WHEN SHE WAS

diagnosed with a fibroid tumor last year, Kathleen Dodds found herself in a bind. She didn't have health insurance because she couldn't afford it. With no insurance, the surgery she needed was prohibitively expensive.

"They were quoting me $30,000, tentatively, paid out of pocket," says Dodds, 42, a Portland, Ore.-based horse trainer. "There was no way I could afford it here."

But 7,200 miles away in India was an affordable solution. Through IndUSHealth, a company in Raleigh, N.C., that arranges medical care in India for U.S. citizens, Dodds flew out to the Apollo hospital in Delhi, where she had a successful hysterectomy that allowed her to return to her horseback riding students just two-and-a-half weeks later.

The total cost: just under $10,000, including round-trip airfare, transportation to and from the hospital, a one-week hospital stay where she says she was treated with more care and attention than she had ever experienced in the U.S., capped by 10 days at a "gorgeous hotel."

"It was actually a pleasant situation, considering that I was having major surgery," she says. "That, and I don't like Indian food, which was kind of hard for me."

As medical costs soar in the U.S., the number of uninsured has swelled, exceeding 46 million, or nearly 16% of Americans last year, according to Census Bureau statistics. As a result, more and more folks are choosing what's known as medical tourism and heading overseas for surgeries and dental treatments they couldn't otherwise afford.

In 2006 alone, an estimated 150,000 Americans traveled abroad for medical care, a number expected to double by next year, according to Josef Woodman, author of "Patients Beyond Borders: Everybody's Guide to Affordable, World-Class Medical Tourism." Nearly half of those around 70,000 had medically necessary surgeries like hip replacements or spinal work, heart surgeries like bypass or valve replacements, and even cancer treatments.

And while plastic surgery and dental procedures aren't to be ignored either (an estimated 40,000 Americans journeyed to Mexico last year to get dental treatment, Woodman says) medically necessary surgeries are the procedures saving patients the most money. Depending on the type of procedure and which country you go to, you could expect to save between 15% and 85%, Woodman says. A hip replacement, for example one of the most common surgeries sought abroad would typically cost $60,000 to $70,000 in the U.S. but just $15,000 in India, all costs included.

It's savings that even state officials and insurance companies are noticing. This year, bills have been introduced in two states, Colorado and West Virginia, that would require the insurance companies for state employees to cover medical procedures in overseas hospitals, including travel expenses and hotel stays for the patient and a travel companion. (It's not exactly a vacation, but a hotel stay, for recuperation, is almost always necessary.)

What's more, these bills mandate that the insurers give patients an incentive for choosing the less expensive overseas treatment by passing along 20% of the costs savings to the patient. The remaining 80% savings is to be deposited in an account used to reduce health premiums for all covered employees, says Ray Canterbury, one of 10 sponsors of the bill in the West Virginia House of Delegates. "The reason we introduced this bill is rising health-care costs," he says. "It's an effort to put pressure on domestic health-care companies, to put more pressure on prices."

Overseas the number of hospitals seeking accreditation from the Joint Commission International which basically declares a hospital has standards very similar to those in the U.S has increased tremendously since the JCI was founded in 1999. Currently, 120 hospitals have JCI accreditation, with the majority having taken place in the last three or four years, according to Dr. David Jaimovich, JCI's chief medical officer.

Meanwhile, in the U.S., business is booming for medical-travel agencies, which act as middlemen between patients and hospitals from helping you choose the best hospital and make travel arrangements, to gathering and sending your health records overseas and acting as a health concierge: picking you up at the airport, visiting you in the hospital, and so forth.

At PlanetHospital, a medical-travel agency that's been in business since September 2005, sales have doubled every month, says Rudy Rupak, the company's founder. "We get close to 200 phone calls a day," he says. Typically, between 7% and 10% of these turn into sales.

But medical agents aren't just aiming at individual travelers. Rupak, for example, is currently in talks with two insurance companies about adding on policies to their plans that would reimburse patients only up to the cost of the treatment overseas. (He wouldn't disclose the names of the companies but says they are "major insurance providers.") Say, for example, you need knee surgery that costs $10,000 overseas, including travel expenses for you and a companion. Your insurer would tell you that you could either have surgery in India, and get fully reimbursed, or have surgery here in the U.S., but only get reimbursed $10,000. You'd have to pay the rest, amounting to thousands of dollars, out of pocket.

In the past two years, IndUSHealth has shifted its focus to companies, and specifically those that self-insure or pay their employees' health-care costs rather than contract with an insurance provider. The typical arrangement with IndUSHealth resembles what the state representatives of Colorado and West Virginia are trying to implement, namely providing an incentive -- such as getting back 25% of the money saved or waiving the co-pays and deductibles -- for patients to travel abroad for less expensive medical care.

First to get on that train have been several large manufacturing companies with 100,000 or more employees, says Rajesh Rao, the chief executive officer of IndUSHealth. "The level of benefits they're providing to their employees has always been very generous," he says. "And while in other industries they have the luxury to do cost shifting, that's not as easy with unionized blue-collar workers." Particularly interested are employers with large retiree insurance plans, he adds, as they not only look to cut costs, but also have a demographic that isn't actively working, and, presumably, wouldn't mind an all-expense-paid trip to Malaysia, Singapore or South Africa for that hip or knee surgery.

That said, medical tourism isn't without risks. Should something go wrong with your surgery you have no legal recourse as you do at home, says Rick Wade, senior vice president at the American Hospital Association, which represents 85% of all hospitals in the U.S. "In virtually all these cases, you lose your ability to do anything if there's a liability issue," he says. (Incidentally, this is largely why overseas hospitals are that much cheaper. They don't face massive malpractice-insurance costs.)

And the way medical travel agencies get paid is murky. Often, their payment comes from the hospitals they recommend, presenting a potential conflict. This can be a big risk, since it's more difficult for a patient to do due diligence on an overseas hospital than it would be if the facility is in his own neighborhood.

Whether you choose to go abroad for medical care or are asked to do so by your insurance provider or employer, here's what you need to know.

1. Choose the right travel agent

Find a reputable company that will connect you with the best hospitals and doctors for your specific procedure. "Remember, you're not going on vacation," says AHA's Wade.

Make sure the agency employs at least one medical professional, preferably more. These people will talk with you on the phone and recommend hospitals for your treatment, but they are also the ones who have chosen the specific hospitals they work with. "The biggest concern we have is many nonmedically oriented travel agencies have entered into this arena," says JCI's Jaimovich. "I'm not sure what kind of background work they do to ensure the level of care in the hospital."

Interview several agencies, ask them how long they've been in the business (keep in mind, this is a relatively new field), how many clients they've had, and ask for references, Woodman suggests. Make sure the agency responds to all your questions promptly and with care. Also, ask how they will be paid for referring you, and whether there are financial incentives to send you to one hospital or country over another.

2. Find the best hospital

To make sure the hospital you're going to meets international health-care standards, it's best to look for JCI-accredited hospitals. But look for any local accreditation they may have, as well. Most importantly, look at the success rate for your specific procedure at that hospital, Woodman says. Same for your overseas doctor: Look at his or her education, training, experience with your specific surgery. (Most hospitals that participate in medical tourism post that information on their web sites.)

The good news: Many overseas hospitals have affiliations with some of the best medical centers in the U.S., including Johns Hopkins and the Mayo Clinic. In addition, they often have surgeons and physicians who are U.S.-trained. (If you have a problem with overseas doctors, keep this in mind: Many physicians currently in practice here got their training in another country, and vice versa. Also, some U.S. hospitals currently outsource some medical procedures, like radiology, overseas.)

3. Keep your U.S. doctor involved

In an ideal situation, your doctor here should talk with your overseas surgeon before your procedure, and once you're home as well. "I hope there's communication between your physician here and the ones who'll be taking care of you in the foreign hospital," Wade says. "Whatever medications you're taking, are there comparable medications in the foreign country? Do you have special allergies, dietary concerns?"

Once back home, don't hesitate to contact your overseas surgeon with any concerns or questions you may have, or ask your doctor to do so.