Coming in with a concrete "let's make a deal" proposal can't hurt. "Ask to pay the Medicare reimbursement, and offer a very, very aggressive payment plan," suggests Gwynn Smith, a partner with HFS Consultants, an Oakland, Calif., group that works with healthcare organizations. "Offer to put a lot down—20 or 25 percent, more if you can—and pay it off as fast as possible." (Average Medicare payments for many common procedures are available at www.hospitalcompare.hhs.gov.) Your best shot at success, Smith says, is to get in to see the chief financial officer. Lower-level financial counselors "have no idea of the costs," she says.
In a sign of market forces at work, a handful of American hospitals have struck deals with North American Surgery, a Canadian company formed last August to match U.S. hospitals in Kansas, Michigan, New York, Oklahoma, and Washington that are willing to provide certain procedures inexpensively with American patients who need them. Only travel and lodging are extra. Hip or knee replacement or heart-bypass surgery is $14,000; weight-loss surgery is $10,000 or $15,000. The service is free; the company is paid by the hospitals.
Agreeing to offer low prices is mostly what qualifies hospitals to make the list, says Richard Baker, the entrepreneur behind North American Surgery. He says he also makes use of HealthGrades.com, a service that gives hospitals one, three, or five stars for performance. But in the latest ratings, Oklahoma Heart Hospital, one of those on Baker's roster, gets one star ("poor") for bypass surgery death rates in the hospital, at 30 days, and at six months. Baker doesn't concern himself with physicians' performance; he relies on the hospitals to find good surgeons and monitor them.
People who in the end decide to head abroad might consider a last bit of wisdom from those who have gone before: Think of it as medical "travel," and don't count on much "tourism." Few who arrive with a bad back or heart will be up to wandering through Bangkok or New Delhi. And after surgery and one or two weeks of recuperation, will you have the time, money, and energy to extend your stay? Oh, and on flights where coach will cramp your debilitated body and challenge your sanity, spring for business class.