citizen but my niece is not a US citizens and I did not see Mayoclinic is offering any financial support to non US citizens. BTW, she can be either treated in Boston or Mayoclinic. I was googling and someone was sort of in similar situation and he was advised to get patient here and lease an apartment in MA on her name and then his wife may get free healthcare in MA. Not sure whether this is possible or not.

toofache32
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Re: Medical treatment in US for non US citizen

Post by toofache32 » Thu Mar 16, 2017 10:48 pm

sam101 wrote: I was googling and someone was sort of in similar situation and he was advised to get patient here and lease an apartment in MA on her name and then his wife may get free healthcare in MA. Not sure whether this is possible or not.


Who is paying for this "free" healthcare? The rest of us? This sounds like Medicaid. I had a patient step off the plane from another country and find their way to my hospital. Within about 3 days, she had a Medicaid card. I removed her cancer and after almost 2 weeks in the hospital she went back to her home country. I have NO idea how this is possible, but there are obviously many loopholes. Fraud is rampant.

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celia
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Re: Medical treatment in US for non US citizen

Post by celia » Thu Mar 16, 2017 11:00 pm

Is she seeing specialists in her own country? Have they referred her to the best specialist for her condition in her own country? Can that doctor treat her or is he/she so knowledgeable about that condition that he/she knows who the best doctors for it in the world are? I would first exhaust all the possibilities in her home country first.

If that doesn't work, is there a way you or she can find out which doctors are the best for treating her, regardless of where each of them lives (eg, by reading medical journals)? That's what I would look into. One could even be in her country or a lot closer than the U.S.!

Of course, this does not address the financial aspects.

sam101
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Re: Medical treatment in US for non US citizen

Post by sam101 » Thu Mar 16, 2017 11:08 pm

toofache32 wrote:Who is paying for this "free" healthcare? The rest of us? This sounds like Medicaid. I had a patient step off the plane from another country and find their way to my hospital. Within about 3 days, she had a Medicaid card. I removed her cancer and after almost 2 weeks in the hospital she went back to her home country. I have NO idea how this is possible, but there are obviously many loopholes. Fraud is rampant.


I don't want to go that route either and am ready to pay monthly installments remaining of my life to save the life a young and bright kid provided that healthcare institute charge me what they suppose to charge in network insurance companies.Unfortunately they are charging almost 3 times more for someone with no insurance...

sam101
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Re: Medical treatment in US for non US citizen

Post by sam101 » Thu Mar 16, 2017 11:14 pm

celia wrote:Is she seeing specialists in her own country? Have they referred her to the best specialist for her condition in her own country? Can that doctor treat her or is he/she so knowledgeable about that condition that he/she knows who the best doctors for it in the world are? I would first exhaust all the possibilities in her home country first.

If that doesn't work, is there a way you or she can find out which doctors are the best for treating her, regardless of where each of them lives (eg, by reading medical journals)? That's what I would look into. One could even be in her country or a lot closer than the U.S.!

Of course, this does not address the financial aspects.

Thanks! This condition requires stem cell transplant and there is no specialty or treatment for this ailment in her own country. Even in US there is 40% success for treating this disease.And only 2 places where this can be treated are Boston and Mayoclinic...

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Re: Medical treatment in US for non US citizen

Post by calif.engineer » Fri Mar 17, 2017 12:26 am

toofache32 wrote:
sam101 wrote: I was googling and someone was sort of in similar situation and he was advised to get patient here and lease an apartment in MA on her name and then his wife may get free healthcare in MA. Not sure whether this is possible or not.


Who is paying for this "free" healthcare? The rest of us? This sounds like Medicaid. I had a patient step off the plane from another country and find their way to my hospital. Within about 3 days, she had a Medicaid card. I removed her cancer and after almost 2 weeks in the hospital she went back to her home country. I have NO idea how this is possible, but there are obviously many loopholes. Fraud is rampant.


Can I ask you which state you live in? As you say, the rest of us pay for this. You should report these cases of fraud to the relevant authorities. I am sure the foreigner who came here had close relatives who live in the USA, who know how to milk the system.

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Re: Medical treatment in US for non US citizen

Post by denovo » Fri Mar 17, 2017 4:48 am

sam101 wrote:
celia wrote:Is she seeing specialists in her own country? Have they referred her to the best specialist for her condition in her own country? Can that doctor treat her or is he/she so knowledgeable about that condition that he/she knows who the best doctors for it in the world are? I would first exhaust all the possibilities in her home country first.

If that doesn't work, is there a way you or she can find out which doctors are the best for treating her, regardless of where each of them lives (eg, by reading medical journals)? That's what I would look into. One could even be in her country or a lot closer than the U.S.!

Of course, this does not address the financial aspects.

Thanks! This condition requires stem cell transplant and there is no specialty or treatment for this ailment in her own country. Even in US there is 40% success for treating this disease.And only 2 places where this can be treated are Boston and Mayoclinic...



Best thing in this situation is to get off the internet and pick up the phone. Call the facilities/institutes who are providing this treatment and explain the situation and see what they say. My deepest sympathies for your family's situation.
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Re: Medical treatment in US for non US citizen

Post by katnok » Fri Mar 17, 2017 5:14 am

sam101,

How old is your niece? And if you do not mind sharing, what's her diagnosis?

This information might be helpful to check to see if the cost you mentioned is reasonable (if you are going to pay from your pocket), and also if she necessarily needs to be treated in the US.

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Re: Medical treatment in US for non US citizen

Post by toofache32 » Fri Mar 17, 2017 6:17 am

sam101 wrote:
toofache32 wrote:Who is paying for this "free" healthcare? The rest of us? This sounds like Medicaid. I had a patient step off the plane from another country and find their way to my hospital. Within about 3 days, she had a Medicaid card. I removed her cancer and after almost 2 weeks in the hospital she went back to her home country. I have NO idea how this is possible, but there are obviously many loopholes. Fraud is rampant.


I don't want to go that route either and am ready to pay monthly installments remaining of my life to save the life a young and bright kid provided that healthcare institute charge me what they suppose to charge in network insurance companies.Unfortunately they are charging almost 3 times more for someone with no insurance...


This is unfortunately required by insurance companies. The insurance companies do this to push patients towards buying insurance.

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Watty
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Re: Medical treatment in US for non US citizen

Post by Watty » Fri Mar 17, 2017 7:18 am

denovo wrote:Best thing in this situation is to get off the internet and pick up the phone. Call the facilities/institutes who are providing this treatment and explain the situation and see what they say. My deepest sympathies for your family's situation.


+1

They may be willing to work with you if you can pay cash in advance. A payment plan is likely not an option because there is such a high risk they will never be paid.

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in_reality
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Re: Medical treatment in US for non US citizen

Post by in_reality » Fri Mar 17, 2017 7:57 am

sam101 wrote:
toofache32 wrote:Who is paying for this "free" healthcare? The rest of us? This sounds like Medicaid. I had a patient step off the plane from another country and find their way to my hospital. Within about 3 days, she had a Medicaid card. I removed her cancer and after almost 2 weeks in the hospital she went back to her home country. I have NO idea how this is possible, but there are obviously many loopholes. Fraud is rampant.


I don't want to go that route either and am ready to pay monthly installments remaining of my life to save the life a young and bright kid provided that healthcare institute charge me what they suppose to charge in network insurance companies. Unfortunately they are charging almost 3 times more for someone with no insurance...


The Mayo in some cases offers in-network prices for the uninsured. They state they don't do that for international patients but you may want to do the form and call and see if they are able to help.

Keep in mind too that health care costs money.

There was another program in MN that was the first to do pancreas transplants, first to do kidney transplants in diabetic patients ... first successful liver transplant, trained all the individuals who did the first heart patients, did the first successful bone marrow transplants. They developed a drug for improved bone marrow transplants and made it available to other institutions who couldn't manufacture their own. They applied for FDA approval to receive money from those institutions for the costs of the experimental (but successful) drug, but approval didn't come for years and eventually charges were brought for illegally manufacturing drugs. In the meantime, how many patients had been helped? Finally the charges were dismissed but only after the medical school had lost 86 faculty members. https://www.ncbi.nlm.nih.gov/pubmed/7575112

So I am sure the Mayo would like to help. Keep in mind though, that they do face harsh financial realities. If they have a bed in the program with no patient to fill it, I suspect they'd try to offer in-network prices. If there is a waiting list filled with insured people in the network, or people who will pay out of network prices, it would seem in the institutions interests to serve them first.

I truly wish that young kid well. By the way, I do know many stupid people though who are fine human beings and don't think being bright should qualify one for special treatment. Bright people aren't necessarily kind to their fellow humans and it's the kind ones I think we should be helping!
Last edited by in_reality on Fri Mar 17, 2017 8:00 am, edited 1 time in total.
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Re: Medical treatment in US for non US citizen

Post by Jack FFR1846 » Fri Mar 17, 2017 7:58 am

There is NO free healthcare in Massachusetts. As a lifelong resident, I can say that for certain. What may have come across is the fact that we have Romneycare. This was in place long before Obamacare and was essentially the model to start Obamacare. In Mass, we have a requirement to buy approved health insurance and for employers to provide access to group health insurance. As a result, 96.72% of Massachusetts residents are covered by health insurance.

It still isn't free and every insurance plan has its own set of deductibles, copays and max out of pocket limits along with requirements to use "in plan" facilities and doctors or you pay more (and if you are brought to an in plan hospital emergency room and an out of plan doctor treats you, you get an additional bill from that out of plan doctor).

So no.....not free.

But some of the top hospitals in the world are in Boston.
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lthenderson
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Re: Medical treatment in US for non US citizen

Post by lthenderson » Fri Mar 17, 2017 8:43 am

Is your niece a greencard holder? I ask because my non-US citizen mother-in-law has U.S. health Insurance through the ACA but she had to have a greencard in order to apply. It is also not free. I pay the full premium which has risen 275% in four years and is now a little over $1000/month.

One avenue would be to see what is involved with petitioning your niece to become a U.S. greencard holder. I'm guessing the timeframe involved however might be longer than your niece can wait.

Best of luck.

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Re: Medical treatment in US for non US citizen

Post by msk » Fri Mar 17, 2017 9:03 am

I think the first step is to verify that the treatment is definitely not available outside the USA. I.e. if the treatment is out of the initial experimental phase. These days roll outs of new treatments can happen very fast, especially in countries with less intense reviews of clinical trials than the USA. And all countries will cost you much less than the USA. I have a relative who received bone marrow transplant and thalidomide therapy in India a couple of years back for multiple melanoma when there was not much hope for her. She is now leading a vigorous new-born life. India seems to offer even more advanced facilities than Thailand, already very popular and established for medical tourism, especially when it comes to novel treatments.

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Re: Medical treatment in US for non US citizen

Post by sam101 » Fri Mar 17, 2017 10:15 am

lthenderson wrote:Is your niece a greencard holder? I ask because my non-US citizen mother-in-law has U.S. health Insurance through the ACA but she had to have a greencard in order to apply. It is also not free. I pay the full premium which has risen 275% in four years and is now a little over $1000/month.

One avenue would be to see what is involved with petitioning your niece to become a U.S. greencard holder. I'm guessing the timeframe involved however might be longer than your niece can wait.

Best of luck.

No she is not GC holder. Do you know how long it takes to petition other than parents and siblings to become GC holder ?

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Re: Medical treatment in US for non US citizen

Post by sam101 » Fri Mar 17, 2017 10:18 am

msk wrote:I think the first step is to verify that the treatment is definitely not available outside the USA. I.e. if the treatment is out of the initial experimental phase. These days roll outs of new treatments can happen very fast, especially in countries with less intense reviews of clinical trials than the USA. And all countries will cost you much less than the USA. I have a relative who received bone marrow transplant and thalidomide therapy in India a couple of years back for multiple melanoma when there was not much hope for her. She is now leading a vigorous new-born life. India seems to offer even more advanced facilities than Thailand, already very popular and established for medical tourism, especially when it comes to novel treatments.


Could you please provide the name of the institute/ city and doctor who performed this procedure? I would appreciate if you can share some additional info like how many cases they do a year and what is the success rate etc

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Re: Medical treatment in US for non US citizen

Post by ktd » Fri Mar 17, 2017 10:40 am

toofache32 wrote:
sam101 wrote: I was googling and someone was sort of in similar situation and he was advised to get patient here and lease an apartment in MA on her name and then his wife may get free healthcare in MA. Not sure whether this is possible or not.


Who is paying for this "free" healthcare? The rest of us? This sounds like Medicaid. I had a patient step off the plane from another country and find their way to my hospital. Within about 3 days, she had a Medicaid card. I removed her cancer and after almost 2 weeks in the hospital she went back to her home country. I have NO idea how this is possible, but there are obviously many loopholes. Fraud is rampant.



I know people did this (not family members but friends of friends). Diagnosed cancer/disease in another country, bought tickets to US and checked in the hospital and got treatment. Hospital sent bills but they were long gone.

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Re: Medical treatment in US for non US citizen

Post by jim234 » Fri Mar 17, 2017 11:03 am

ACA / Medicaid requires US legal residency (citizen or green card). For someone to fly in and out is a case of fraud.

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Re: Medical treatment in US for non US citizen

Post by lthenderson » Fri Mar 17, 2017 11:11 am

sam101 wrote:
lthenderson wrote:Is your niece a greencard holder? I ask because my non-US citizen mother-in-law has U.S. health Insurance through the ACA but she had to have a greencard in order to apply. It is also not free. I pay the full premium which has risen 275% in four years and is now a little over $1000/month.

One avenue would be to see what is involved with petitioning your niece to become a U.S. greencard holder. I'm guessing the timeframe involved however might be longer than your niece can wait.

Best of luck.

No she is not GC holder. Do you know how long it takes to petition other than parents and siblings to become GC holder ?


It is highly dependent on what country your niece is a citizen. Each country has an allotment of greencards given out per year. Your niece would also be considered an F4 status (sibling and family) which is the lowest status for petitioning someone. (If your parent was a citizen, the status for married sons/daughters and offspring is considered F3 status. Unmarried sons/daughters of U.S. citizens over age 21 is F2 status. Under 21 is F1 Status.) Depending on country of origin and status, it can be less than a year to 20+ years. We petitioned my mother-in-law in less than a year. Others I have known waited 13 years for approval from other countries.

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Re: Medical treatment in US for non US citizen

Post by TX_TURTLE » Fri Mar 17, 2017 11:24 am

Be aware that when you sponsor a relative you may become financially responsible for him or her. Check this article http://www.alllaw.com/articles/nolo/us-immigration/financial-responsibility-sponsor-permanent-resident.html

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Re: Medical treatment in US for non US citizen

Post by sam101 » Fri Mar 17, 2017 11:25 am

jim234 wrote:ACA / Medicaid requires US legal residency (citizen or green card). For someone to fly in and out is a case of fraud.


Agree

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Re: Medical treatment in US for non US citizen

Post by ved » Fri Mar 17, 2017 11:49 am

Can you contact some charities in your niece's home country and in the US to see if they can sponsor her treatment (or negotiate with the hospital for a lower amount that you could pay)?

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Re: Medical treatment in US for non US citizen

Post by investordoc » Fri Mar 17, 2017 12:02 pm

Sam
How old is your niece? Look at the St. Jude Children's hospital site " http://www.stjude.org". They are a children's hospital in Memphis, TN. They will treat childhood cancers regardless of ability to pay. I don't know age limits. I don't know if you need to be a US citizen. Good luck and God bless.
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Re: Medical treatment in US for non US citizen

Post by Alto Astral » Fri Mar 17, 2017 12:53 pm

I did this a few years back and I can tell you a few things.

1. I first did online second opinions with a few medical centers such as Massacusetts General Hospital, MayoClinic, Cleveland Clinic and a couple of others. For Cleveland Clinic, its $565 (http://my.clevelandclinic.org/online-se ... t#cost-tab) You can email them scans,CDs with MRI, medical reports etc and send a document with your questions. The surgeon/expert there will email you a response/opinion depending on the case file

2. If you opt to go with one of the hospitals, they will give you an estimate expense. For us it was around $150K or so. They will want you to wire this amount upfront before they schedule the surgery/procedure. I emptied out my meager Roth IRAs, took 401k loan, dropped my cash balance to <$500, took loans from friends, accepted money from relatives. We scraped the amount and wired it, did the surgery. The surgery was not a success.

3. With Cleveland Clinic they will offer you some kind of price-protection. Meaning, your expenses won't go above a certain max amount for a surgery. A kind of insurance. This gives you at least some out-of-pocket max.

4. We had to come up with an additional unanticipated $50k for highly needed physiotherapy-post surgery. Keep this in mind. Again the payments will need to be upfront. Since its not a part of the original estimate, we need to come up with this separately.

5. They went back home and saw deterioration in a year. We opted to come back and do another one to stop worsening conditions. Another $100K or so. Upfront. This time all from me.

6. You will find that charities/foundations are typically not interested in rare and high cost cases. Majority of them only consider US citizens.

7. You will not be able to deduct any of this in your tax returns since your niece is not your dependent.

8. Any county or city hospital that accepts patients without insurance will not work for you. You need specialty treatment offered by only a few hospitals.

9. Would I do it all over again? Yes.

Your best bet would be to come up with all the cash upfront by taking loans from relatives, sell property etc.

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Re: Medical treatment in US for non US citizen

Post by toofache32 » Fri Mar 17, 2017 1:52 pm

ktd wrote:
toofache32 wrote:
sam101 wrote: I was googling and someone was sort of in similar situation and he was advised to get patient here and lease an apartment in MA on her name and then his wife may get free healthcare in MA. Not sure whether this is possible or not.


Who is paying for this "free" healthcare? The rest of us? This sounds like Medicaid. I had a patient step off the plane from another country and find their way to my hospital. Within about 3 days, she had a Medicaid card. I removed her cancer and after almost 2 weeks in the hospital she went back to her home country. I have NO idea how this is possible, but there are obviously many loopholes. Fraud is rampant.



I know people did this (not family members but friends of friends). Diagnosed cancer/disease in another country, bought tickets to US and checked in the hospital and got treatment. Hospital sent bills but they were long gone.


I see it a several times a year in my main hospital which is the county hospital. It's really no different than other non-citizens already living in the USA who don't have any insurance. Medicaid or not, the rest of us pay their bills either way.

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Re: Medical treatment in US for non US citizen

Post by LadyGeek » Fri Mar 17, 2017 3:55 pm

Please stay on-topic. Rants about non-US citizens, fraud, insurance costs, the state of US health care, and other general complaints are off-topic.
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Re: Medical treatment in US for non US citizen

Post by drawpoker » Fri Mar 17, 2017 7:00 pm

IngognitoUSA wrote:..... would be prudent for government to release names of Medicaid and Welfare rolls, I know of few people with substantial assets overseas but get Medicaid and welfare.


To clarify:

For the states who adopted Medicaid expansion under the ACA assets are no longer counted. Eligibility goes strictly by income instead. So these people you know who have their "substantial assets" overseas can bring them home with no fears if their state of legal residence has adopted Medicaid expansion.

For the states who did NOT adopt Medicaid expansion the traditional rules still apply - assets are subject to limits.

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Re: Medical treatment in US for non US citizen

Post by IngognitoUSA » Fri Mar 17, 2017 7:46 pm

drawpoker wrote:
IngognitoUSA wrote:..... would be prudent for government to release names of Medicaid and Welfare rolls, I know of few people with substantial assets overseas but get Medicaid and welfare.


To clarify:

For the states who adopted Medicaid expansion under the ACA assets are no longer counted. Eligibility goes strictly by income instead. So these people you know who have their "substantial assets" overseas can bring them home with no fears if their state of legal residence has adopted Medicaid expansion.

For the states who did NOT adopt Medicaid expansion the traditional rules still apply - assets are subject to limits.

I think there might be clawback on assets upon death of Medicaid recipient.

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Re: Medical treatment in US for non US citizen

Post by drawpoker » Fri Mar 17, 2017 8:14 pm

IngognitoUSA wrote:
drawpoker wrote:
IngognitoUSA wrote:..... would be prudent for government to release names of Medicaid and Welfare rolls, I know of few people with substantial assets overseas but get Medicaid and welfare.


To clarify:

For the states who adopted Medicaid expansion under the ACA assets are no longer counted. Eligibility goes strictly by income instead. So these people you know who have their "substantial assets" overseas can bring them home with no fears if their state of legal residence has adopted Medicaid expansion.

For the states who did NOT adopt Medicaid expansion the traditional rules still apply - assets are subject to limits.

I think there might be clawback on assets upon death of Medicaid recipient.


You are referring to benefits under LTSS Medicaid which is a diff. program than regular Medicaid.

Medicaid LTSS still retains asset/resources tests, hence, the law does allow for recovery of some funds upon the death of a beneficiary receiving LTSS benefits (usually someone in long-term nursing home care) When people think of that type of Medicaid benefits, it is also commonly associated with the terms 5 year or 7 year "Look back" period which addresses disposal or transfer of assets.

But for regular Medicaid health insurance coverage, for individuals or families, the states that adopted expansion had to agree to eliminate the limitations on assets and make a determination solely on income. Only exception to this change is for a very small group who are above the income thresholds as outlined in the article here:

http://theincidentaleconomist.com/wordp ... sset-test/

Getting back to the thread :

OP, have you considered contacting your Congressman's/woman's office? I have heard of cases where a Congressman has interceded on behalf of a constituent's crisis with a family member outside the country needing emergency medical treatment in the U.S. Speeding up the visa/green card/entry process with the State Dept, etc.
It's worth a try.

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Re: Medical treatment in US for non US citizen

Post by sam101 » Fri Mar 17, 2017 8:47 pm

drawpoker wrote:
IngognitoUSA wrote:
drawpoker wrote:
IngognitoUSA wrote:...
Getting back to the thread :

OP, have you considered contacting your Congressman's/woman's office? I have heard of cases where a Congressman has interceded on behalf of a constituent's crisis with a family member outside the country needing emergency medical treatment in the U.S. Speeding up the visa/green card/entry process with the State Dept, etc.
It's worth a try.


No I haven't contacted congressman or Senator yet but will send them a request assistance message shortly by filling up online form. Not a bad idea--Thanks

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Re: Medical treatment in US for non US citizen

Post by Alto Astral » Fri Mar 17, 2017 8:56 pm

sam101 wrote:
drawpoker wrote:
IngognitoUSA wrote:
drawpoker wrote:
IngognitoUSA wrote:...
Getting back to the thread :

OP, have you considered contacting your Congressman's/woman's office? I have heard of cases where a Congressman has interceded on behalf of a constituent's crisis with a family member outside the country needing emergency medical treatment in the U.S. Speeding up the visa/green card/entry process with the State Dept, etc.
It's worth a try.


No I haven't contacted congressman or Senator yet but will send them a request assistance message shortly by filling up online form. Not a bad idea--Thanks

The tourist/medical visa process is pretty straightforward. You can start the process before deciding the final hospital. At the visa interview, the officer will ask about plans, finances etc. USCIS/immigration does not consider letters from senators etc. They make independent decisions. I know a case where they've denied simple tourist visas despite letters from senator. By the way, senators are pretty generous writing letters of recommendation etc. But it does not sway decisions of the immigration officer. While it does not hurt, your time is better spent on the actual issue - financing.

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Re: Medical treatment in US for non US citizen

Post by drawpoker » Fri Mar 17, 2017 9:39 pm

Um, er, Alto Astral, didn't I specifically post OP should appeal to "congressman" Not U.S. senator. Largely because of just exactly what you posted re: experience with senators on this sort of thing.

Congress/men/women are much, much more approachable on this sort of thing. Since they represent a narrowly-defined constituent base - Congressional district. Unlike a state-wide elected Senator. [OT comments removed by admin LadyGeek]

OP, take advantage of this known shrewdness/political savvy from your congressional rep to help your niece.

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Re: Medical treatment in US for non US citizen

Post by 2comma » Fri Mar 17, 2017 10:10 pm

I wonder if her home country has any government agencies/politicians, philanthropist or organizations that may be willing to assist in either raising funds or helping her to enter the US (perhaps on a temporary emergency basis)?

As far as St. Jude the cut-off age is 21 and they do accept international patients but unfortunately they don't perform the procedure needed in this case.
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Re: Medical treatment in US for non US citizen

Post by LadyGeek » Fri Mar 17, 2017 10:12 pm

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Re: Medical treatment in US for non US citizen

Post by msk » Fri Mar 17, 2017 10:41 pm

sam101 wrote:
msk wrote:I think the first step is to verify that the treatment is definitely not available outside the USA. I.e. if the treatment is out of the initial experimental phase. These days roll outs of new treatments can happen very fast, especially in countries with less intense reviews of clinical trials than the USA. And all countries will cost you much less than the USA. I have a relative who received bone marrow transplant and thalidomide therapy in India a couple of years back for multiple melanoma when there was not much hope for her. She is now leading a vigorous new-born life. India seems to offer even more advanced facilities than Thailand, already very popular and established for medical tourism, especially when it comes to novel treatments.


Could you please provide the name of the institute/ city and doctor who performed this procedure? I would appreciate if you can share some additional info like how many cases they do a year and what is the success rate etc

I'll have to contact the lady and get the hospital name, if that is the precise kind of treatment you are actually looking for. I think to progress further you really have to chat with your niece's specialist(s), get his/her recommendation and then follow up with a thorough internet search. The point I was trying to make is that there are many alternative locations around the world where certain novel procedures/surgeries, etc. are executed at a cost, generally much lower than in the USA. Unfortunately you cannot assume that your local specialist knows "best". Here's my own lengthy recent history that may explain how things may go. I went to Thailand (Bumrugrad Hospital) to get hemorrhoids and colon polyp(s) removed by a colon-rectal specialist. Where I am currently resident the hospitals were slating me for surgery by a general surgeon but I wanted a narrow (colon-rectal) specialist in case the polyps were more of an issue than the hemorrhoids. Locally it would have taken several more months to get the surgery scheduled by the narrower specialist. Anyway, arranged appointments and flew to Bangkok, had the surgery within a week. Total cost under $15k including flights and hotel. But they also found I had a heart murmur that needed further diagnosis. Back home I had multiple tests both privately and in public hospitals and was advised I needed a mitral valve repair (open heart surgery, not just open chest). I was also advised that for such a delicate operation I would be best off in France (where the procedure was invented) or at a handful of other world class facilities. Seems that mitral valve repairs are much more delicate than mitral valve replacements (done routinely in our local hospitals). Internet search showed that other candidate locations for repair could be the Cleveland Clinic, Mayo Clinic and the Montreal Heart Institute. Projected cost in Paris was $40k to $50k. I preferred a nearby location with cost no object. Nearest was Cleveland Clinic in Abu Dhabi, cost projected at $200k to $300k. Similar to US levels but I preferred it because of less air travel (many hours by car) than Paris. My cardiologists (by then I had several!) were happy with the choice. Then I found out that one of my niece's classmates (now in his 40s) had trained at the Cleveland Clinic and was performing heart surgeries at our local university hospital. Phoned up the kid and asked for his advice. He said no problem Uncle, we have a 95% success rate with mitral valve repairs and I can schedule you in within a couple of weeks! So I went into our local university hospital, he cut me up, got a mitral valve repair, one bypass and he even replaced my aortic valve (seems it did not look too good even though it was still working OK). All for free. Now almost a year later, I feel fine, no more heart murmurs. You really have to do some thorough homework. Bangkok Hospital seems to be the place to go for some cancers, Bumrugrad Hospital for coronary bypasses, knee/hip replacements, an Apollo Hospital in Hyderabad for brain tumors, Hamburg in Germany for sports injuries, etc., etc. For my mitral valve repair I Googled research papers on the topic. Try the same for the exact diagnosis for your niece. You need a clinic at the active research level, but located outside the USA and Canada. Canada charges basically the same as the USA for nonresidents, though free for locals. Quite likely her doctor simply recalled the name of the hospital of the last bit of news that came out concerning that condition, but Google is more thorough.

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Re: Medical treatment in US for non US citizen

Post by LadyGeek » Fri Mar 17, 2017 10:46 pm

Please don't post personally identifiable information here, as it will show up in a google search. Posting a doctor's name here may not be a good idea. Instead use Private Messages to communicate the info.

Remember that this is an anonymous internet forum. There is no way to verify the information, so please do your own due diligence. Also see the disclaimer at the bottom of every forum page:

No guarantees are made as to the accuracy of the information on this site or the appropriateness of any advice to your particular situation.
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Re: Medical treatment in US for non US citizen

Post by sawhorse » Fri Mar 17, 2017 11:09 pm

Most likely they are quoting the "chargemaster" charge for foreign patients which can be in extreme cases 20 times or more higher than what the hospital is willing to accept from insured Americans. As the director of Memorial Sloan Kettering said in an article in Time magazine, they make it unreasonably high in case their patient is Middle East royalty. It's part of their business model. Before anyone jumps on me for saying that, I'm only repeating what the director said.

There are medical billing advocates that specialize in negotiating prices for people in this situation. You may want to look into that.

Try to find a medical billing advocate very familiar with the specific hospitals.

Unfortunately for a little European boy I was trying to help, Memorial Sloan Kettering refused to budge on their price for foreigners. Their price was five times higher than for an insured American kid. They wouldn't budge the slightest. It was an awful situation because they led the family on telling them that something could be worked out. The boy died.

I hope the Mayo Clinic is different.

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Re: Medical treatment in US for non US citizen

Post by Alto Astral » Fri Mar 17, 2017 11:33 pm

sawhorse wrote:...Unfortunately for a little European boy I was trying to help, Memorial Sloan Kettering refused to budge on their price for foreigners. Their price was five times higher than for an insured American kid. They wouldn't budge the slightest. ...

Similarly with Johns Hopkins. Not only did they refuse to budge, they discouraged us from paying their own estimate. When we asked if there could be any discounts, they said that there is a very good chance that it will go over the estimates and that we would not be able to meet it. We ended up choosing another hospital in the US that felt more welcoming. Keep in mind that there are very limited places where we could do this kind of thing.

I want the OP to use these anecdotes to recognize the constraints/policies that the hospital systems need to work with. Also keep in mind that the best estimates will very likely be exceeded. However, MayoClinic that does your procedure, is well known (along with Cleveland Clinic) to keep their costs very low and efficiency high. So the costs will likely be relatively lower at Mayo.

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Re: Medical treatment in US for non US citizen

Post by celia » Sat Mar 18, 2017 12:51 pm

sam101 wrote:Even in US there is 40% success for treating this disease.And only 2 places where this can be treated are Boston and Mayoclinic...

To keep things in perspective, that also means there is, unfortunately, a 60% chance she still won't recover. Then the money you spent is gone. You may also want to consider if your money could instead be used to help improve her current quality of life.

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Re: Medical treatment in US for non US citizen

Post by Nowizard » Sun Mar 19, 2017 12:38 pm

Toothache: I do not understand the comment about insurance companies requiring providers/hospitals to charge multiples of what they are paid when the patient is covered by insurance. In my practice there were many patients who had no insurance who negotiated payment based on the amount an insurance company would have paid if the patient had insurance. In my area of practice, providers set their charges where they did only because they did want to recapture the highest amount covered by any insurance company contracted with them. They did not expect that amount to be paid by anyone and would have considered that to be unethical.

Tim

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Re: Medical treatment in US for non US citizen

Post by toofache32 » Sun Mar 19, 2017 2:55 pm

Nowizard wrote:Toothache: I do not understand the comment about insurance companies requiring providers/hospitals to charge multiples of what they are paid when the patient is covered by insurance. In my practice there were many patients who had no insurance who negotiated payment based on the amount an insurance company would have paid if the patient had insurance. In my area of practice, providers set their charges where they did only because they did want to recapture the highest amount covered by any insurance company contracted with them. They did not expect that amount to be paid by anyone and would have considered that to be unethical.

Tim


Many contracts require doctors to only have ONE fee schedule. This means you have to charge the same to insured patients and non-insured patients. The in-network insurance company doesn't care what you "charge" them because the same contract says the insurance can pay what they feel they can get away with and there's nothing you can do about it and you cannot collect the difference from the patient.

So why on earth would physicians bill higher amounts than the insurance pays?? I'm glad you asked that question.

Here's why physicians bill for much higher fees than they would otherwise accept: every doctor has maybe 50-100 CPT codes they bill for commonly. They have no idea what each insurance will pay and they find out when they get their check. Every once in a blue moon, there will be an insurance company that pays the doctor's full fee for 1 particular CPT code. This means the insurance company's allowed amount is actually higher than what was billed for some reason. So to capture the maximum THAT insurance will pay next time, they raise the fee for that code. But remember, now they have to bill that amount to ALL insurances and uninsured patients. Over time, this happens to most of the codes so now we have an entire fee schedule that is inflated. Remember, the in-network provider is contractually required to bill this inflated fee to everyone including uninsured patients. This is by design to force uninsured patients to think "oh man I need to get some insurance" and is how insurance companies contractually use doctors to incentivize patients to get insurance...pretty genius actually.

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Re: Medical treatment in US for non US citizen

Post by sawhorse » Sun Mar 19, 2017 5:40 pm

toofache32 wrote:
Nowizard wrote:Toothache: I do not understand the comment about insurance companies requiring providers/hospitals to charge multiples of what they are paid when the patient is covered by insurance. In my practice there were many patients who had no insurance who negotiated payment based on the amount an insurance company would have paid if the patient had insurance. In my area of practice, providers set their charges where they did only because they did want to recapture the highest amount covered by any insurance company contracted with them. They did not expect that amount to be paid by anyone and would have considered that to be unethical.

Tim


Many contracts require doctors to only have ONE fee schedule. This means you have to charge the same to insured patients and non-insured patients. The in-network insurance company doesn't care what you "charge" them because the same contract says the insurance can pay what they feel they can get away with and there's nothing you can do about it and you cannot collect the difference from the patient.

So why on earth would physicians bill higher amounts than the insurance pays?? I'm glad you asked that question.

Here's why physicians bill for much higher fees than they would otherwise accept: every doctor has maybe 50-100 CPT codes they bill for commonly. They have no idea what each insurance will pay and they find out when they get their check. Every once in a blue moon, there will be an insurance company that pays the doctor's full fee for 1 particular CPT code. This means the insurance company's allowed amount is actually higher than what was billed for some reason. So to capture the maximum THAT insurance will pay next time, they raise the fee for that code. But remember, now they have to bill that amount to ALL insurances and uninsured patients. Over time, this happens to most of the codes so now we have an entire fee schedule that is inflated. Remember, the in-network provider is contractually required to bill this inflated fee to everyone including uninsured patients. This is by design to force uninsured patients to think "oh man I need to get some insurance" and is how insurance companies contractually use doctors to incentivize patients to get insurance...pretty genius actually.


That's what Tim said. He's also saying that there is nothing to prevent them from negotiating a discount with uninsured patients. They do this all the time. They officially charge an inflated price but then give the uninsured patients a discount.

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Re: Medical treatment in US for non US citizen

Post by toofache32 » Sun Mar 19, 2017 9:24 pm

sawhorse wrote:
toofache32 wrote:
Nowizard wrote:Toothache: I do not understand the comment about insurance companies requiring providers/hospitals to charge multiples of what they are paid when the patient is covered by insurance. In my practice there were many patients who had no insurance who negotiated payment based on the amount an insurance company would have paid if the patient had insurance. In my area of practice, providers set their charges where they did only because they did want to recapture the highest amount covered by any insurance company contracted with them. They did not expect that amount to be paid by anyone and would have considered that to be unethical.

Tim


Many contracts require doctors to only have ONE fee schedule. This means you have to charge the same to insured patients and non-insured patients. The in-network insurance company doesn't care what you "charge" them because the same contract says the insurance can pay what they feel they can get away with and there's nothing you can do about it and you cannot collect the difference from the patient.

So why on earth would physicians bill higher amounts than the insurance pays?? I'm glad you asked that question.

Here's why physicians bill for much higher fees than they would otherwise accept: every doctor has maybe 50-100 CPT codes they bill for commonly. They have no idea what each insurance will pay and they find out when they get their check. Every once in a blue moon, there will be an insurance company that pays the doctor's full fee for 1 particular CPT code. This means the insurance company's allowed amount is actually higher than what was billed for some reason. So to capture the maximum THAT insurance will pay next time, they raise the fee for that code. But remember, now they have to bill that amount to ALL insurances and uninsured patients. Over time, this happens to most of the codes so now we have an entire fee schedule that is inflated. Remember, the in-network provider is contractually required to bill this inflated fee to everyone including uninsured patients. This is by design to force uninsured patients to think "oh man I need to get some insurance" and is how insurance companies contractually use doctors to incentivize patients to get insurance...pretty genius actually.


That's what Tim said. He's also saying that there is nothing to prevent them from negotiating a discount with uninsured patients. They do this all the time. They officially charge an inflated price but then give the uninsured patients a discount.


This is certainly a grey area but the lectures I have attended on this topic recommend having detailed, written criteria to avoid looking like you have multiple fee schedules. Supposedly, it's safest to start with your regular full billed rates, and offer a percentage discount off that...instead of just coming up with a fee out of the air. The most common "loophole" to my knowledge is to offer a TOS (time of service) discount to everyone, including both insurance companies and cash patients. In other words, everyone gets a discount of X percent if they pay in full at the time of service (including the insurance company :wink: ). Since insurance companies never pay on the day of service, they are never "eligible" for this discount. I'm not sure if this has been legally challenged or not. I haven't signed an insurance contract in several years since I am no longer in-network with any medical insurances, so maybe things have changed.

This is an interesting Q&A: http://www.medicalmanagement.com/aac/aac000607-1.htm
Last edited by toofache32 on Mon Mar 20, 2017 12:21 am, edited 1 time in total.

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Re: Medical treatment in US for non US citizen

Post by LadyGeek » Sun Mar 19, 2017 9:29 pm

The discussion is digressing to one of general medical billing practices. Please stay on-topic, which is:
sam101 wrote:Hi All,
I am based in US and my niece is living outside US. Unfortunately she has been diagnosed with rare type of disease and can be treated most likely in US. The total expenses are around $350,000 for someone with no insurance. This amount is something I can't pay off entire my life. I would appreciate if someone can let me know what are the options for treating her in USA. Additionally, how do i get her here. Will appreciate your help

Thanks,
Sam
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Re: Medical treatment in US for non US citizen

Post by in_reality » Sun Mar 19, 2017 9:40 pm

sawhorse wrote:
toofache32 wrote:
Nowizard wrote:Toothache: I do not understand the comment about insurance companies requiring providers/hospitals to charge multiples of what they are paid when the patient is covered by insurance. In my practice there were many patients who had no insurance who negotiated payment based on the amount an insurance company would have paid if the patient had insurance. In my area of practice, providers set their charges where they did only because they did want to recapture the highest amount covered by any insurance company contracted with them. They did not expect that amount to be paid by anyone and would have considered that to be unethical.

Tim


Many contracts require doctors to only have ONE fee schedule. This means you have to charge the same to insured patients and non-insured patients. The in-network insurance company doesn't care what you "charge" them because the same contract says the insurance can pay what they feel they can get away with and there's nothing you can do about it and you cannot collect the difference from the patient.

So why on earth would physicians bill higher amounts than the insurance pays?? I'm glad you asked that question.

Here's why physicians bill for much higher fees than they would otherwise accept: every doctor has maybe 50-100 CPT codes they bill for commonly. They have no idea what each insurance will pay and they find out when they get their check. Every once in a blue moon, there will be an insurance company that pays the doctor's full fee for 1 particular CPT code. This means the insurance company's allowed amount is actually higher than what was billed for some reason. So to capture the maximum THAT insurance will pay next time, they raise the fee for that code. But remember, now they have to bill that amount to ALL insurances and uninsured patients. Over time, this happens to most of the codes so now we have an entire fee schedule that is inflated. Remember, the in-network provider is contractually required to bill this inflated fee to everyone including uninsured patients. This is by design to force uninsured patients to think "oh man I need to get some insurance" and is how insurance companies contractually use doctors to incentivize patients to get insurance...pretty genius actually.


That's what Tim said. He's also saying that there is nothing to prevent them from negotiating a discount with uninsured patients. They do this all the time. They officially charge an inflated price but then give the uninsured patients a discount.


The Mayo's policy is stated as effectively offering the insured rate to uninsured patients, but that they do not that for non-US residents which the OPs niece is.

Uninsured discount

Mayo Clinic's Uninsured Discount Policy will supplement the Mayo Clinic Charitable Care and Financial Assistance Policy, which provides financial assistance.

All Mayo Clinic sites will offer discounted prices to qualified uninsured patients for medically necessary care.

Eligibility is contingent upon patient cooperation with efforts to apply for available Medicaid, Medicare or other Medical Assistance programs.

The uninsured discount will apply to medically necessary inpatient and outpatient services for patients residing in the United States. The discount will not be offered to international patients or for cosmetic or elective procedures that are not medically necessary.


For Uninsured (self-pay) or underinsured patients
http://www.mayoclinic.org/patient-visit ... d-patients

In any case, the application for financial assistance is here. No harm in applying.
http://www.mayoclinic.org/patient-visit ... assistance
[60% US _ 26% DEV _ 14% EM] | (-16% LC _ +8% MC _ +8% SC) | [47% FND/VAL _ 40% MKT _ 7% MOM _ 6% REIT] | (+/- 5% or *25% rebalancing bands)

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Re: Medical treatment in US for non US citizen

Post by ram » Sun Mar 19, 2017 9:55 pm

Many hospitals in south Asia and southeast Asia have US trained physicians on staff and can provide most (but not all) healthcare available at tertiary care centers in US for 5 to 40% of the published US rate. (rack rate).
Many US hospitals will give substantial discounts on published rates if paid in cash in advance. (call and ask)
Ram

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Re: Medical treatment in US for non US citizen

Post by sawhorse » Wed Mar 22, 2017 8:53 am

toofache32 wrote:So why on earth would physicians bill higher amounts than the insurance pays?? I'm glad you asked that question.

Here's why physicians bill for much higher fees than they would otherwise accept: every doctor has maybe 50-100 CPT codes they bill for commonly. They have no idea what each insurance will pay and they find out when they get their check. Every once in a blue moon, there will be an insurance company that pays the doctor's full fee for 1 particular CPT code. This means the insurance company's allowed amount is actually higher than what was billed for some reason. So to capture the maximum THAT insurance will pay next time, they raise the fee for that code. But remember, now they have to bill that amount to ALL insurances and uninsured patients. Over time, this happens to most of the codes so now we have an entire fee schedule that is inflated. Remember, the in-network provider is contractually required to bill this inflated fee to everyone including uninsured patients.


This isn't always true. In fact it usually isn't for the most common codes. A doctor or facility might accept, say, 5 private insurances. For common codes that they bill multiple times a day, they know what each insurance pays. They know that none of the insurances reimburse anything close to $76 for a simple urine pregancy test. Yet they still bill that amount. (This is an actual charge I received.) They know none of the insurances pay $900 for a 30 minute consultation. Yet they bill that and make patients without American insurance pay upfront for it.

If what you say is true, then facilities or doctors that accept the same insurances would have the same fee schedules. They don't. To the contrary, they can vary widely. We're talking 10 times or more for some tests and basic equipment (IV equipment etc).

A director of MSKCC spoke about this as a business model (his exact words). They even created a department that specializes in recruiting wealthy foreign patients. It has an extremely nice lobby.

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Re: Medical treatment in US for non US citizen

Post by toofache32 » Wed Mar 22, 2017 12:10 pm

sawhorse wrote:
toofache32 wrote:So why on earth would physicians bill higher amounts than the insurance pays?? I'm glad you asked that question.

Here's why physicians bill for much higher fees than they would otherwise accept: every doctor has maybe 50-100 CPT codes they bill for commonly. They have no idea what each insurance will pay and they find out when they get their check. Every once in a blue moon, there will be an insurance company that pays the doctor's full fee for 1 particular CPT code. This means the insurance company's allowed amount is actually higher than what was billed for some reason. So to capture the maximum THAT insurance will pay next time, they raise the fee for that code. But remember, now they have to bill that amount to ALL insurances and uninsured patients. Over time, this happens to most of the codes so now we have an entire fee schedule that is inflated. Remember, the in-network provider is contractually required to bill this inflated fee to everyone including uninsured patients.


This isn't always true. In fact it usually isn't for the most common codes. A doctor or facility might accept, say, 5 private insurances. For common codes that they bill multiple times a day, they know what each insurance pays. They know that none of the insurances reimburse anything close to $76 for a simple urine pregancy test. Yet they still bill that amount. (This is an actual charge I received.) They know none of the insurances pay $900 for a 30 minute consultation. Yet they bill that and make patients without American insurance pay upfront for it.

If what you say is true, then facilities or doctors that accept the same insurances would have the same fee schedules. They don't. To the contrary, they can vary widely. We're talking 10 times or more for some tests and basic equipment (IV equipment etc).

A director of MSKCC spoke about this as a business model (his exact words). They even created a department that specializes in recruiting wealthy foreign patients. It has an extremely nice lobby.


I stand by my statement that the doctors don't really know what they will be paid unless they are part of a major University or hospital system that has bargaining power and was actually allowed to negotiate fees. Nobody builds a business around the hopes of a Saudi Prince someday getting sick and hoping he will pick you. And 5 insurance companies is alot. BCBS in my area has about 12 different plans, and they all pay differently and we often cannot even figure out which BCBS plan a patient has. Multiply this by Cigna, Aetna, Humana, and United HealthScare and now you have 50+ plans from only 5 insurance companies.

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