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Gard News 197, February/April 2010

Medical costs both in the US and world-wide continue to escalate to unprecedented levels and have generally exceeded the inflation rate.  For those cases in which immediate medical care is required, there are actions that shipowners and managers can take to control costs without compromising the quality of care offered to sick or injured individuals.

Case management services
Case management services involve the early intervention of a medical case manager1  who takes a pro-active role in co-coordinating the care received by an individual while under the care of a doctor or after being admitted to a medical facility.  The medical case manager is able to give advice in order to ensure quality care for sick or injured parties while staying alert to the potential for excessive testing or unnecessary treatments before they have been performed.  Medical case managers bill on an hourly basis for their service. 

The early intervention of a medical case manager, particularly in a serious matter, can reduce the time spent in a medical facility by identifying acceptable treatment facilities in an individual's home country.  Frequently, expediting repatriation to an individual's home country will lead to a quicker recovery as the sick or injured party will be in a familiar environment surrounded by family and friends and without the language difficulties often experienced by being in a foreign land.  While it is difficult to quantify the savings resulting from utilisation of case management services, it is usually an important factor in the effective and cost-efficient handling of a serious illness or injury.

Medical audit and review
Medical audit and review services are separate and distinct from case management services, as audit and review services are generally engaged after the medical services have been rendered. Several independent service companies undertake the review and audit of medical expenses for cases in the US (where medical services are on a "for profit" basis) and on a world-wide basis.  Most of these services operate on a "no cure, no pay" basis, which is to say that they do not earn any fees unless they are successful in achieving a reduction of the medical costs.  The fee charged is usually based on a pre-arranged percentage of the total amount saved by the review/audit.2 Gard has arrangements with such a service to review and audit medical provider bills in the US and in many other countries on a reduced fee basis. Gard members who avail themselves of this service have enjoyed reductions in medical charges which can average nearly 40 per cent in the US.

In a recent case, a hospital in Florida sent a bill to the member which exceeded USD 321,000. The audit and review service engaged for the member by Gard found duplicate charges and excess billing, recommending a final payment of the bill in the amount of USD 13,700. While similar savings can not be guaranteed in every case, this is a clear illustration of the importance of reviewing medical provider bills.  Reductions can be obtained on bills at any level and while it may not seem worthwhile to review and audit small bills, the cumulative savings which can be obtained will result in a reduction of medical expenses for all Gard members.3  

It is important to note that medical audits can also be performed in countries other than the US. Several of the medical audit contractors have world-wide audit capabilities. Greater use of these services should lead to additional reductions in the overall cost of medical care.

Prompt contact with the local correspondent or Gard office
Once a medical service provider has been paid by the member or the agent, it is nearly impossible to reduce the charges later.  It is equally difficult to dispute the medical necessity of a test once the test has been performed.

When used on a coordinated basis, medical case management and audit/review services can be a useful tool in obtaining the best available medical care on a cost-effective basis. In order to derive the maximum benefit from these tools, it is important to make prompt contact with the local correspondent or Gard office.  If this contact can be made before landing the individual for medical care, there may also be an opportunity to offer guidance in selecting the best treatment facility for the individual involved.

Prompt reporting, use of the best medical providers and thorough review and audit of all medical expenses will result in more effective use of resources for all members.  Gard will be pleased to discuss the necessary steps to implement this course of action with individual members.

1 Usually a nurse-practitioner or physician's assistant.
2 Some services charge a flat line by line service fee whether or not there is a saving. 
3 Some members have directly contracted with audit/review services.  Gard does not have access to the savings they may enjoy.