B-2 Visas for Medical Treatment Scrutinized
Posted Dec 07, 2001

In a cable issued in late November 2001, the U.S. Department of State (DOS) advised consular officers to be wary when issuing B-2 visas for foreign nationals to obtain medical treatment in the U.S.

The DOS cable informed consular officers of the unintended consequences of issuing B-2 visas for the purpose of obtaining medical treatment. Consular officers are directed to review the items set out in the cable with respect to whether the applicants have overcome the "public charge" provisions required for admission to the U.S. In short, all persons coming to the U.S. must demonstrate that they will not become a "public charge" which would require the U.S. government expend funds for their support.

The problems with visitors coming to the U.S. on the B-2 visa for medical treatment arise from the law called the Emergency Medical Treatment and Active Labor Act (EMTALA). This law requires hospitals to receive and treat any patient with an emergency medical condition. The hospitals must treat the patient, even if s/he does not have insurance or money to pay the bill. The treatment must continue until the patient is in stable medical condition.

Apparently, hospitals have encountered problems where a patient is admitted to the U.S. on the B-2 visa based upon a letter from a doctor stating that s/he will examine and diagnose the applicant at no cost. The doctor conducts an initial office visit and diagnosis, then referring the patient to a hospital. If the condition is an emergency, the hospital is obligated under EMTALA to provide follow-up treatment, irrespective of whether the patient can afford to pay the medical costs associated with the emergency treatment. These cases can potentially cost the hospitals hundreds of thousands of dollars each year. This drains funds raised by charities and, sometimes, valuable tax dollars intended for the treatment of local, indigent patients. The DOS cable cited the example of a young leukemia patient who was admitted based on a letter from a Maryland doctor stating he would "care for" the child. The doctor referred the case to Children's National Hospital Center. The case is expected to cost $650,000. According to the DOS, this is not an isolated case.

In light of the EMTALA requirements, the consular officers are now directed to ask questions to ascertain the nature and duration of the expected medical treatment. If the expected treatment extends beyond the initial doctor's office visit, the consular officers are to determine who will perform the follow-up treatment and who will pay for the follow-up treatment. Ideally, a sponsoring hospital would provide written documentation of the treatment it is willing to provide and under what circumstances it will provide this treatment.

The DOS cable recognizes that consular officers do not usually have medical expertise and that there are humanitarian concerns in applications for B-2 medical visas. They direct that each case be given a sympathetic and thorough hearing. Nonetheless, the consular officers are to be alert to medical travel that may result in unexpected, high costs to U.S. hospitals. In these circumstances, the B-2 applicants are to be encouraged to locate a charity and/or U.S. hospital willing to sponsor the treatment. In the absence of such a sponsor, the applicants are to be directed to obtain a cost estimate and present evidence of sufficient funds to pay for the treatment before the consulate can issue the B-2 visa for medical treatment.