Travel to France for surgery

[Guest altrisk]

A man plans to travel to France for a surgical procedure that is not available in the US. Can we reimburse travel and surgical expenses?

[papogi]

The IRS doesn't care who actually provides the services. The restriction is that the services generally must be prescribed by a physician. The Section 213 definition of physician includes the rule that they must be legally authorized to practice in the state. As long as this is satisfied, it appears this could be reimbursable. Be sure that there is no significant "pleasure" side to this trip.

[Guest altrisk]

Thanks for the input.

We're wondering whether licensed in France meets the "licensed in the state requirement?"

We have concerns about the travel expenses too. How are we to know whether he is out having a little vacation in Paris, or if he is only there for the medical treatment?

Are experimental treatments permissable under the code?

[Guest MSMA]

And don't forget about the other aspects too...such as lodging, meals, etc for a person ($50 a night max) who MUST accompany the patient.

[Guest altrisk]

yes. We notice the $50 limit for lodging, etc. But I was under the impression that travel expenses could be reimbursed at cost.

[Guest MSMA]

Okay - the curiosity is killing me...I am sure you have asked what the surgical procedure is specifically for? It would be a prudent thing to ask for the treating physicians to provide a ball-park figure of what the surgery is for, the anticipated hospitalization time etc...then, one presumes, there would also be concern about post-hospitalization recovery time...how long before he can fly home...which then raises the question of: is this "recovery" period to be recompensed as well? This certainly raises more than 1 question! I would be wary of the fine lines between "medical care" and "general improvement of health".....

[papogi]

If the procedure is being done in a typical, multi-services hospital, I don't think the IRS would argue that the hopital does not satisfy the " equivalent of a licensed hospital" provision in Section 213. My opinion is that you are safe there.

As for the vacationing aspect of the trip. Request an itinerary showing all the days in France and a brief description of the events of each day. You can then reimburse the travel expenses each way, and then determine if say more than half of the days were spent with no "medical purposes."

[david rigby]

I might volunteer to "accompany" the patient.

[jeanine]

I think we still need to know what the procedure is that can only be done in France, and why? Not approved by FDA in USA? Wouldn't that be experimental?

[jpod]

Who was it on M-A-S-H who used to say: "horse hockey!!"

[Guest altrisk]

OK - The guy has a condition that causes the tendon in his pinkie to tighten up. Soft tissue is cut to give it some play.

The patient states that the procedure is performed with a needle in France, making a very small hole. In the US, a small incision is made through which the correction is made. We are also told that the needle takes several applications, so he must be implying that this will be an extended stay.

Sounds like a vacation in Paris to me.

[david rigby]

Denied!

[Guest MSMA]

Sounded like Dupuytrens Contracture...did a little research...sounds like the "needle" treatment may just be shots of cortisone...but then again...

At this point, I too would lean against paying...BUT knowing how "open-minded" (i.e. lenient towards the participant) the IRS can be - my guess is that they would authorize it because it is not distinctly a cosmetic procedure.

[jsb]

Within reasonable boundaries, medical treatment is medical treatment. Probably need to reimburse the procedure. Travel is another thing. Is the same procedure available locally? Would the IRS allow a deduction for travel to Paris for a routine procedure available in the US? Would it make a difference if the person trying to deduct travel from California to, say, the Mayo Clinic for treatment of tendonitis? (I think I'll load up my FSA next year and go to Hawaii for some tennis elbow treatments.)

[Guest altrisk]

Thank you. In the end, this is precisely the question:

"If someone can have a similar procedure done locally, is the individual entitled to travel afar if they so choose so as to obtain services from the provider of their choice?"

As silly as this seems, I don't recall any efficiency requirements in 213...unless I missed them. But then, it's not intended to be a managed care program.

Thoughts?

[papogi]

You're exactly right that it's not intended to be a managed care program. Is the treatment prescribed by a physician, and intended to correct or alleviate the effects of a medical condition. Even though it's only the guy's pinky, this sure seems like it's "medical." If the treatment is not available in the US, then they have to go elsewhere. Expenses incurred in foreign countries are reimbursable. I think you are right that patients should normally go to the nearest place where something can be done. If they choose to travel, then there must not be a significant "pleasure" side to the trip, otherwise the travel expenses will not be reimbursable. I think that this is the test that the guy will fail. I realize he's going to France for the treatment, and he might not otherwise be going except that he has problems with his pinky. I think he's OK getting the medical expenses reimbursed, but the itinerary should be scrutinized before any travel expenses are paid.

[Lisa Hand]

One more question you might want to ask, is it legal? If the treatment is not legal, in the US, Pub 502 specifically states " you cannot include in medial expenses amounts you pay for illegal operations, treatments, or controlled substances whether rendered or prescribed by licensed or unlicensed practioners."

[BeckyMiller]

Amazing - I have a similar situation. Individual can get the surgery done in the US for $80,000 at a hospital that has only done 3 or 4 such operations. That facility actually recommended that the person go to France where the same surgery is $3,000 and is done by the physicians who instructed the guys now doing it here in the US. These French physicians are board certified in the US.

(This is a different guy with a different medical complaint.)

So - now what do you think?

I say - Yes.

P.S. There is no vacation attribute to this trip. The individual involved is in constant pain at this time. His wife is accompanying him to help him through the stress of travel. But, they have young kids here at home, so they will come home as soon as they possibly can.

[papogi]

Again, as long as they don't have any significant "pleasure" part added to the trip, I would also reimburse this.

[Moe Howard]

Colonel Henry Potter