Please could you tell us a little about where Mega Assistance is based and its origins?
Mega Assistance Services is a privately owned Canadian company registered in British Columbia. We also have staff working from Mexico. It was first created in in 1985 to service clients of a major assistance company with travellers from around the world visiting Western Canada and the Pacific North West region of the US. Then, we extended our services to other insurance and assistance companies, not only in North America but worldwide.
How did you come to work in this industry?
Like many of us, by coincidence. I arrived in Canada in 2011 with a one-year visa and started in the kitchen of a restaurant to learn English and pay the bills. I also wrote articles for a newspaper and taught French. I needed to find a certain type of job to match the government requirements to stay longer and I found Mega Assistance. Now, I’m a thankful Canadian citizen. At first, I was covering the night shifts. More recently, I have been working from Mexico to strengthen our network in Latin America.
What are some of the key changes you’ve had to make to your business operations in order to adapt to Covid-19?
We did not need to implement a whole new process to adapt as we have been doing some of our work from home since 2012. So far, we have been able to keep our entire staff on board and I hope it stays that way despite the crisis. On the assistance side, we launched telemedicine solutions in about 40 countries, as a direct result of increased demand for such services. We also started to offer house-call visits to American patients in the US to generate an alternative source of income. Since 2019, we’ve donated a part of our profit to help people in British Columbia and in Mexico who are unable to pay for their medications, but we’ve had to pause this for the time being due to the Covid crisis. I hope we can restart it in the second part of 2021 or in 2022.
We do not add any mark-up percentage whenever we use a network to reprice a claim
How does Mega Assistance ensure the best prices for insurers?
We avoid directing patients to the hospital when it is not necessary. We provide cashless solutions for telemedicine, house calls and visits with general practioners and specialists worldwide. Most of our volume is in North and Latin America, Europe, Thailand, Australia and New Zealand. Being able to provide these alternatives is an initial type of cost containment. We also have a variety of cost containment solutions for hospital cases.
In addition, our Pay Smarter payment option allows our clients to settle invoices in their own currency. It is a way for them to save on the extra cost of international transfers. It’s a feature that we implemented a year ago and that has been used successfully by our European clients.
What are your current thoughts on the structure of the cost containment industry?
Firstly, it does not seem completely right to consider cost containment and assistance separately, as case management can really impact the final claim. There is a strong relationship between both, but they do not seem to be equally valued; although they are both necessary. Some peers and payers consider assistance services as underpaid or cost containment services as overcharged. I tend to agree, and believe a better balance could be found, especially for the US market due to the high medical costs there.
we launched telemedicine solutions in about 40 countries, as a direct result of increased demand for such services
At this time, with the current model in place, the mark-up made by cost containment companies for having obtained a discount on a single large claim can represent as much as what an air ambulance gets paid for a mission. I see this as a paradox when the objective is to reduce the cost of a claim. It is also interesting when you know how these discounts are achieved. A minority of them are obtained through direct agreements with providers. Some companies only work that way. It is a good positioning but it is hard to achieve the best possible results on any type of claims with this single option. In addition, the turnaround can be slow and makes it difficult to handle a significant volume. That is why a majority of US claims are not even directly repriced by the cost containment companies but by the large American networks they have access too. They are the ones getting the discounts against a commission percentage. Typically, the cost containment companies then add some extra points to their clients depending on how big their volume is. Of course, it is not an easy task. They have to automatize their process to handle a high volume of claims daily while providing complementary services not always offered by the networks used. All of this combined comes at cost.
But does it truly justify such a high mark-up on these US hospital cases? Fairness is difficult to define sometimes. After all, when a company is able to save you thousands of dollars, their value is clear to see. It is also a way to compensate the lower incomes generated by assistance services and to create additional jobs, which can be seen as a positive thing too.
How is your cost containment offering different?
On our side, we used to work that way too, as it has been the norm. We decided it was time to offer an alternative for the US market in the interest of our clients. We do not establish a commission percentage based on their volume. We do not add any mark-up percentage whenever we use a network to reprice a claim. We simply charge a case fee. We believe it is more transparent and reflects the nature of the work truly done behind the scene. We have also been negotiating claims directly for 15 years and do it whenever it makes more sense.
For these services, we have options free of commission fee or with a low percentage. It represents a significant difference for the payers on the final bill. I would also add that discounts are not everything. Cost containment companies use networks to apply discounts on the urgent care and specialists visits. These discounts are based on insurance contracted rate although. We have our methods to obtain a final lower price, but without showing specific discount.
How do you manage cost containment in other regions of the world?
In Latin America, hospital claims for foreigners are often grossly overcharged too. In the Cancun-Playa Del Carmen-Cozumel area, there is a system where the doctors working inside the all-inclusive hotels send many of the foreign patients to an affiliated hospital, no matter how minor the symptoms, and preferably by an expensive ground ambulance as part of the deal. These hospitals will then hire a billing company in the US to inflate the claim and write it with an American format. We get discounts there too, but its best to avoid using these facilities whenever possible. We work there with other private hospitals that charge a more reasonable amount. We also have cost-effective solutions with large discounts for the rest of the country, as well as in the Dominican Republic, Costa Rica, and Peru.
What is your approach to an efficient patient journey?
We contact patients directly, when authorized, not only by email or by phone but often via WhatsApp. When people are travelling, it is often the best way to reach them quickly. Efficient communication often makes a positive difference in the case coordination. Patients are satisfied. They do not have to call an operator back and provide their case ID number again. It is a way to offer a more interactive and personalised service as we can answer any question in real-time. That’s our signature and it goes beyond the fact of faxing a VOB/GOP to a provider.