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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 list (www.jointcommissioninternational.com/23218/iortiz/), 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 28 points with an index:

1. 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);
2. Birth, death, marriage certificates (with 10 copies apiece in case they're needed for estate purposes);
3. Your passport information in case they have to contact the U.S. Embassy for any reason;
4. List and location of all household bills that must be paid with due dates;
5. Divorce decrees with all relevant settlement information;
6. Location of wills, trusts and any power of attorney information;
7. Advanced healthcare directives;
8. Adoption papers, if applicable;
9. Key identification numbers, including drivers' license, Social Security, passport and employee identification data;
10. Recent bank and brokerage statements;
11. Detailed funeral and burial wishes;
12. Location of cash that may be used to handle other emergency expenses;
13. Copies of recent medical records in case you're incapacitated;
14. Copies of deeds for primary home, vacation and investment properties;
15. Car title, lease, loan information and license plate data;
16. All insurance policy (health, disability, life, auto and long-term care) with agent contact information;
17. Photocopies of credit and debit cards, front and back (displaying the individual's signature);
18. A current copy of the individual's home financial software program reflecting up-to-date financial data;
19. All password information necessary to get inside any computers, PDAs and cell phones you own;
20. The locations for all investment documents;
21. Notes on house maintenance and service providers;
22. Where safe deposit, lockbox and filing cabinet keys are;
23. The name and number of your human resources department at work;
24. Location of tax returns for the last three years;
25. 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;
26. All user IDs and passwords for online accounts;
27. Guidelines on what to do about orphaned pets, including set plans for who will adopt them and pay for their care.
28. 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 was authored in cooperation with Financial Planning Association.