JANUARY 18, 2016 — The UK P&I Club is offering its members some guidance on how to manage U.S. medical costs should a crew member, passenger or other maritime worker onboard a ship fall ill or become injured.
Noting that while the quality of care in the United States is generally regarded as high, the cost of treatment is inconsistent from hospital to hospital, Claims Executive Linda Wright says:
“Unlike other developed countries, the United States does not have a uniform healthcare system. Medical facilities are free to charge any price they wish for procedures and services. As there are no regulations regarding costs, the same procedure at different hospitals may be billed at a wide range of figures.
“It is important to ensure that the injured party is receiving the necessary treatment. With serious injuries, managing the medical services can be difficult without the assistance of a nurse case manager (NCM). The NCM is the liaison between the medical provider and your claims team. The NCM’s assessment of the treatment plan can determine the length of stay and appropriate procedures necessary to ensure progress toward a fit for duty/maximum medical improvement status. Frequent NCM updates, with reports and test results included, assist in monitoring the health of the crew member and preparing for return to the vessel or repatriation home.
“A first step should be the appointment of a medical bill auditing company to review and reduce the costs. A true audit of the services provided on each invoice is the most efficient way. Savings from overcharges, coding/billing compliance, and errors can best be determined by a diligent review of each item on a bill. Members should receive a copy of the itemized bill with procedure codes and fees to compare to the medical reports.
“Members could also enlist a medical review company that has prearranged percentage discounts from medical providers. For example, if a bill for a serious injury or illness totals $100,000 and the bill review has a contract to offer 25% discount, $25,000 would be saved on the bill. It is important to recognize that a blanket discount for all services may not always be the best strategy to minimise costs.
“The importance of appointing an appropriate medical management company at the onset of an injury or illness is high. However, the choice of a medical manager is sometimes made by the local vessel agent (prior to contacting the Club), who may have been recruited by a specific company. If the Club and Member are not involved immediately after the incident, medical management control may be lost to the agent’s choice. Often the Club sees expensive management handling charges and weak discounts across the board from these arrangements.”