What services does Medigo provide, and what’s your role in the company?

Medigo is a medical third-party administrator (TPA) and assistance company based in Berlin, Germany. We support all stakeholders of the health and travel insurance industry by providing their members with cashless access to medical facilities – from a simple outpatient appointment for an expat or a diplomat to repatriating a traveller or managing complex large loss cases.

Beyond network access, our focus is on delivering excellent claims management and cost containment services to our clients, may it be international private medical insurers, travel insurers, or other TPAs or assistance companies.
At Medigo, I oversee our global network. In short, I am responsible.

What’s your background in the medical assistance and travel insurance sector, and how did you progress to your current role with Medigo? 

I have been working in this industry for over a decade now. I started off in 2014 in the travel and health operations division of AXA Partners in Turkey. Shortly after, I was asked to lead the international medical network team of the Istanbul office. It is this role that gave me my first exposure to communication with other stakeholders globally and that got me immersed in network building for international patients.

Although accreditations are important signals, they should never replace the independent and thorough assessment that any company should do before enrolling providers into its network

I moved to Germany in 2018 and joined Medigo to be their Medical Network Manager. I led Medigo’s transition from a network made of small clinics fit for medical travel purposes to a network of over 5,200 leading inpatient and outpatient facilities in over 150 countries. It has been quite the journey, but I have enjoyed supporting the company’s development into a full-fledged medical TPA and assistance company. I have now been Head of Network at Medigo since 2021. 

When assessing a hospital to see if they could join a medical network, what are some of the key attributes you could look for?

When considering the enrolment of a provider into Medigo’s network, we look at four main pillars:

• Regulatory compliance: adherence to local and international healthcare and data protection standards
• Medical quality: overall treatment capabilities, expertise of medical staff and level of the medical equipment
• Reputation: references, accreditations, awards and international standing
• Pricing: transparent, reasonable and customary pricing policies. 

We use a matrix with a grading system for each pillar to determine the eligibility of a provider. We might also consider other subjective factors such as the readiness of a provider to work with international patients, e.g. do they have English-speaking staff?

Equally important are the periodic reviews that we conduct to assess if our providers maintain these quality criteria over time.

What role does hospital accreditation play in bringing a medical provider into your medical network?

Hospital accreditations are certainly an important aspect of the initial evaluation process. They demonstrate the adherence of a healthcare provider to international standards. Their determination to keep this accreditation over the years is a sign of resilience and quality. The fact that they regularly undergo external audits is an external sign of validation.

However, although accreditations are important signals, they should never replace the independent and thorough assessment that any company should do before enrolling providers into its network. 

Simplifying the international patient journey is key to meeting customer needs and expectations. What role are the latest technology solutions playing in helping to achieve this aim?

As with every other industry that has gone through a wave of digitalisation, I think that new technologies have a huge potential to make the patient journey smoother, less bureaucratic – especially in an international context – and to save all stakeholders time and money. It really should be about reducing friction and focusing on what matters – ensuring that the patient’s treatment goes well. 

That is why Medigo has always heavily invested in technology – and we continue to do so. We have built our own claims management software and strongly encourage all our partners to exchange data through application programming interface (API) endpoints; we have  deployed payment cards to reduce the number of reimbursements claims and we are very close to finishing a complete artificial intelligence (AI) overhaul of that system.

Payment card solutions are a great tool to enable cashless access globally, even with providers that wouldn’t have been empanelled in our network otherwise

We firmly believe that claims management processes shouldn’t get in the way or delay a patient’s treatment, and new technologies can help us in that direction.

Cashless solutions are great for making patient journeys better, but are there any risks for medical providers or insurers if a patient abuses their payment card?

Payment card solutions are a great tool to enable cashless access globally, even with providers that wouldn’t have been empanelled in our network otherwise – for instance, small pharmacies or rural GP practices. There are some risks of abuse. However, with the right controls and processes in place, I believe that these risks can be mitigated and reduced to a minuscule level.

Our experience with these cards has been that they are not suitable for every type of policy and that the implementation must be done the right way. Education of healthcare facilities is also key. I am sure that these solutions will become increasingly common in the coming years. 

In the global travel insurance sector, you never know what language your customer might speak, or which country they might end up needing assistance in. How do you ensure you are prepared to deal with any and every eventuality?

It is indeed complicated to be ready for every single eventuality. This is why choosing the right providers is so important. Many of these situations can be remedied by working with medical facilities who employ English-speaking staff. Offering multilingual telemedicine solutions is also an alternative to handle the simplest cases.

Besides that, we made sure that we have the in-house linguistic capabilities to deal with the most common situations. Most of our staff is bilingual, if not trilingual or quadrilingual. Our claims management team speaks 15-plus languages, from English, French and Spanish to Mandarin, Farsi or Urdu. 

Even with all these precautions, there are some cases that we cannot accommodate through our network or with the support of our team. In such instances, we must resort to translator services. 

How important are second medical opinion (SMO) services when it comes to improving customer trust in the insurance sector? What role do these services play from a cost containment perspective?

I am unsure that SMOs really improve trust in the insurance sector, but they play a key role in generating better health outcomes. They are an important part of the services we offer at Medigo and we would recommend an SMO to most people with a serious condition. They can often lead to an improvement in the patient’s treatment outcomes with new recommendations or a more accurate diagnosis. Even if only used to put the patients’ minds at ease, they are a great tool. They are a very cost-effective option to access the world’s best specialists and consultants.

There needs to be a better integration between the different stakeholders of the industry to improve communication and make the service delivery as seamless as possible

In our experience, insurers and reinsurers can really benefit from getting an independent evaluation on the medical necessity of a treatment plan for the larger and most expensive cases. They serve as a validation tool. Having an expert’s opinion about the best and most cost-effective treatment options can avoid very expensive treatments down the line. 

What do you think the medical assistance industry and hospital industry could do better to work more effectively and efficiently when managing the care of international patients?

There needs to be a better integration between the different stakeholders of the industry to improve communication and make the service delivery as seamless as possible. I do think as well that the industry needs to proactively embrace new technologies and the changing needs and requirements of our customers – instead of reacting to it. 

In some regions, healthcare providers really need to digitalise some of their administrative functions to improve efficiency and the work with other stakeholders. 

Understanding the industry, the requirements, and integrating supporting services relevant to international patients into their own roster is very important. Lastly, building support teams that can accommodate the cultural and linguistic diversity of the patients they treat will add immense value.  

These are ongoing processes which need work to continuously stay current and relevant.