Complication insurance for self pay

[Luann]

I have been researching, reading the fine print & going round in circles on some of the insurance web pages. This is what I've learned, maybe it will save someone else some time.

The insurance web forms ask if the hospital is JCI, if you are having your surgery in Mexico - few hospitals presently have this certification - it is for Joint Commission International. None in Tijuana are JCI at least at the time of this post. Even though the hospital may not be JCI, it still could be covered under their plan. Hospital Mi Doctor is an accredited facility in Mexico, just not JCI.

Global Protective Insurance offers coverage for a 6 month period after your surgery. My $100,000 policy cost $602. Then they tack on another 3% handling fee. Handling - how? They aren't doing anything with it that shouldn't already be covered by buying the darn policy. Anyway the $100,000 sounds very generous, but it only translates to 10% of the total policy covering medical complication & treatment. They limit the cost of thrombosis treatment to only $2,500 though. Maybe the amount is higher if you buy a plan with higher coverage, not sure on that. 10% coverage available for flights back & forth, hotel stays, meals etc which I didn't consider a top priority. It pays out 100% of the policy for death, & pays $5000 for repatriation - if you die they will cover the cost of flying you back. This may sound morbid but for anyone having a major surgery this is a possibility - & for a medical tourist it would be a hugely costly & bureaucratic mess to leave your loved ones. Especially at a time when they would be overwhelmed & grief stricken. It covers a third of the policy pay out for severe disfigurement - which I'm not sure is useful for this surgery, but might be for plastic surgery. Also a third of the total policy for loss of fertility - which is definitely not going to be a covered event for me at my age! I thought about skipping the cost of this insurance, because I am not made of money & it already seems like a huge splurge. In the end though, I thought about my son & how horrible it would be for him if the unthinkable happened. At least this would give him a little extra cushion because estate & probate can take forever. You have to have $ in the meantime; his grandparents have passed on & there isn't a huge amount of family support.

7 Corners had a policy that was a few dollars cheaper, but appeared to only cover for the time period of your trip. I even got on the phone & spoke to a rep & he had to put me on hold to check. He told me he couldn't find anything regarding a length of time post surgery it would cover, so he said likely it only covers for the duration of your trip. My main concern is coming back home & discovering a big problem - I know my surgeon would cover a surgical complication at no added cost - but sometimes complications pop up a time later. If I needed to be treated once I got back to the US - at least I would have some funds to cover an ER visit & some diagnostics. Sometimes your doctor or the ER will code it so the insurance company isn't wise to the fact it resulted from a non-covered surgery. But they don't have to & insurance will deny it if they get wind of the fact.

I called a third company, Compass Benefits Group & got the voice mail / saw the email address of someone who had contacted me with info on the Global Protective insurance. I don't know if these 2 companies are the same or if the same rep deals with both. I did read on their website that their worldwide medical tourism plan covers surgery even inside the US - so if you are private paying your surgery inside the US this should be a plan that would cover.

[reading mom]

Thanks for sharing the result of your research. This info will surly help some self pay folks!

[B Simons]

The GPS - Global Protective Solutions program is designed specifically for international medical travellers. It covers two aspects that are not picked up by "normal" travel/trip insurance.
Normal travel insurance that is available in North America and most of the world EXCLUDES people who travel specifically to receive a medical procedure or treatment, so these policies offer no coverage for medical travellers.
So the GPS program provides two areas of coverage - 1. Travel accident, injury and illness relating to the travel portion of your trip. If you get sick, have an accident and need medical care the policy will respond. 2. Medical Complications coverage. The policy then provides a host of different benefits with specific limits in the event of a medical complication. These benefits go beyond those costs associated with additional treatment. It includes, Death, Repatriation of remains, Disability, Additional Medical or Surgical Treatment, Additional treatment of Thrombosis, Additional medical treatment of a medical complication for failed or unfavourable outcomes. Travel, meals, accommodation expenses, dependent care/family coordination, residence modification, physiotherapy/rehab, severe disfigurement and finally loss of reproductive function.
Typically in a claim situation several of these benefits will be triggered, and each benefit will pay up to its allotted limit. All benefits triggered cannot exceed the Capital Sum Limit that you choose.
GPS is the only medical travel insurance for US Inbound medical travellers, as well as being available on a global basis.
The coverage for medical complications is for a period of 6 months post surgery. The program will provide benefits in both the host and home countries, which means that you can seek treatment of a medical complication at home or the policy will provide benefits to get you back to the original surgeon or surgeon that is best suited to handle your particular situation.