HOMS - Medicare - DR Medicare

drtampa

Bronze
Oct 1, 2004
1,087
29
48
New Ulm, TX
My Tampa physician today explained how this Santiago hospital can provide Medicare coverage in the DR. He says that off-shore hospitals affliliated with or operated by US companies, Mayo or Cleveland etc, just bill Medicare as though the treatment took place in the US.
He also says that there is a Medicare supplement, for about $250 per couple per month, that covers off-shore treatment for Medicare at the same cost to the patient as US treatment. This is not supposed to be travelers insurance. Are any of you aware of this?
 

HOWMAR

Silver
Jan 28, 2004
2,624
2
0
Medicare does NOT knowingly pay for services rendered outside the US. If you find a Dominican provider who says you can get coverage by billing as if the service is provided in the US you are possibly an accessory to Medicare fraud.

See the Medicare policy below from their website.

That said, there are Medicare supplemental policies which will cover you outside the US. The coverage is by the supplemental carrier, not Medicare.

Travel Outside of the United States
Coverage under Medicare The Original Medicare Plan generally does not cover care outside the United States. Puerto Rico, the U.S. Virgin Islands, Guam, American Samoa, and the Northern Mariana Islands are considered part of the United States. There are some exceptions.

In rare cases, Medicare can pay for inpatient hospital services that you get in Canada or Mexico. Medicare can pay only if:


You are in the United States when a medical emergency occurs and the Canadian or Mexican hospital is closer than the nearest U.S. hospital that can treat the emergency.
You are traveling through Canada without unreasonable delay by the most direct route between Alaska and another state when a medical emergency occurs and the Canadian hospital is closer than the nearest United States hospital that can treat the emergency.
You live in the United States and the Canadian or Mexican hospital is closer to your home than the nearest United States hospital that can treat your medical condition, regardless of whether an emergency exists.


Medicare also pays for doctor and ambulance services furnished in Canada or Mexico in connection with a covered inpatient hospital stay.
The amount you need to pay Health care services and supplies are Not covered outside the United States except under limited circumstances.

You pay the part of the charge that you would normally pay for covered services.
The part of Medicare that pays for this service or supply Part A Benefit
Medicare Contact for additional information State of New Jersey Fiscal Intermediary: 1-800-633-4227
1-800-MEDICARE
Important notes You must pay an annual $124 (in 2006) deductible for Part B services and supplies before Medicare begins to pay its share.
Actual amounts you must pay may be higher if a doctor, health care provider, or supplier does not accept assignment.

Additional Information There are no Local Medical Review Policies (LMRPs) or National Coverage Determinations (NCDs) currently associated with this coverage topic.
 

Dolores1

DR1
May 3, 2000
8,215
37
48
www.
Your Tampa physician may be right, but once the hospital opens. It still is under construction. But I have always heard that they plan to become the first to accept Medicare in the DR. The snag has been the qualifications of the nurses. From what I understand they would have to give recent medical grads nurses status in order to fill the requirement, as Dominican nurses do not fit the qualifications required by Medicare. Let us wait and see how this comes along.
 

drtampa

Bronze
Oct 1, 2004
1,087
29
48
New Ulm, TX
L A Times article, in the St Pete Times today, on foreign hospitals says that, "Medicare has accredited 88 foreign hospitals through a joint international commission".
Hopefully that is in the future for HOMS.
 
Last edited:

Ken

Platinum
Jan 1, 2002
13,884
495
83
drtampa said:
L A Times article, in the St Pete Times today, on foreign hospitals says that, "Medicare has accrediated 88 foreign hospitals through a joint international commission".
Hopefully that is in the future for HOMS.

Does the article say which hospitals and whether more will be accredited?
 

drtampa

Bronze
Oct 1, 2004
1,087
29
48
New Ulm, TX
Sorry. It did not mention specific hospitals. THe main thurst of the article was that self-insured US corporations are sending their employees to foreign hospitals for surgical procedures to avoid the cost of US hospitals.
 

drtampa

Bronze
Oct 1, 2004
1,087
29
48
New Ulm, TX
Ken:
I called Medicare this morning. At 6:00 AM you get right through. They are supposed to forward a request to the proper person who will call or send me a listing. However, this is dealing with Medicare so who knows if I will ever get an answer.
Earl
 

HOWMAR

Silver
Jan 28, 2004
2,624
2
0
I think if you read the article you will see that it does talk about foreign hospitals being certified, but NOT by Medicare, but by the same agency that certifies hospitals hospitals for Medicare. I believe that agency is The Joint Commission on Accreditation.

In any event, I have yet to see any changes in Medicare Regulations which would expand their coverage outside the US. With the deficit they are running, I doubt this will happen.

http://www.latimes.com/news/printedition/la-fi-outsource30jul30,1,736228.story?ctrack=1&cset=true

Milstein, of Mercer Health & Benefits, says hospital quality is not a major worry because over the years, the same agency that accredits most American hospitals for participation in Medicare — the federally funded health plan for the elderly and disabled — has accredited 88 foreign hospitals through a joint international commission