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But there are risks. Patients have little or no legal recourse in medical malpractice cases because of relatively weak patient-protection laws in such countries as India and Thailand, popular surgery destinations among Americans. And U.S. medical organizations and government agencies do not oversee foreign facilities.
"Foremost, surgery is a serious business," Bruce Cunningham, a plastic surgeon from Minneapolis, testified at a recent Senate hearing on medical tourism. "Patients simply cannot make informed decisions about medical care, or establish a proper physician-patient relationship, from travel brochures."
Milstein, of Mercer Health & Benefits, says hospital quality is not a major worry because over the years, the same agency that accredits most American hospitals for participation in Medicare - the federally funded health plan for the elderly and disabled - has accredited 88 foreign hospitals through a joint international commission.
Bumrungrad Hospital in Bangkok, Thailand, and Apollo Hospitals in India, for example, are internationally recognized institutions. Despite the Third World conditions outside, the hospitals resemble five-star hotels and are equipped with the latest technology, American patients have reported. Many of the doctors are trained in the U.S., and visiting Americans are pampered around the clock, they have said.
Still, traveling far from home to undergo a serious surgery may not appeal to everybody.
"Some of our employees have never even been on a plane," said Blackley, Blue Ridge's benefits director.
The company has not fully implemented the plan to all employees but hopes to do so in coming months, she said. Employees will be offered incentives such as waived co-pays to travel abroad for certain types of surgeries, but they will not be required to do so. Garrett will be a Blue Ridge test case, and company officials are expected to visit the facilities in India soon.
"It sounds crazy," Blackley said, "but desperate times call for desperate measures."
As more companies join the ranks, the concept may not sound that extreme, Milstein said: "The perception will change gradually, as more patients go through the experience."
The savings can be sizable.
A coronary artery bypass surgery costs about $6,500 at Apollo Hospitals in India, Milstein estimated.
The average price in California is $60,400.
Some health plans in California, such as Blue Cross of California and Health Net, have insurance plans with approved providers in Mexico. The plans offer lower premiums but are limited to those living near the border.
United Group, the health insurance manager that recently added Bangkok's Bumrungrad Hospital to its provider network, offers low-premium insurance called a Mini-Med plan that covers basic medical treatment but only a few major procedures.
Surgery coverage for Mini-Med's 20,000 subscribers is capped at about $3,000, said Jonathan Edelheit, United Group's vice president of sales. By going to Bangkok, subscribers may be able to afford a surgery that would have been prohibitively expensive in the US.
Along similar lines, a Malibu-based start-up, PlanetHospital, hopes to create a health insurance plan that covers primary care in the US but major procedures in foreign hospitals.
"America has the best medical treatment," said founder Rupak Acharya. "Problem is, much of it is inaccessible."
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