By Tammy Bradly, VP Clinical Product Development, Coventry Workers’ Comp Services
Ever been on vacation in a foreign country and found yourself struggling to order lunch from a menu printed in another language and the waiter doesn’t speak English? Frustrating, particularly if you end up with something you didn’t want. Food is one thing; however, imagine if you are ill or injured and don’t know where to go for care or find yourself unable to communicate with the healthcare provider once you got there? According to statistics from the U.S. State Department, over 6 million Americans are now either working or studying overseas. Survey results collected from this year’s RIMS Conference attendees indicated that managing injuries abroad is top of mind for U.S. Risk Managers. When asked about their biggest care management concerns, Risk Managers rated “Managing injuries occurring outside the U.S.” their #1 concern.
Although the frequency of injuries occurring abroad is not nearly as high as those based in the U.S., navigating a global healthcare system while ensuring that employees receive the best possible medical care, is extremely complex. At the point of injury the employee, often times traveling alone, is faced with deciding: Do I need treatment? What type of treatment? Where do I go? How do I know I will receive quality care? How do I pay for it? This uncertainty creates stress for the employee and could potentially lead to inadequate treatment, a poor recovery and an unsatisfied employee. The situation can be easily avoided if a plan is in place for managing injuries abroad.
Access to Care – Plan Ahead
Unlike the U.S., in many foreign countries providers can and will demand payment in advance of treatment or require payment before releasing the individual from the hospital and the cost of most services (especially hospitalization) isn’t an amount commonly carried around in one’s wallet. International provider networks have agreements with local providers and medical facilities for services ranging from routine outpatient care to inpatient hospitalization. Proactively partnering with an established international network ensures employees have access to quality care when necessary and cashless access to such services directs attention to the employee’s care and wellbeing vs. ability to pay.
Breaking the barriers – Coordination of Care
When an injury or illness occurs abroad, immediate 24/7 access to a team of clinicians experienced with breaking cultural and language barriers, eliminating time zone challenges and facilitating care ranging from simple provider visits to air ambulance evacuation is critical.
While it is a complex management process, injury management that safeguards international workers can be simplified. The goal must be to ensure that those injured workers receive prompt clinical triage and appropriate medical care when an injury occurs. Contracting with an entity experienced in coordinating medical care abroad on a 24/7 basis takes the burden from the employer, freeing them to focus on employee support.
Putting it in Perspective
Coordinating care abroad is time consuming and the injured worker’s needs may vary depending upon extent of injury, availability of care and the particular country where care is being delivered.
Consider the worker injured in the U.S. who returned home to their country of origin, located their own provider and began treatment. The claim handler made numerous but unsuccessful attempts to obtain a treatment plan and work status from the treating provider struggling with communication and cultural barriers. By referring the claim to the international case management team, they immediately established communication with the provider to make direct payment arrangements, obtain medical documentation and coordinated a treatment plan that resulted in a release to return-to-work.
Or consider the employee hospitalized in Singapore due to a fractured pelvis with an expected hospitalization of 3 to 4 weeks. The claim handler was having difficulty communicating with the injured employee and the treating provider due to time zone differences, and had been unsuccessful at obtaining any medical information from the hospital to effectively manage the case. Once pulled in, the international team was able to leverage their network provider relationship, and establish direct communication with the hospital to obtain medical information and facilitate discharge planning. The international case management team established a relationship with the employee, provided support and re-assurance to alleviate much of his anxiety while coordinating discharge activities, travel home to the U.S. and coordination of services upon his arrival. Ongoing case management services were coordinated with a local field case manager to ensure medical services weren’t interrupted upon his arrival back in the U.S. The employee was extremely grateful to have someone to communicate with and coordinate his needs while hospitalized abroad and he was successfully discharged 2 weeks sooner than expected.
The outcomes were positive in both of these scenarios, however, a plan to triage and channel these employees to credentialed network providers at the point of injury, would have reduced the initial communication issues regarding treatment plans and provider payment expectations.
Global Presence – Peace of Mind
If managing injuries abroad is a growing concern for you, finding a partner who can offer international provider network access and care management allows you to be ready when the situation occurs. The partner you select should be prepared to:
- Provide cashless access to quality medical providers and facilities in the foreign countries where your employees work
- Offer 24/7 multi-lingual support and scheduling for emergency, routine and planned tertiary care management
- Coordinate medical care, procurement of equipment and case management to ensure appropriate provision of medical care
- Assist with emergencies, evacuations and repatriation when necessary
As with strategic claim management stateside, a high quality international case management solution will ensure appropriate levels of care in the right locations which will ultimately affect overall medical, disability and cost outcomes. A high touch approach is sure to reduce the understandable anxiety associated with this unfamiliar process and improve your employee satisfaction. In the long run, your claims staff should enjoy a hassle-free support system allowing them to deliver the same quality claim support that they offer in the states. Peace of mind for all involved.
About Tammy Bradly
Tammy Bradly is vice president of clinical product development for Coventry Workers’ Comp Services. Bradly is a certified case manager with more than 20 years of comprehensive industry experience through service delivery, operations management, and product development. She holds several national certifications, including certified case manager (CCM), certified rehabilitation counselor (CRC) and certified program disability manager (CPDM). She is a licensed professional counselor in the state of Alabama.
About Coventry WCS
Coventry Workers’ Comp Services, a division of Aetna, is the leading provider of cost and care management solutions for property and casualty insurance carriers, (workers’ compensation and auto insurers), third-party administrators and self-insured employers. We design best-in-class products and services to help our partners restore the health and productivity of injured workers and insureds as quickly and as cost effectively as possible. We accomplish this by developing and maintaining consultative, trusting partnerships with our clients and stakeholders, built on a foundation of innovative and customized solutions that support the claims management process.
Coventry WCS is a WorkCompWire Advertising Partner.
This is not a paid placement.