European Medical Travel Conference Venice 2010 Presentation
1. European Medical Travel Conference 2010 5 th – 7 th May, Venice Overview of U.S. Health Insurance and Liability Risk Dale C. Van Demark EpsteinBeckerGreen [email_address]
2. THE CORE CONTEXT PATIENT PROVIDER GOVERNMENT (Payor, Regulator and Employer) EMPLOYER PAYOR
3. THE PAYMENT DYNAMIC PATIENT EMPLOYER Premiums Co-pay; Deductible; Self-Pay PROVIDER Private Insurance Employer Plan Medicare Medicaid CHAMPUS TRICARE PAYOR Fee for Service Premiums
4. THE REGULATORY DYNAMIC PATIENT EMPLOYER FEDERAL REGULATION EMPLOYER PLAN PAYOR PROVIDER INSURANCE STATE REGULATION
5.
6. THE MEDICAL TRAVEL CONTEXT Part I (Self-Pay) Fee Payment Dynamic PATIENT FOREIGN PROVIDER FACILITATOR Regulatory Dynamic: “Buyer Beware” Fee
7. THE MEDICAL TRAVEL CONTEXT Part 2 (Insurance) PATIENT FOREIGN PROVIDER EMPLOYER INSURANCE FACILITATOR STATE REGULATIONS THE CONUNDRUM Will a State approve a plan that includes providers over which it has no regulatory control? The California Approach Fee Premiums Premiums Fee
8. THE MEDICAL TRAVEL CONTEXT Part 3 (Employer Plans) PATIENT FOREIGN PROVIDER EMPLOYER EMPLOYER PLAN FACILITATOR FEDERAL REGULATION THE CONUNDRUM Will Plan trustees approve a plan that includes providers over which no state nor the federal government has control? The Fiduciary Decision Fee Premiums Premiums Fee
9. LIABILITY AND MEDICAL TRAVEL Part 1 (Provider Liability) PATIENT (U.S.) INTERNATIONAL BORDER FOREIGN PROVIDER INJURY Lawsuit? - Jurisdiction - Forum Lawsuit? - Extent of rights/recovery - Practicality
10. LIABILITY AND MEDICAL TRAVEL Part 2 (Facilitator Liability) PATIENT (U.S.) INTERNATIONAL BORDER FOREIGN PROVIDER INJURY Basis for Liability? Agency? “ Negligent Credentialing” FACILITATOR (U.S.)
11. LIABILITY AND MEDICAL TRAVEL Part 3 (Payor Liability) PATIENT (U.S.) INTERNATIONAL BORDER FOREIGN PROVIDER INJURY Basis for Liability? Agency? “ Negligent Credentialing” Breach of Fiduciary Duty (Employer Plan) PAYOR (U.S.)
![European Medical Travel Conference 2010 5 th – 7 th May, Venice Overview of U.S. Health Insurance and Liability Risk Dale C. Van Demark EpsteinBeckerGreen [email_address]](https://image.slidesharecdn.com/emcmtconference2010presentation-12843988680832-phpapp01/85/European-Medical-Travel-Conference-Venice-2010-Presentation-1-320.jpg)
