Their health in your (insurer’s) hands – trusting the benefits of medical networks

As a broker or financial adviser looking at extending your product range to generate more revenue, you might be considering international private medical insurance (IPMI). This expanding and profitable market offers excellent medical cover for those with clients spending a good proportion of their time living or working abroad.

The ability for insurers to deliver the IPMI ‘promise’ is heavily dependent on medical networks. In this piece I’ll be providing an overview of medical networks: what they are and the benefit they provide to your clients.

A medical network is made up of hospitals, healthcare clinics and consultants. Networks run into the thousands of medical facilities and, for some of the larger insurers, this figure is in the hundreds of thousands across the globe. Contractual agreements will be in place to provide healthcare services to an insurer’s members.

Networks bring a number of benefits to members:

Offering a comprehensive range of services

The vast scale of networks means that insurers can, with relative certainty, offer their members every conceivable type of treatment they might require, and usually in their local vicinity. Where a suitable local facility isn’t in place, the insurer will implement evacuation or repatriation procedures to transport the member to another region for their care.

Insurers will also have facilities within their networks that offer specialist treatments for uncommon cancers and other conditions so that members unfortunate enough to need this level of care can get the treatment they need.

The benefit of direct settlement

Generally speaking, members that use their insurer’s network for treatment won’t have to worry about paying for the care out of their own pocket and claiming back the money. Insurers will have a direct settlement agreement with the medical providers in their networks, allowing fees to be settled without the member’s involvement.

Where a member chooses a facility outside of the network, in most instances they will have to pay for treatment and claim back.

Avoiding excessive medical fees

A member is free to choose a medical facility outside of their insurer’s network for treatment. However, they run the risk of fees being outside the scope of what is acceptable, and their insurer refusing to meet the full cost of treatment. Members are advised to use a facility within the network. In general, they won’t have to pay for their treatment up front and there’s no risk of being out of pocket.

With insurers negotiating favourable and more certain rates with their in-network facilities, it’s in their interest for members to choose this route for their treatment.

Offering a high standard of care

In-network medical facilities are, to a large degree, vetted by the insurer. It’s not practical to fully vet all facilities, especially in the larger networks, but you can be very confident in the standard of care your clients will receive. Out of network facilities won’t have the backing of the insurer’s expert vetting process and care quality can be less certain.

Making specialist care available

Members calling their insurer for advice on accessing the care will often receive a recommendation to use a facility that has the specific expertise and resources their particular circumstances require. If a members chooses for themselves, the medical provider may be tempted—for financial reasons—to take on the case even if another facility is better suited to offer treatment.

As their adviser, you’ll not want your clients to risk their health. Being away from their home country can be a daunting experience, especially for first time expats. You’ll want to be happy that they can access medical care they need quickly and easily. Clients covered by international private medical insurance will be free to choose where to access their treatment. Go outside of their insurer’s network and the care they receive might be perfectly acceptable. However, choosing an in-network facility adds an element of certainty, at a time when additional assurance could well be welcome.