When I decided to have elective surgery in Europe, I was covered by an American health care plan. Economic, cultural, and practice differences assure that this will not be an easy union, and my case worker at WorldWide worked with me for weeks as we put the deal together. She was great and everything worked out fine, but I thought it was worth recounting some of the experiences for those facing similar circumstances.
0) During the pre-surgical workup, I needed to pay bills out-of-pocket before leaving the doctor’s office, then submit the paperwork to WorldWide for reimbursement. The x-rays were non-controversial, well documented and covered. The consultation with the surgeon was reimbursed at 10%, supposedly due to incorrect procedure coding.
Since the doctor’s report (in Italian) is translated by WorldWide before being processed by their US payment group, the error was internal, but took a month to even get that acknowledged. Time differences and their reluctance to make international phone calls complicated the process further. Keep all documentation and be prepared to follow-up relentlessly if reimbursement falls inexplicably short.
1) Prior to admission, there are two issues to be overcome, and the provider asks for two weeks to resolve them with the hospital.
One was to determine whether the hospital was an in- or out- of network, and thus eligible for 90% or 70% coverage of the procedure, respectively. The provider first issued estimates supporting both conclusions, forcing another review.
The second was what my out-of-pocket limit would be: by limiting both their payment and my exposure, the hospital had to accept some risk as well. In the end, it was around $3000, above the yearly maximum deductable for the policy, which I still need to sort out.
At that point a Guarantee of Coverage (GOC) is issued: get a copy as it’s your contract for the care. Until that document is available, the prep is not complete.
I’d say that the ‘two week’ rule is really a minimum: in practice, things can take longer, and I was literally on the phone with the case managers up to the final night.
2) Once admitted, the insurance proceeds incrementally, which confused the doctors and hospital a lot. Aimed at assuring quality and managing cost, it’s a surprising bit of over-control and micro-management that baffles the Europeans. The provider pre-approves the first two days of care, then reviews the case to determine what to approve for the next two days, and so on.
It leads to a recurring comedy of communications.
Questions would be faxed in from the US, the doctor would come ask why he was getting questions, I’d look for someone who understood US procedures enough to answer, WorldWide would call the doctor’s cell, I’d call WorldWide: it became a very active rotation.
3) Some in-hospital costs were not covered: I was given a pair of crutches and asked for 68 CHF, cash, to cover them. The pharmacy charges for discharge meds (150 CHF) and admission deductable (50 CHF) could slip onto a visa card.
It’s best to be prepared with a contingency fund and a card with an adequate credit limit in case this comes up.
- Plan things early with the hospital, doctor, and insurer to help connect people together, and make sure everyone has the same name, date, and case number.
- Get a strong working relationship with the case manager and use only them to track progress and to answer questions.
- Don’t start until the GOC is in hand, and walk away to Plan B (US-Based) if the issues don’t clearly resolve.
- Have some extra cash and credit on hand when you go in.
- Keep track of your deductibles and reimbursement paperwork.