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All the Hacks: Money, Points & Life
Medical Travel: Better Care and Lower Costs for Surgery, IVF, Dental, Advanced Screenings and More with Josef Woodman
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- [00:03]
A
Medical travel is gaining popularity as a huge way to save. But is it actually safe, cost effective and worth considering? Today I'm talking to Joseph Woodman, who literally wrote the book on the topic.
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B
And says what people really don't know is that health care is as good or better overseas cross borders than they can get here in the United States.
- [00:24]
A
So in this episode we're going to break down the facts from cost savings up to 65% to the best countries for different procedures, how to find the right doctors, avoid common pitfalls and even leverage travel rewards to make medical travel more affordable. I'm Chris Hutchins. If you enjoy this episode, please share it with a friend or leave a comment or review. And if you want to keep upgrading your life, money and travel, click follow or subscribe now. Let's get into it right after this. This episode is brought to you by NetSuite. What does the future hold for business? Ask nine experts and you'll get 10 different answers, both Bull market bear market inflation up, inflation down. It would be amazing if we had a crystal ball, but until we do, over 38,000 businesses have future proofed their business with NetSuite by Oracle, the number one Cloud ERP bringing accounting, financial management, inventory and HR into one fluid platform with one unified business management suite. There is one source of truth giving you the visibility and control you need to make quick decisions and and when you're closing the books in days, not weeks, you're spending less time looking backwards and more time planning for the future with actionable data. Which is exactly what I'd want as a CEO. Speaking of opportunity, download their CFO's guide to AI and machine learning at AllTheHacks.com NetSuite the guide is free to you at AllTheHacks.comNetSuite N E T S U I T e all the hacks.com Netsuite.
- [01:54]
C
Joseph, what do you think are some of the most common myths about medical travel and how do they actually compare to reality?
- [02:01]
B
Well, I think the main myth, especially for people who haven't traveled overseas, there's a big misconception that US has the very best healthcare. And we do. But in order to take advantage of that healthcare, a significant number of people, mostly at the bottom of the pyramid or toward the middle of the pyramid economically can't afford it. We've priced ourselves out of the market so we don't universally have great healthcare. We're like everywhere else. What people really don't know is that healthcare is as good or better overseas. Cross borders than they can get here in the United States. And the conception there is. Anyone who hasn't traveled overseas can't imagine a Four Seasons or a Hilton or a Denny's or a J. Crew or a Costco. All of those exist in almost every city in the world now. And yet people who can't conceptualize that are not going to be able to get their arms around being on an operating table or a dental treatment chair in a mind blowingly advanced hygienic environment. They just can't see that happening. What they see is a mud hut, rusty scalpels, and doctors that don't know English.
- [03:08]
C
And let's talk about that last one. As I've been preparing for this, I've been talking about medical travel to people. And a lot of people have told me there's so much nuance in medical terminology. How are we going to get past the language barrier? Is that something anyone even needs to worry about?
- [03:23]
B
That's a good question. Ten years ago, yes. When my father, who really was the inspiration for this book some 23 years ago, traveled to Puerto Vallarta for a mouthful of dental care. Very few of the sites in Mexico or anywhere in the world were in English. Very few clinics were actually consciously serving the international patient. All right. He was a pioneer. He always was. And when he mentioned it to me, I didn't know any better. And I said, what are you doing again? And he said, well, you want to come join me? And that's how this whole journey started. But at that time, none of those websites were in English. He had to go and find somebody and translate them. There are language barriers. That's part of the screening process. If someone refers you to a clinic or you find a clinic online and you contact them and their English isn't good, move on. The top clinics around the world that we've identified in our book, all of them speak English. That's a prerequisite because they serve an English speaking patient from the United States, from Canada, from the uk. Those are the three big markets. So if you have trouble with the language, move on. You'll find a clinic that caters to the international patient and speaks good English or they have good translators. If you're in a foreign country like South Korea or Thailand, where English is a little more foreign than, let's say in Mexico.
- [04:45]
C
Backing up. Since not everyone listening is familiar with traveling for medical procedures or diagnostics, why should someone even be considering this over domestic options for us outbound?
- [04:58]
B
And I'm assuming that's what we're mostly Talking about the main reason for traveling. It's cost, cost, and cost. There's a lot of people that feel they have a false sense of security, that they're insured. They've got a skinny plan with zero premiums, and then they get really sick. And there's all these exclusions and deductibles and co pays and gotchas, not to mention claims denials and prior authorization that they have to get through. And now it's wide open. The huge driver is cost. I have personally talked with people who were in for a simple colonoscopy, and they got charged by their insurance company something like 2,300, $2,500, and they thought they were covered. You can get a colonoscopy down the road in Mexico, Costa Rica, almost anywhere. That's an easy one. And that's 5, $600. With the latest technology, the latest machines, best doctors, best drugs, which come with colonoscopies.
- [05:58]
C
That sounds like almost 75% savings. Is that kind of a rough average or how does that range compare? And are there certain things where the savings is better or worse?
- [06:08]
B
The average savings that we tell patients they can expect, whether it's a complex dental procedure or an orthopedic procedure like a new knee or a new hip, which is very common, or IVF, is anywhere from 40 to 65%. So if you want to just figure roughly half, that's a good number. People who've been goaded by advertising or social media where they're advertising some cost that is 80, 85% saving, 90% savings. You really want to watch out for that cost. Shopping is one of the biggest mistakes that a medical traveler can make. Those are the people that get into trouble because a clinic's got to make money too. So they can't offer a knee procedure for $800. They gotta pay their rent, they gotta keep their equipment up, they gotta feed their families. So if you aren't within that 50 to 70%, 40 to 60% cost range, you want to look out if it's not enough of a savings. By the time you add your travel, your accommodations, your dining and all that, unless you're tacking it on to your procedure, then you're probably not saving enough.
- [07:17]
C
Where does that savings come from? How is it able to be so much cheaper?
- [07:21]
B
That's interesting. The American Dental association just released numbers on what a dental specialist makes as a salary, that's pretty staggering. 186, 240, $250,000 a year. They deserve probably every penny they get. The cost of living in the United States is much higher. Cost of living in places like Mexico, Costa Rica, Thailand, even South Korea is much, much lower. There's not quite the emphasis on high pay. Doctors are perceived more as technicians rather than deities of some kind. And so the cost is lower. Another thing that people don't really talk about, not that big a deal, but it affects things, is that companies that produce a lot of that expensive equipment, like a cyber knife for cancer, or even proton therapy for other kinds of cancer, or a simple MRI machine or a CTI machine, they make deals with those countries that can't afford the prices of the instrumentation. So the hospitals and the clinics that buy those instruments pay a much, much lower price, and that gets passed down to the patient. Also, speaking of that, they utilize that instrumentation. I've seen it in clinic after clinic. I've seen MRIs just lying around gathering dust in US hospitals because one doctor in one department decides he wants some sexy mri. Another doctor in another department says, I want this mri. I want that. And they're not utilized. And so the expense gets really high. You go to a hospital, like, for example, Bomangrad in Thailand, that thing is going 24, 7. And in fact, they've got two prices. They've got a daytime price, it's about $450 for an MRI, as opposed to 25 to $3200 here in the United States if you're not covered. They have a nighttime price, which I really love, and it's $210. Same thing, same equipment, the same level of radiologists that is giving you the scan. And I went there just to check it out one night, and it was a very different world. And it was something that really touched me. There were a lot of farmers, peasants, people that weren't well off. And a $215 was a month's pay for these people. But they offered it to them because they knew that they couldn't afford it. So it was kind of a little bit of a loss leader. The margins on it were very high. Most of it was for pediatrics, people trying to save their kids. It was just kind of cool to know. But the point being is those kinds of things add up. Cost of living is lower in other countries, Cost of instrumentation is lower. But I would also say that the efficiencies are much higher for those clinics and hospitals that specifically cater to the international patient, because they got to get them in and out of there fast, because a lot of them only have a weekend. They've only got Four, four or five days to be there. So they have implemented strategies which are really interesting. If you want an implant in the United States, it's three or four appointments over a span of four or five months. Doesn't have to be that way. Your butts in the dental chair a lot over that period of time and some people might not be able to handle that, but you know, you're in and out in three days if you want like a, a dental implant or a root canal or a set of veneers. Same thing with hip surgery. They've really accelerated the process without compromising the clinical excellence.
- [10:50]
C
Yeah, I have a friend that just came back from Bamingrad and said the facility was just out of this world. He didn't know what his expectations were, but when he left, it felt better from a facility standpoint than many hospitals he'd been to in the U.S. one thing we didn't talk about, so maybe you can tell me, is how much should people be concerned with the quality of the doctors? Where are a lot of these doctors getting trained? Is that a worry for anyone?
- [11:15]
B
Well, it can be a worry and it should be certainly a concern. I mean, your doctor is the one that's got his or her hands on you. You want to look at the quality of the clinic. Is it accredited? Does it have a lot of chops, does it get great reviews? But the bottom line is you really want to look at that doctor. So finding the right doctors is job number one. Once you've chosen your destination and are.
- [11:36]
C
Most of the doctors in these kind of premier facilities trained, locally trained abroad.
- [11:42]
B
You get an interesting mix of doctors. I've talked to a fair number of them and a lot of them are kind of refugees from the US healthcare system because they're tired of being harassed by the insurance companies to keep things moving along to meet quotas because the reimbursement rates are so low, et cetera. So at Bomegrad, for example, it's the top international medical travel hospital in the world. Some 45% of their patients are from other countries. But they have 300American board certified doctors and surgeons in that hospital. That's an anomaly. So if you're checking on credentials again, you're doing your own research, you're referring yourself, you have to trust that the University of Birmingham in the UK puts out good doctors. On the other hand, in the United States, one out of every seven surgeons is of Indian descent. They were trained in India and they're now in the United States. And people don't really question that because they have a higher level of comfort when they're in the United States, if they knew this exact same doctor was going to treat them in Bangalore or Chennai, they might run 100 miles from that. So a lot of it's a matter of perception. I'm not taking away from the research that's necessary. But to answer your question, yeah, it's a mix. There's a lot of American trained doctors, especially in Mexico and Costa Rica. But there's a lot of doctors that have been trained in perfectly good, high quality universities. India, Thailand, Turkey, believe it or not, has great training. They're one of the biggest manufacturers of U.S. pharmaceuticals in the world. Chances are if you do a lot of pharmaceuticals or any at all, it's coming from either Canada, Turkey, or two or three other sources. So people don't appreciate the fact that so much of the health care that we receive originates from foreign lands. It just happens to end up in the United States.
- [13:38]
C
Okay, so obviously, cost savings, great quality can be great. What types of procedures are things that people should be considering or maybe not considering medical travel for?
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B
Oh, good question. And that took almost a year and a half worth of research when we first decided to do the book, because we just thought, well, just find out the hospitals and clinics that are offering these procedures and find the great hospitals and clinics. But it's not that easy. So just from a procedural standpoint, it needs to be a procedure that doesn't take a massive amount of treatment over a long period of time. So the bad news, first, cancer treatments are not great. The best types of treatments are treatments that have short surgery times and short recovery times. And oddly, those are procedures that you really wouldn't think about. Like, for example, an open heart procedure you would think would be not a candidate. But it's a pretty simple procedure, and they want you up and walking around within two or three days and 10 days, you're going to be able to get on a plane and go home. That's a good procedure. Not a common procedure, but it's a good one. So bad procedures are ones that take a long time with multiple visits to the doctor, long, long recovery periods. That's one reason I don't like bariatrics and weight loss programs, even though they're heavily advertised. And you see a lot of that appearing in the media. But bariatrics has got all kinds of risks associated with it, and at least one or two visits to the doctor afterwards to check on complications. And so the better procedures, the good news is it's about 15 or 20 procedures that are most recommended by doctors and most used by patients. Almost all dental procedures. The caveat that implants, as you may know, sometimes take a second visit. That's just the nature of an implant. They put the abutment in your bone has to grow around the abutment. Then you have to come back. That's true in the United States and anywhere else in the globe. But it's got short recovery periods and you go home after your first treatment, you come back three months later, you go home after your second treatment. Orthopedics is good. The surgeries have improved to the point where they want you up and walking around almost the next day. IVF is good if you're willing to travel a couple of times because not every IVF is successful, so you get a failure rate. So you might have to go back a couple of times. Though somebody from New York isn't going to want to go to Bangkok for ivf. It's too expensive to travel.
- [16:13]
A
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- [18:48]
C
That My wife happened to go through IVF and part of the process was egg retrieval implantation. But also there were a lot of drugs she had to administer shots with. Some of these treatments that might require medication prescriptions. Do they provide all of those abroad? Do they work with your doctor at home to kind of help get all the medications you need? I know some of those medications often need to be refriger, so maybe you couldn't take home a full supply from your trip to Thailand. How does a lot of that work?
- [19:17]
B
Good question. The prescriptions that I've had written for me, as long as they're in English and they're on a Dr. Stationary, can be filled in the United States. If it's not in that language, you want to make sure that you've gone to a really great hospital that has their own pharmacy. Most of these big hospitals have their own pharmacies and they don't mess around with the quality of prescriptions. So they're a lot like the us. They've got a lot of screening for counterfeit prescriptions for prescriptions made by poor manufacturers. And what you want to do is also focus on the brand name. Don't get the generic unless it's just prohibitively expensive.
- [19:55]
C
So it sounds like for the prescriptions you might need, that you can get at the time of the procedure, you can get them there, and if you need them later, they can actually write prescriptions. Do doctors ever do follow ups?
- [20:06]
B
Virtually, not so much. A lot of people who are trying to save money on medical travel are ashamed to talk to their specialist or they don't want to let them know that they're traveling. And it's really important to give your doctor a heads up. And there's no shame in saying, doc, I can't afford you. And I found a great clinic. It's JCI accredited. This is where I want to go. It may or may not be that your doctor and your destination in your foreign country would follow up, but the fact that you've given your doc notice and you brought back all of your paperwork, that's another big mistake people make is they toss their paperwork, they leave in the hotel room. You got to bring back your screening, your blood tests, your consultation notes, all of that. And then a doc is going to be able to pick up where your other doc left off if a complication develops or if they need to go in and do something else or have some follow up.
- [21:00]
C
Yeah. The friend of mine who went to Bumrungrad in Thailand told me that the hospital has an app that has all of your medical records there. And he was just amazed when he came home, he took his father as well. And the access to the records of everything that happened he thought were better than the access that he gets going to see a doctor in the U.S.
- [21:18]
B
Oh, it's so frustrating. I'm in an age where I'm seeing a doctor a little more these days. And even at Duke Medical, it was voted in Time magazine many years ago the top medical facility in the United States. And they still haven't got your universal healthcare record together. Every time I come in, they have to ask me a series of questions, including, do you have black lung disease? No, I have not been in a coal mine in the last two weeks since I saw you. Because the technology for universal healthcare records is 20 years old, and yet it just isn't centralized. I know they know everything about you. They just aren't making it available to the consumer and in many cases to the institution. The reasons for that are a mystery to me. But it is true that they have better health care records and a better bead on your health and the notes, et cetera, et cetera. In other institutions that I've been to.
- [22:07]
C
Overseas, are there any treatments that someone Listening might think, oh wow, that seems like an obvious candidate for medical travel, but for some reason that maybe isn't obvious, is actually really not a good candidate.
- [22:20]
B
You mentioned before, what's the main reason people travel? For care. And I said cost, cost and cost and that is about 95% of it. But a lot of people travel because they want to get access to care that isn't allowed in the United States. Like for example, stem cell treatments. Right. Because stem cell is good for some joint stuff, but it's not a cure all and it doesn't do a whole lot for cancer. So you want to watch out for some of those experimental treatments that look like they might be a good deal or it might be a good thing to go for or it's heavily advertised. So stem cell treatments are heavily advertised. If you search for stem cell Mexico, stem cell Thailand, stem cell Singapore, which is a lot of legitimate stem cell work, mostly for orthopedics, you're going to get a lot of ads, you're going to get a lot of sponsored stuff. And those are people that are trying to lure Americans and UK people and other folks to an experimental treatment that may or may not be a good idea. It's another one that's got a lot of prep work has to be done there post analysis that has to be done that often can't be done remotely. So yeah, there are treatments like that, but the top treatments and the treatments that are the most sought after are the ones that are elective, that aren't covered by insurance anyway. So dentistry, cosmetic surgery, a lot of orthopedics, especially if you're pre Medicare and your insurance company is giving you Trouble covering it. IVF for younger folks, that's really expensive. It's 40, 50 and $60,000 and up. You can get that in a JCI accredited clinic in Barbados. And they've got actually statistics that show that the less stress you're under when you undergo an IVF treatment, the higher your success rates. And why not chill out on a beach, it's not a surgery and contemplate having a baby. And this is one of the few JCI accredited fertility clinics in the world. You know, it's a plane flight away.
- [24:17]
C
Now you mentioned JCI a bunch of times. What is JCI accreditation and how important is that when doing research?
- [24:24]
B
Well, short answer, your first question is JCI stands for Joint Commission International. The Joint Commission is an accreditation agency that puts their seal of approval on hospitals throughout the United States. And it's so important that if you're A hospital that's trying to accept Medicare and Medicaid, you have to be JC accredited. About 25 years ago, hospitals began to export some of their services. Like Cleveland Clinic had plans to build an Abu Dhabi. John Hopkins went to Singapore and established a cancer institute. JC Joint Commission saw the writing on the wall and said, oh, we better go international. And what they did was they applied all the principles and all of the criteria. They have 3,000 criteria that a hospital has to meet in order to be JCI accredited. Full survey and they do a full scan of the hospital physically and then they accredit the hospital and survey it once every three years. It's a gold standard. Just to let you know, when we started researching the book, there were 27 JCI hospitals around the world. Today there are over a thousand. So that gives you an idea of how much this industry has grown and how the quality of healthcare has improved in countries that used to be considered third world countries or industrializing nations. And their healthcare has improved dramatically. And they've got state of the art equipment, state of the art doctors, state of the art strategies and procedures that we don't often have in the United States. That said, just because a hospital or clinic is not JCI accredited doesn't mean it's not a great hospital. So you have to look for other sources of accreditation, like are they members of the Ministry of Health? And as the Ministry of Health of Malaysia or Thailand or Mexico, are they certified? Are they registered at the Ministry of Health? What's their ratings? That's why medical travel just isn't for everybody. It's for people that can do their own research and have the confidence that they can land on a hospital or a clinic that they believe is a quality clinic. And a lot of people don't really do research. They can't even research their own healthcare here in the United States and figure out whether a doctor is a good doctor. Many of them just blindly take the referral from their general practitioner, walk into the specialist office, don't ask anything about the background, and lay down on the operating table. I don't think that's a good idea in the US and I certainly don't think it's a good idea abroad.
- [26:45]
C
Funny enough, this reminds me of something related to airline points and miles. To get the most value from your credit card or airline points, you really need to find the right flights on the right dates. And you can make those points worth sometimes five, ten times as much as they would be if you just log in and book the flight. You were looking for.
- [27:05]
B
Right.
- [27:05]
C
And I know a lot of people that just don't have the time to do that. But the savings is so great that there's a whole industry of what's called award booking services where you might pay them $200 and tell them, here's how many points I have with this bank and this credit card and they'll go out and find you the flight to Japan that might save you $5,000.
- [27:25]
B
Yeah.
- [27:25]
C
And so does something like that exist in this world where if I know that I have a treatment or a surgery that's $20,000, I know I can save a significant sum of money. Are there people I could hire with some of that savings to help me through this process and say, hey, I need a hip replacement, it's not going to be covered. Can you help me find a good facility overseas to make this easier?
- [27:50]
B
Yes. There are medical travel agencies that help patients in need identify the best destination, the best hospitals, the best clinics. It's online, it's transactional, but yes, it's kind of a mom and pop business that really is often started by a well meaning patient that has a relationship with a hospital. There are very few agents that have a full blown network that you can choose from and that you can contact patient services representative and get a little bit of help. We've worked closely in the past with a group called Medical Departures. They started out as Dental Departures. Actually it was a former Expedia executive that decided he was going to establish the TripAdvisor for medical tourism. Harded his family off to Mexico, found 200 clinics, started to do really well. They were really good quality clinics. And then the cartels kind of got in the way and he fled to Thailand thinking everything was going to crash. His business did not crash. Mexico still is the largest go to destination for Americans seeking health care. He went off to Thailand to serve the Australia, Oceania, Southeast Asia market and did really well there. And they've got a network of around 3,000 clinics and some 27 countries. And they're probably the largest medical travel agency serving Americans. There's a lot of agencies like Medigo and they also serve patients who are in need, don't trust themselves enough to do their own research. These agencies do the research, vet the clinics, vet the doctors, keep the profiles up to date, make sure the certifications are up to date, and recommend clinics and doctors. And they often work by taking a commission out of the treatment. Usually the services are free.
- [29:34]
C
If someone listening thinks I have the procedure, whether it's any of the ones you listed, that's a good candidate for this. What's kind of a framework for how they might think about the steps between do I want to do this to I've found the facility and I'm going, what's the first thing someone should do?
- [29:51]
B
It really depends on the patient. It's individual. But for me, the first thing you want to do is figure out which destination is best for your treatment. Some destinations are better for some treatments than others. Oddly enough, India is great for hips and knees orthopedics. But in general, you want to choose your destination first. And some people have a preference. They might have a family member in Istanbul, they might have a friend, and they might want to travel to a particular destination for a procedure that doesn't demand more than eight or nine days of recovery. And they'd want to recover in that particular country. So choose a destination first. The destinations that we outline in Patients beyond borders, there's some 15 or 20 of them. Took us a year and a half to eliminate a lot of the destinations that might have good healthcare, but bad travelability can't get there in less than two hops. So it's complex. But if you do your research, you're naturally going to find those destinations from those service companies or from a book like Patients Beyond Borders, and that'll be a screen right there. We're not going to recommend Cyprus. It's too hard to get to. They've got great health care. Too hard to get to. We're not going to recommend the Philippines. Quality of care isn't great, even though they've got a lot of care. That said, if you're looking for a hair transplant, you want to look at Turkey, because they're the top dog for hair transplants for one reason or another. If you're looking for dental work, there's plenty of great dental work along the border in Mexico or in Cancun or in Puerto Vallarta or in Mexico city. At least 100 clinics that are just top quality can match any clinic in the United States.
- [31:25]
C
Mexico is to the US and how cheap it is to travel there, even some parts of Central America. Are there other procedures like dental that are worth looking closer to home early on that aren't as far away as Thailand and Turkey?
- [31:39]
B
Well, money's always going to be an issue, so the further away a destination is, the more it's going to cost you in travel. Now, that might be offset by Thailand, which once you get there, is incredibly inexpensive. But there are a lot of other issues. If you're morbidly obese and you're going in for a hip procedure. It's a little tougher to get on a plane and fly out there. So we think of medical travel in concentric circles of four hour time slots around the globe. And so generally, as a rule of thumb, if you have to travel more than four hours for your care, you want to make sure that you're doing it for the right reasons. So for the United States, it's Mexico, Costa Rica and Colombia are the best destinations. So it may not be sexy to talk about, but some 80% of outbound US travel is in fact for complex dental care. Wherever you go, that's the number. And some 70 or 80% of that is to Mexico. And I know the media loves to talk about heroic heart procedures and cancer treatments that save the life of a medical travel, but that's not really the reality. It's usually pretty mundane, but it saves people of their lives in some cases. There was a guy in Iowa that he was literally on the verge of selling his farm and he ended up getting a hip procedure in India in Chennai. And it was a great success and he saved a boatload of money as far as proximity goes. Yeah. Mexico for dental, for orthopedics, for some ivf. IVF is coming up in Mexico for wellness checks. They're beginning to offer a lot of wellness checks, simple scans, an mri, a ct. When I blew my shoulder out and I was pre Medicare, I couldn't get the price of an MRI and they didn't want to authorize it. I can't remember exactly what the circumstances, but Duke wasn't going to write the code to authorize that mri. And so I nosed around, finally went into the accounting department and some dusty accountant said he's flipping through receipts. 20 531. I don't know, it's about 30, $200 for an MRI out of pocket. I ended up at Boingrad and it was $416, so it was worth the trip to Thailand. Now I'm in the unusual position of doing a lot of travel. A lot of people don't have that luxury. So it's going to be more important for them to want to look at places closer to home and see if that procedure is offered in a Mexico or Costa Rica or Colombia. Colombia has great heart work. Costa Rica has two or three JCI accredited hospitals in San Jose and Esco Zoo. Esco Zoo. There's a hospital, CIMA C I M A that is JCI accredited. They're in a town, a suburb of San Jose, which is kind of seedy, but the suburb looks like any American town. It's got a Ritz Carlton right next to it and right next to that is the Hampton Inn. So you can go budget, you can go luxury and end up at a hospital that's a multi specialty hospital and get almost any kind of normal procedure that you're looking for.
- [34:38]
A
This episode is brought to you by Green Chef. I'm excited to be kicking this year off, right? And if you want to start creating better eating habits that last, you should be looking at Green Chef because they make it easy with so many dietitian developed recipes that feature fresh organic produce and quality whole foods delivered to your door each week. We've been cooking with Green Chef for almost two years now and we absolutely love it. It's like a cheat code for eating healthy and clean because ingredients are pre portioned, sauces are pre made which means there's less prep and less mess and more time to eat a delicious meal. Even better, they make it easy to eat right for your lifestyle or dietary need, whether that's Mediterranean, keto, plant based, gluten free and more. Plus you can customize your meals by doubling and or swapping proteins. And if you want to stay on track during your busiest days, they have salads that are ready in five minutes or less ready to blend smoothies and grab and go protein packed breakfasts thrive all year with clean easy meals from Green chef. Go to AllTheHacks.com Greenchef and use code AllTheHacksFree to get started with free salads for two months plus 50% off your first box. Again, that's AllTheHacks.com GreenChef and the code all the hacks free. This episode is brought to you by Shopify. When I decided to go full time on the podcast, the future was uncertain. But now we have a membership, we sell gift cards and we're even organizing trips around the world. So if you have business dreams in your future, you should definitely check out Shopify because Shopify is the global commerce platform that helps you sell at every stage of your business. Whether you're just getting started or you just hit your millionth order, Shopify is there to support your success every step of the way. From their all in one e commerce platform to their award winning support to their in person POS system. Wherever and whatever you're selling, Shopify has got you covered and is there to help you grow. Oh, and to help you sell more with less effort, check out the AI powered Shopify Magic. It's no wonder that Shopify powers 10% of all e commerce in the US because they have the Internet's best converting checkout percent better on average compared to other leading platforms. Sign up for a $1 per month trial period at allthehacks.com shopify go to allthehacks.com shopifY now to grow your business no matter what stage you're in. Allthehacks.com Shopify I just want to thank you quick for listening to and supporting the show. Your support is what keeps this show going. To get all of the URLs, codes, deals and discounts from our partners, you can go to allthehacks.com deals so please consider supporting those who support us.
- [37:24]
C
For your MRI example, you mentioned you should tell your doctors at home what's happening, but is this something you could plan with them in advance? One of the procedures that I looked at when I got a positive calcium score was to get a CT angiogram and somehow insurance covered it. But even though I don't think they were supposed to, which is not a typical situation, but it was going to be thousands of dollars, could I work with my doctor and say, hey, could I go get this somewhere else where it's $400 and have the results sent over to you and kind of do it in partnership? Have you seen doctors be receptive to doing kind of the imaging work in other countries where the MRIs or the CT scans are a lot less expensive?
- [38:04]
B
That's a good question. I don't know that doctors would have predispositions about going overseas. They haven't been overseas themselves a lot of times. They're not big travelers. Sometimes they cast a jaundiced eye. In general, also, they feel somewhat competitive. It's one of the reasons why cosmetic surgery costs in the United States have been held down because so many people in the 20th century traveled for cosmetic surgery work to the point where it was actually cutting in to the care that was being offered in the United States. What I would say, though, for something like a scan, just go ahead and get it. They're all the same. They have exactly the same results. They're recorded by the same machines. Just make them make sure they're in English and then bring the results home, which is exactly what I did when I went to Bulmergrad with my mri.
- [38:48]
C
And you had no issue with your doctor saying, here are my results. And they're like, oh, they look just like the results I would get here.
- [38:53]
B
Yeah, exactly. Yeah. And they're done by qualified radiologists, et cetera. So the doctor doesn't have much to argue with there. And that's why you want to inform your doctor first before you leave. Because if you do have complications when you come back, your doc at least has been informed and they can dig in using your paperwork, your X rays, your blood work, all the aftercare stuff, all the nodes, and then pick up where the doctor left off. After all, healthcare is becoming more and more plug and play. I know a lot of people that in later stage cancer, they want to take their wives to Israel because they've never been to Israel or never been to Turkey or never been to wherever, and they can get their chemo there. If they schedule it and they got the right prescription for chemo, they can just drop into the hospital or arrange it, get their chemo or their radiation done in a foreign country. The reason we don't like cancer is because if you adopted that country for all of your cancer care, you're going to end up going back all the time for what, six, eight, ten treatments or whatever the regimen is. But healthcare has become more plug and play. So for scans, if you have an executive checkup, like Malaysia is really great with executive medical checkups. South Korea is really good. So if you brought that back in English, that should satisfy any specialist or any gp.
- [40:07]
C
The procedure that the friend of mine who went to Bumerunga got was actually an executive checkup for himself and his father. And this actually became the subject of a dinner conversation last night because my in laws are here and they just never even heard of this idea of going to get an executive physical. And we talked a lot about concierge medical practices in the US where you might spend 10, 15, $20,000 a year and have a doctor who's going to do all the diagnostics, they're gonna do all the blood work, all the ultrasound, the mri, all the scans, and sit down for hours with you to talk about all the results to make sure that there's not anything important to follow up on. For some people, they can afford that. For some people, there are enough new companies, and I'm actually gonna probably do an episode on them where you could just go do the blood work, right? You could spend three to $700 and get a bunch of biomarkers tested. You can schedule a DEXA scan or a VO2 max thing. But I was looking at this list, and for hundreds of dollars, less than $1,000, you can get the full suite of executive physical things, stress tests, EKGs, ultrasounds, CT scans and all the blood tests, urine tests, stool test, all of it in a day with a couple hours with doctors to be able to talk about the results for under $1,000. And my father in law was like, when are we going to Thailand? This is amazing. And the friend of mine who went is now going to just make it part of his annual thing every year he's going to fly to Thailand to go to this hospital. They've got all his records and he can get everything checked up and follow up. And yes, you can do that in the US either by piecing it together yourself or spending probably tens of thousands of dollars. But viewing this not just from the lens of I need treatment, but I want to be preventative with my health care. I want to diagnose, you know, anything that I need to be worried about. I want to understand any of my deficiencies. Even I until researching this episode and talking with a friend of mine didn't realize that this is not just an option for I need to replace a hip, I need to do ivf. I need to do this thing. But I just want to stay ahead of my health. And it costs a fraction of what it would cost to do those things here. And so yes, it's great that there are a bunch of new companies launching a lot of these tests to make it cheaper in the US but it's not even close. A full blood panel with a lot of companies in the US is not that different from an entire day on site with a doctor who focuses on interpreting these results and thinking about longevity and a bunch of other much more expensive tests. So that's one. I'm glad you re brought up executive physicals because I'm not sure if everyone knows what the term executive physical is, but it's really a lot more than height, weight, cholesterol panel and blood panel. It's very thorough, kind of what you.
- [42:51]
B
Get in the United States. When I was in South Korea getting a physical, I finally had to stop when they wanted to do an endoscopy and a colonoscopy. I was like enough. I've had the CT, I've had the MRI. I think it was around $1,100 for the whole thing. It was crazy low. And again, top hospital, super clean, all the right equipment. Those are the kinds of things that you almost have to see to believe.
- [43:12]
C
And so now I'm a promoter for a hospital I have no affiliation with. And I'm sure there are other hospitals that do just as great as job. You did in South Korea. So that's just something I'll encourage people to take a look at if they want to be more proactive about their health and don't want to spend the cost it takes to be that proactive in the US So that's really helpful. Different topic, but something we didn't talk on. In that checklist. You said start with where you're going to go, do some research, find the right facility. We talked about accreditation. Your book has a ton of resources. In fact, the reason we're talking is because I tried to find a person who's researched more than one destination and you were clearly the standout. Everyone else I looked for was like, I know a lot about Turkey or Thailand or a region. What do you suggest people look for when they're picking the actual doctor they would work with overseas?
- [44:03]
B
We outline that in detail in the book. But in short, you look for doctors that have been board certified in their country, you look for doctors that have been registered in their home country. If you can find an American board certified doctor or surgeon, all the better. Reviews are becoming really important. I know they get gamed and sooner or later Google's going to start gaming their reviews, but for now, they're pretty straight up. If you look up a doctor or you look up a clinic, the reviews are pretty straight up. They haven't been tampered with. And reviews are becoming more and more important in the healthcare community, just like they're important on Amazon or TripAdvisor or Airbnb or whatever. Healthcare is becoming commoditized in that way and I put a lot of weight on reviews. When I research clinics and hospitals, I put a weight on the number of reviews and of course the rating. If it's 20 reviews, not so much. If it's a thousand Reviews with a 4.6 or 4.7 rating. That's great.
- [45:00]
C
One thing we didn't talk about, how far in advance do people need to plan for a lot of medical travel? I know in the US I waited three, four months to see a cardiologist. So is this something that you plan incredibly long out or can you plan it as late as I'm in Thailand right now listening to this podcast. Maybe I should go get this executive physical tomorrow.
- [45:22]
B
That might be a stretch, but you wouldn't have to wait more than a couple or three days. And often they will find a way to fit you in. How they do that I don't really know because they don't sacrifice the quality. So it's a kind of A bifurcated question. The wait times are much, much shorter in clinics and hospitals that serve international patients because they know that they have to do things very rapidly. However, as far as your planning goes, you should be planning your trip four to six months out so that you can get the very best plane fares, you can get the very best deals on your hotel. You want to get a hotel that's close to your hospitals because you don't want to get caught in some of the amazing snarly traffic in Bangkok or Kuala Lumpur or even in Cancun. So you want to do your actual planning once you've decided on a doctor or facility further out. That said, if you're in country and you want to go to a top quality dentist, almost always schedule the next day. These people work 24 7, they're maniacs. It's not a good idea to have your son meet you in Bangkok when he's like 22 years old. But he gets off the plane and I said, well, let's go get a massage. And he said, well, you know, I thought dad, I thought we got. You had really good cheap healthcare here in Bangkok. And I said, yeah, you do. You want to go to a dentist? And he said, yeah, I've got a toothache. So we scheduled the next day and really high quality clinic in a gorgeous shopping mall. Four stories of shopping across from a foreign car company. I don't know how they got those cars on the fourth floor. Lamborghinis and Bugattis and all BMWs and all kinds of stuff. And the clinic was right across from that. And he got his teeth done and when he was walking out, he was begging the dentist when he got the bill to go do more work. And the guy says, you don't need more work, I'm not going to do more work on you. But the whole bill was like $180 for all kinds of work. So yeah, the wait times can be very short for a lot of the traditional stuff. If you need a heart procedure. Yeah, might take a week or two to work that in. Speaking of which, transplants, that's a no. No. People ask me a lot about transplants because transplants are so incredibly expensive. But we don't even deal with transplants. It's just too much red tape.
- [47:38]
C
You don't mean hair transplants, you mean.
- [47:40]
B
Like organ transplant, liver transplants, heart transplants? People are on waiting lists and they're desperate.
- [47:46]
C
And to your point about wait times, my friend was at Bumengard with this executive physical and the doctor came to him and said, hey, there's a few spots on your back. I'd love a dermatologist to look at it. And if they need to do anything, they can do it, but it's going to be a wait. And he goes, oh, do I need to come back tomorrow? He goes, no, no, no. Maybe 20, 30 minutes. And he was just dying that like, they were so apologetic that seeing a dermatologist to do a check and a procedure last minute would take 20 or 30 minutes and added a hundred dollars to the visit.
- [48:17]
B
I always bring my laptop with me to a hospital because I like to work rather than just sit around and twiddle my thumbs. And the third time that I sat down at Bomengrad and was greeted by a nurse three minutes later, I looked up and I said, how do you get any work done around here? And it was hilarious. Yeah, I don't want to oversell it, but it's a really different experience. And people that go to the right hospitals and the right clinics for the right reasons come back glowing. And that's one of the big reasons why medical travel is growing so rapidly, is, number one, the inventory is growing of quality clinics around the world that wasn't there 15 and 20 years ago. And that leads to more and more patients having patient experiences, which leads to word of mouth, which leads to a growing industry. Not to mention the fact that health care costs rose another 8% last year out of pocket.
- [49:07]
C
Do you recommend people get a more beefed up travel insurance policy or anything like that when they're doing medical travel?
- [49:14]
B
Not really. I'm not a lawyer. I don't want to be liable for it, But I would say you're probably at less risk because you're in a very protected environment. In most medical travel experiences, a shuttle or even a limousine picks you up at the airport, takes you to your hotel, or takes you to your hospital. You're in a very sheltered environment and you're not going to be out there partying and wandering around the streets drinking and having a ball. So your chances of actually coming to some kind of harm and needing travel insurance are probably lower as a medical traveler, but it all depends on your appetite for risk. So if you want travel insurance, fine. If you don't, that's fine. But don't confuse travel insurance with medical travel insurance, because travel insurance has nothing to do with premeditated planned medical travel.
- [50:00]
C
And is there anything that people should be thinking about on that front if they're kind of worried something could go wrong and they want to be protected.
- [50:08]
B
There just isn't enough. I mean, it's still basically a very large cottage business. If you're asking some kind of an insurance that covers the medical traveler, there is, but it's too expensive.
- [50:19]
C
And last, what are some common mistakes or things that kind of a first timer might overlook or kind of your list of don'ts when someone's looking to go do some medical travel?
- [50:30]
B
The main thing, and I can't emphasize it enough, don't cost shop. Once you've done your research, don't try to get the best price. Don't try to get the greatest discount because that's what gets so many patients in trouble. Don't fail to do your research. Don't fail to really thoroughly research your doctor or your clinic. I would also say don't scrimp on lodging and accommodations. You don't need to go to the Ritz or Four Seasons, but don't go to some guest house that doesn't have a lot of facilities. You want to spend quality time recovering from the shock of a complex, dental treatment or surgery. Don't settle for second best. You want to get a clinic that's really well accredited, looks good, feels good, and don't fail to walk away. If you've done all your homework and you get there and you've had a great customer experience and you see the doctor and you actually get to the clinic and somehow you don't like it, walk away. Even in country, while you're there, you might be able to find a clinic that's even better. But trust your instincts, they're most often right. I mentioned cuisine. Watch out for the local cuisine. Don't be too adventurous. Save that for a little later after you're fully recovered. And once again, I can't emphasize it enough. Don't cost shop. That's what gets most people in trouble.
- [51:45]
C
And you said don't be too adventurous right before your procedure. Two things. One, how much buffer time do you like to put around your medical travel and how appropriate is it to combine it with a vacation?
- [51:57]
B
That depends on the depth of the procedure. If you're just going for a teeth cleaning or a veneers or a whitening or something like that, and there's not a lot of invasive activity, you can plan a vacation around it. The other choice is to take your vacation first. A lot of people don't like doing that because, ah, I've got this dental procedure ahead of me, or I've got this medical procedure, it makes me nervous. But you could always take it first and then Go in for your treatment. Most doctors want 8 to 10 days for you to stay in country. And they often make you sign paperwork that commits you to staying eight to 10 days, because if you don't have a complication eight to 10 days out, then chances are you're not going to have a complication. The wound management is going to be behind you, the antibiotics regimen will be largely behind you, and they want you to stay in country to protect you. So if you've got the time and most people don't, 10 days after your procedure, knock your lights out, party on, but don't do what I did. I got an implant in Costa Rica the next day, got on a bus for Domenical on the coast and literally fell out of the bus halfway because the roads were so bumpy that it was killing me and I was swelling by the hour. I should have never left my hotel room. This was my first medical travel experience early in the research stages of the book. So the mistakes that you see that I list in the book are mostly mistakes that I and colleagues of mine have made in their journeys.
- [53:22]
C
The book's fantastic. Anyone that wants to go deep should check it out. You mentioned you're working on a new version. When does it come out?
- [53:28]
B
Comes out in the late summer, early fall. It's taken even more time for us to do the research because the data took so long to rebuild after the pandemic where everything went to zero. Clinics weren't open, borders weren't open, medical travel dropped to zero. As far as the general information, there's some updated stuff in there for technology. The introduction is going to be a little more political because of some of the recent occurrences. A wound has been lanced with some of the recent events, and the shortcomings of US Healthcare are now very much out in the open, and people like me are no longer lone voices in the wilderness. And I do believe that medical travel is going to become more and more of an option, especially for younger folks, 40s and 50s. They're going to be much more prone to looking for options because a lot of people right now are really pissed off and they want to find options. And the options, unlike 15 and 20 years ago, are now out there for almost every reasonable procedure that you can think of.
- [54:25]
C
For the people listening to this show, I think they're probably well versed in the game of points and miles, which can take the travel cost of medical travel down to almost nothing. And so if you figure the right credit card signup bonus might cover your entire trip to whatever country you're going to. And that just makes it an even more valuable proposition to consider medical travel.
- [54:48]
B
There are some larger companies that are actually very close to carving out partnerships with some of these medical travel providers to provide a loyalty card strictly for medical travel. So watch out for that.
- [55:00]
C
That's great. We covered a lot. Where can people find you and the book and any other resources you've put together?
- [55:06]
B
PatientsBeyondBorders.com and find the book anywhere. It's in digital form, it's in book form. I hate to say it, but I'd advise people to wait a few months until the fifth edition comes out. But the general information in the fourth edition, how to plan your trip, what to do when you get there, how to keep yourself safe when you get back, all remains current because healthcare doesn't really change that much. How to take care of yourself pre surgery and post op have not changed very much in the last five years.
- [55:37]
C
Great. We'll put links to everything you mentioned in the show notes. Joseph, thank you so much for being here.
- [55:42]
B
Thank you and I appreciate your time and I wish anyone who is influenced by this show a safe and healthy medical journey.
- [55:50]
A
Such a great episode. Thank you so much for listening. I really hope you enjoyed it and if you did, please consider clicking that Follow or Subscribe subscribe button if you haven't already. It really helps us out and there's no better way to support us than doing that. Or sharing the show with a friend, colleague or family member or even a random stranger is totally appreciated. Also, links to everything in this and all other episodes are at allthehacks.com where you can also find all the deals we find as well as links to the top credit card bonuses. Finally, if you have any feedback, want to get into touch or share a question you have for a future mailbag episode? You can email me at podcast@AllTheHacks.com. that's it for this week. I'll see you next week.