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Some readers will recall an article published in Gard News issue No. 158,1 which included comments with respect to medical audits in the United States. Experience from recent cases indicates that a reminder may be justified.

The quality of medical treatment in the United States is generally regarded as first-class. However, anyone with experience from injury and illness cases in the US will be painfully aware that the downside can be exorbitant medical costs. In some instances the bills themselves may trigger conditions such as shock, heart attack and stroke.

1 "Must the cost of medical care for seamen in the US be a bitter pill?".

The question then becomes how to control medical costs. In the US there are several companies that specialise in medical audits. They scrutinise every item on the medical bills in order to find out whether the hospital charges are proper and whether double billing or "unbundling" has occurred. Some of the audit companies charge a percentage of the savings achieved as their fee. If this is the case, then nothing is lost by submitting medical bills for audit. Other companies charge a minimum fee plus a percentage of the savings achieved or a charge based on the number of line items.

Standard procedure in connection with incidents in the US is that Gard's local correspondents are informed as soon as possible. In order to save time the ship should request their attendance immediately when an illness or injury occurs. Based on experience this seems to be particularly important in connection with hospitalisations in the Gulf of Mexico area. The local correspondents will in turn contact Gard's general correspondent for the US, Trimar Defense Services Inc. in New York. Trimar routinely submits medical bills to an audit company and savings have been significant - in some matters involving serious illness, several tens of thousand US dollars. The companies most frequently used to charge a percentage of the savings as their fee with no minimum amount. Unless the amount in question is very small Gard recommends that no payment of medical costs be effected by the ship's agent before Gard's correspondents have been consulted with regard to a possible audit.

The companies used by Trimar also provide case management services for which they currently charge an hourly rate of USD 85-95. In the capacity of case manager they ensure that the crewmember gets the best treatment at an economic rate. The steps they take to ensure efficient delivery of the best medical treatment can reduce the risk of a lawsuit in the US. Moreover, through their network the case managers are in the best position to arrange repatriation at the most convenient time at a competitive rate.

In addition to medical audits, at least one other measure can be considered in order to reduce medical costs. If a non-US crewmember is hospitalised in the US, then the first priority will of course be to secure the best possible treatment. On the other hand, a US hospital may continue treatment of a foreign patient for longer than may be necessary (in the judgment of a medical professional), thereby increasing their revenue. Although the doctors' orders should be followed, the patient should be repatriated to his home country for follow-up treatment as soon as he is fit to travel. Needless to say, repatriation should only be arranged if the required treatment is available in the country of residence. However, the Philippines and India for example have first- class hospitals. In most situations an injured or ill patient will recover more quickly in their home environment where they are encouraged by their family and friends and medical personnel who speak their native language. Gard's local correspondents can be of assistance in ensuring that crewmembers are referred to the best medical providers.

Members are requested to keep the above in mind when faced with illness and injury matters in the US, particularly the need for the ship to promptly notify the local Gard correspondent in the event an illness or injury occur requiring medical treatment in the US (especially at ports in the Gulf of Mexico).

Any comments to this article can be e-mailed to the Gard News Editorial Team.

Gard News is published quarterly by Gard Services AS, Arendal, Norway.