Before getting two artificial disks to ease the grinding pain in his back, Wayne King asked prospective surgeons where they trained and how many disk replacements they had done.

Then he flew to Malaysia for the operation.

Rising health costs and dwindling insurance coverage are driving hundreds of thousands of Americans to travel far to avoid potentially devastating medical bills.

Among them are King, an insurance adjuster who lives in east Sacramento, as well as a Sacramento City firefighter who underwent major dental reconstruction in Tijuana, and an Elk Grove couple heading to India for fertility treatment.

Other than organ transplants, there's little data on the safety of medical travel, but "there is no question that it is increasing," said Dr. Arnold Milstein, chief physician at Mercer Health and Benefits, a firm that advises companies on medical insurance.

"In the U.S., it's getting to be pretty Darwinian in terms of who lives and who dies," said Milstein. Or who hurts and who doesn't.

King was driven by a steady, intense pressure on his midsection caused by one collapsed and one partly collapsed disk. It's like having an arthritic joint, but in the spine, said his rehabilitation specialist, Dr. Michael Hembd of Sacramento.

"I was absolutely miserable," King said. "I had no life."

Standing or sitting for more than a few minutes were equally tormenting. Painkillers fogged his mind. He withdrew from friends and snapped at relatives.

A standard treatment would be spinal fusion surgery, to immobilize a section of spine. An emerging alternative is disk replacement. Both have flaws, failing to cut pain in up to a fourth of the people who get them, said Dr. Serena Hu, an orthopedic surgeon at UC San Francisco who has researched disk replacement. But there is some suggestion that disk replacement may put less strain on nearby disks.

King was convinced replacement would give him better mobility and less risk of other disks degenerating.

Although European surgeons have replaced two neighboring disks for well over a decade, many U.S. insurance companies will only pay for single disk replacement because success of two-disk surgeries – what King wanted – haven't been tracked as long.

He appealed his insurance company's denial. He changed jobs to try to improve his coverage. He was told yes, then no just days before Hu would have operated.

"I said screw it, I'm just going to do it and file bankruptcy, but the hospital wanted $50,000 down" on the $105,000 treatment, King said.

Ultimately, after months of Internet research and hiring MedRetreat, a medical travel organizer, he traveled in January to Gleneagles hospital in Malaysia.

The bill – surgery, hospitalization, hotels and airfare for himself, his partner and his mother – came to $27,000. King borrowed from relatives and his 401(k).