The Things You Discover

[newmexicoNita]

On 10/9/2019 at 7:19 PM, amygutman said:

Actual cruise ship doc here to answer your question....

 

Across the cruise lines having 2 sets of clinic hours 3-4 hours morning and afternoon are common. We take care of crew and guests during both times - no designated time for crew vs guests, though crew can have early appointments on a specific basis (i.e. the medical doc and nurse may also perform their physicals on-board which takes an hour or so). 

 

The doc and nurse are available 24/7 when not in clinic...there is never a time on board that you do not have access to them in an emergency. I have been woken up at 0300 for "emergency ear wax removal" only to have the patient refuse when they realize there is a fee for this service. 

 

No...clinic visits are not free - just like drinks, shirts and bingo are not free. But I guarantee you it is significantly cheaper than anything you can get on land in the US. I have been in emergency medicine for well over 2 decades and tell you that you will never pay less for outstanding concierge service than on a cruise ship. And it truly is concierge. The nurses and physicians are excellently trained, screened and have backgrounds consisting of never less than 3 years in EM, critical care, or IM with emergency training. They will speak your language or have translator services provided for free. They will provide care from a band-aid to resuscitating you with no advanced radiography, performing our own labs and x-rays, splinting, suturing and dispensing and mixing medications. We have little back-up while also trying to arrange your transfer to a land-based facility which can mean coordinating care between multiple international entities, ships and military forces. 

 

What are we doing when we are not in the limited clinic hours? Follow-ups, infection control, drills, training, educational initiatives, paperwork necessary to land the ship in every single foreign country - yes...at 0300 in the morning when you want your nausea medication (which...by the way is free on most cruise ships for a smile and a thank you), the doc is up filing paperwork 4 hours before every port to make sure the ship can actually dock and you can go on your excursion. We check the water supply on the ship constantly, serial sanitation controls, perform physical exams, coordinate care and transportation for every crew and guest member who needs a treatment evaluation in a foreign county, and do this in 24 hours shifts which are then followed by 8-12 hours of being "off call" - but generally are full of training, more paperwork, and helping our in the clinic when it is busy. Even worse...if you happen to have a private island day - the doc who was on the prior 24 hours for clinic and shift generally follows you to that island for another 12-16 hour day to ensure your safety on that island...and then has 4-6 hours off before starting another 36 hour "day".

 

So yes...there are limited clinic hours. But please understand that you will never have faster and easier access to quality health care than on a ship. It's not a Level 1 Trauma Center, and we have absolute limitations on how we can help you in critical illnesses, but I have never been more proud of the work done by this dedicated group of professionals. 

We have had reasons to use the medical center on about 1/2 dozen cruises and never been disappointed with the service with one exception and that was not NCL. Have we had our problems all solved? Of course not but we have been treated with care and concern and been able to live with whatever is bothering us until we can see our own doctor . The charges have never been much different than what we would pay at home for urgent care. We do send the bill  submit our bill to insurance when we return to the states and they pick up the cost as if we had seen a doctor here. The two things worth remembering are: 1-even with travel insurance you may not get paid. It depends on the situation. They will not step in until you have billed your insurance company and it may not be worth the hassle if the bill isn't too outrageously high and 2-Medicare will not cover anything if you are out of the country or let's say, they have told us, if they were to cover it the wait time could be up to 9 months. Again, because our situations have not been in the thousands of dollars range we haven't bothered. 

[Oakman58]

OP here, I wasn’t questioning the quality of the health care or the competence of the medical staff.  I’m sure they are all highly skilled in their respective fields of medicine.

 

I do have issue with the medical center only being open 3 hours a day.  As shoff515 mentioned, they can add an additional charge to your bill because the medical center had to be opened.  I mean really, 3 hours per every 24.

 

A word about travel insurance…don’t leave home without it.  As newmexicoNita pointed out, for Americans, Medicare and many other health insurance companies won’t cover you outside of the USA.  Keep all documentation and be sure all paperwork is signed by the appropriate authorities.  Travel insurance companies will eventually live up to their obligations but that doesn’t mean they won’t make you jump through a lot of hoops first.  Depending on your financial situation, you may just give up on a claim rather than put up with the hassle.

[suometar]

18 hours ago, amygutman said:

I am glad to hear your husband did well - and yes...we do spend way, way too much of our time in front of a computer vs in front of our patients. This is a sad fact of medicine, but it absolutely does help the patient, family and (sometimes most importantly) insurance companies understand what we did. 

New York is a very expensive state to have a medical emergency in - I live and practice emergency medicine in NY and a short trip across the border could drop prices as much as 40% for some diagnoses and treatments. 

 

 

The fact that everything that was done to my husband (all 19 pages of it) was documented was certainly not meant as a criticism, quite on the contrary: we submitted them to our health insurance (not travel insurance), and two weeks later we received a check in the amount that we had paid.

On the other hand, Mt. Sinai initially rejected our claim but again our health insurance went to bat for us and we only had to pay $250 for the hospital admittance.

[suometar]

In my original post I mentioned that we were on the Getaway. I must have had a senior moment because the ship was actually the Escape. However, I stand by everything else I wrote.

[amygutman]

On 10/10/2019 at 11:41 PM, ShelleyQT said:

I was very impressed with the care I received from the medical clinic when I came down with a horrible case of the Flu (not a stomach virus) while on a cruise.

 

I strongly advise everyone to get travel insurance before you go!

Amen to that!

[amygutman]

On 10/11/2019 at 5:33 PM, suometar said:

 

The fact that everything that was done to my husband (all 19 pages of it) was documented was certainly not meant as a criticism, quite on the contrary: we submitted them to our health insurance (not travel insurance), and two weeks later we received a check in the amount that we had paid.

On the other hand, Mt. Sinai initially rejected our claim but again our health insurance went to bat for us and we only had to pay $250 for the hospital admittance.

Certainly took it as praise, not a criticism about the documentation - I am sorry if it sounded otherwise. 

As painful as it is sitting at a computer when we really need to be tending to a patient, that documentation of your medical record is so incredibly important to you, the medical officials taking over that patient's care, and to the insurance companies. 

There was a great "article of the year" about 10 years back that noted that the average physician during a 12 hour shift "clicks" their mouse 10,000 times. 10,000!!!! 

[amygutman]

On 10/11/2019 at 7:50 AM, Oakman58 said:

OP here, I wasn’t questioning the quality of the health care or the competence of the medical staff.  I’m sure they are all highly skilled in their respective fields of medicine.

 

I do have issue with the medical center only being open 3 hours a day.  As shoff515 mentioned, they can add an additional charge to your bill because the medical center had to be opened.  I mean really, 3 hours per every 24.

 

A word about travel insurance…don’t leave home without it.  As newmexicoNita pointed out, for Americans, Medicare and many other health insurance companies won’t cover you outside of the USA.  Keep all documentation and be sure all paperwork is signed by the appropriate authorities.  Travel insurance companies will eventually live up to their obligations but that doesn’t mean they won’t make you jump through a lot of hoops first.  Depending on your financial situation, you may just give up on a claim rather than put up with the hassle.

I wish your wise words would be blasted across the forums - travel insurance is no joke, and not a luxury!!! You are incredibly foolish to travel without - it can cost more than you could imagine for the healthiest, youngest person to have a medical emergency at sea. 

[texasgirl29]

Years ago, aboard a Princess ship, my husband was not feeling well and broke out in spots -- chicken pox! He did not know he had never had them. He was quarantined and the ship doctor made "house calls" to our cabin. 

 

Two years ago aboard Celebrity Eclipse, my BIL ended up in the infirmary with dehydration, seizures and complications brought about in relation to Downs Syndrome. The staff took excellent care of him for several days. My FIL said there was no charge.

 

 

[SouthLyonCruiser]

On 10/9/2019 at 3:59 PM, Oakman58 said:

Under the category of “things I didn’t know.”  I was surprised to discover that the medical center on the Breakaway was only open three hours a day, one and a half hours in the morning and one and a half in the evening.  Now I know why Dr. Adam Bricker could be in so many scenes on the Love Boat, his medical center was always closed.  😄

 

 

On a positive note, there was a vending machine available 24/7 right by the medical center that dispensed important items such as aspirin, antibiotic cream, condoms, etc.

 

My son got a gash on his arm during an NCL excursion and required some stiches. The physician on board said that there would be no charge.

[Markanddonna]

I had a medical problem on a transatlantic. Went to the clinic at 8 AM, had an exam, lab tests, and was given two medications:

$160 total . Competent, inexpensive, and it was all reimbursed by my travel insurance and private insurance when I returned to the US.

 

[billslowsky]

To add another anecdote to this... not specific to the ship's medical.  My spouse got the bends while diving in Belize.  The dive center she was staying at tried to tell her she had the flu; she had to be emergency evacuated to the mainland by helicopter, and spent the next three days being treated in a bariatric chamber.  Her travel buddy had to find lodging on her own.  The bill for the helicopter alone was $15,000 and quickly appeared on our credit card.

 

The insurance eventually paid for all of it; she had substantial coverage.  Coverage through her DAN membership plus travel insurance plus primary medical.

 

Everything had to be filed in order.  Primary insurance first.  They negotiated a lot down, but a lot was left on deductible.  DAN insurance second, took care of most of the rest.  Travel insurance last, they paid on the lodging and some of the helicopter.

 

But it took months, and it's not simply bureaucracy.  A lot of money and proof of loss is required.  You have to be patient.

[lenquixote66]

I have a niece who is an Emergency Medical Doctor in a hospital in NY.She has been on many cruises and has found the ships physicians to be top notch medical professionals.

[amygutman]

21 hours ago, texasgirl29 said:

Years ago, aboard a Princess ship, my husband was not feeling well and broke out in spots -- chicken pox! He did not know he had never had them. He was quarantined and the ship doctor made "house calls" to our cabin. 

 

Two years ago aboard Celebrity Eclipse, my BIL ended up in the infirmary with dehydration, seizures and complications brought about in relation to Downs Syndrome. The staff took excellent care of him for several days. My FIL said there was no charge.

 

 

Chicken pox? Good lord...what misery!

Cannot speak across cruise companies, but sometimes there are ways to reduce or waive charges - being polite and saying thank you goes a long, long way towards charges unless it's a specific medication / durable medical good...those the staff are accountable for and must charge unless the staff captain agrees to waive all / some fees. Kids and those sailing with special needs often get great documentation of care but reduced fees. We generally love catering to these guests. 

 

Also good to know: most cruise companies, from my understanding from "taka taka" among other cruise medical personnel, will completely waive bills for GI / influenza-like illnesses, or injuries sustained on cruise-sponsored activities unless the patient demonstrated gross negligence (i.e. highly intoxicated, asked to stop drinking and doesn't, then gets injured)

[amygutman]

10 hours ago, lenquixote66 said:

I have a niece who is an Emergency Medical Doctor in a hospital in NY.She has been on many cruises and has found the ships physicians to be top notch medical professionals.

That's great to hear - the news only tends to focus on the bad cases and bad outcomes (and usually only one biased side of the story).

Many non-US docs I have met have literally waited years to have their application / hiring approved - the training and background required are challenging enough, but for non-Americans, these positions pay 3-4 times or more their average salary and are highly competitive. As an American EM physician, a ship monthly salary was about what I can earn in a week - but the perks, adventure, travel and humbling experience it is to meet crew each seeking their version of the "American Dream" - that it worth more than money.