Air/Medical evac

[navybankerteacher]

On 11/18/2019 at 12:25 PM, JennyB1977 said:

@Flatbush Flyer I appreciate the heads up! I have spoken to my healthcare provider. "Under your plan benefits for emergency services is covered at $100 copay then paid at 100% of eligible expenses." Then I asked an example. "okay so for example I have a heart attack and am transported to a mexican hospital and then from there need to be moved in network. All I'm out of pocket is $100?" Response - "Yes, that is correct!"

Sounds like you have a very generous, liberal minded employer.

 

However, because this response is so improbable, I would suggest you specifically ask if your coverage would pay for international repatriation on those terms - and ask that it be put in writing. 

 

(I suspect that the meaning of “eligible”, as in “100% of eligible expenses” might not be firmly established.)

[Flatbush Flyer]

1 hour ago, sparks1093 said:

You are thinking 5 figure per person cruise, I'm thinking 3 figure per person cruise (or 3 day cruise to Nassau versus African safari if you'd rather). And while there might be potential negative effect it's outside of our control.

It's all relative. If someone's income is at a lower end of the spectrum, that same thoughtful expenditure consideration/justification should be employed for a 3 figure cruise as well.

[sparks1093]

5 minutes ago, Flatbush Flyer said:

It's all relative. If someone's income is at a lower end of the spectrum, that same thoughtful expenditure consideration/justification should be employed for a 3 figure cruise as well.

What they should do and what they do is a world apart, as you've pointed out many folks don't think about it at all, they're too interested in the here and now.

[pacruise804]

15 minutes ago, Flatbush Flyer said:

It's all relative. If someone's income is at a lower end of the spectrum, that same thoughtful expenditure consideration/justification should be employed for a 3 figure cruise as well.

 

Income really has little to do with it.  Some with $50K or less annual salaries can have a significantly higher net worth than those making $250K because of thoughtful choices.  

 

I agree though that whatever end of the spectrum you are on you should be thoughtful with how you spend your time and money.

[Hlitner]

On 11/18/2019 at 1:19 PM, tinykygal said:

What are some of the plans that 'pay up front?'

My husband has been planning our first trip to Europe.

We don't want to live in fear and stop traveling outside US, but we had never given thought to foreign medical treatment.

Thank you for your input.

You are looking for absolutes in an area that has anything but!  Probably the Cadillac of evacuation policies is that issued by Medjetassist.  They are about evacuation but do not cover any other medical expenses.  Most trip insurance policies include some kind of evacuation coverage and minimal medical.   Some medical-only plans like Geoblue include more generous medical coverage coupled with large evacuation coverage.  When you are faced with a real emergency things happen fast, there can be lots of negotiation, and even the best plans can have problems.  Very few, if any, medical policies will pay in advance on overseas claims and in most cases you will need to provide your own cash payment of a credit card with adequate credit.  When I had to evacuate my DW from Japan back to the USA, our Geoblue policy did purchase her Business Class (lay flat) fare in advance, but this was all negotiated by yours truly.  We had to pay all of our medical bills (many thousands of dollars out-of-pocket and were later (several weeks after filing detailed claims info) reimbursed.   We also had to deal with the stress of emergency treatment (including some surgery) in an Asian hospital where none of the physicians/nurses spoke English  (the hospital.  In our case, the quality of care was outstanding (I have enough personal medical experience to recognize quality) and the patient made a full recovery (after 3 months of care and 3 trips to the operating room).   At the time, the issue of money was a very distant concern although we did go out of our way to communicate and negotiate with our insurance company.

 

One facet of International travel is one's ability to accept some risk or, alternatively pay a lot of money for excellent insurance!  Those of us who do a lot of world travel generally understand the risks and find it acceptable.  Others either learn to live with their "concerns" or stay closer to home.  We recently (on a Princess cruise) dined with a couple where the husband (who is a lawyer) told me he was very "risk adverse" and did not like to take chances.  His wife later expressed her frustration with her husband's inability to accept reasonable risk...which resulted in crimping their travel style.  There is no right or wrong but simply the recognition that we all have our own idea of acceptable risk.

 

Hank

[spookwife]

On 11/18/2019 at 10:28 AM, JennyB1977 said:

I am still employed full time with insurance through work. Am I in the minority that all of this stuff is covered by my health insurance?

Very few employer provided insurance covers travel related issues , or anything out of the country.  

[navybankerteacher]

42 minutes ago, spookwife said:

Very few employer provided insurance covers travel related issues , or anything out of the country.  

A lot of people do not take the time/effort to actually find out what coverage they actually have.

[Elaine5715]

On 11/18/2019 at 12:34 PM, new_cruiser said:

I think they may not have understood the question. I doubt that they will pay for your transportation from Mexico back to the US. They may be talking about just the medical expenses. It is there in the response you received: "eligible expenses."

I would suggest they assume the patient would be traveling back to the US after treatment.  

[ldubs]

On 11/17/2019 at 8:29 PM, Elaine5715 said:

I don't think you would be shocked to hear how many people drop house insurance once they secure their mortgage

 

Gosh, I think I would.  The lender is automatically notified of any lapse in the policy.  In fact, per the standard endorsement, the policy will stay in effect for a few days after the lender is notified.   That provides time for the lender to arrange coverage, which premium the borrower will pay.   

[ldubs]

1 hour ago, Elaine5715 said:

I would suggest they assume the patient would be traveling back to the US after treatment.  

 

Well, that might kind of makes sense, but I would still double check because that would be unusually comprehensive coverage.   For JennyB I hope it is true, but better safe than sorry.  

[Flatbush Flyer]

8 minutes ago, ldubs said:

 

Well, that might kind of makes sense, but I would still double check because that would be unusually comprehensive coverage.   For JennyB I hope it is true, but better safe than sorry.  

IMO, it makes no sense that a med insurance phone rep would assume the caller will be traveling internationally (and, from her post here, I'm betting she didn't say that). The more usual question they would handle would be related to someone going to the nearest emergency room at home (locally or in the U.S.) but then needing/wanting to be transferred to an "in network" hospital if admission is appropriate/ordered. 

[ldubs]

2 minutes ago, Flatbush Flyer said:

IMO, it makes no sense that a med insurance phone rep would assume the caller will be traveling internationally (and, from her post here, I'm betting she didn't say that). The more usual question they would handle would be related to someone going to the nearest emergency room at home (locally or in the U.S.) but then needing/wanting to be transferred to an "in network" hospital if admission is appropriate/ordered. 

 

Yeah, I'm kinda guessing that the ins company rep was responding to the international coverage for emergency room care, which is not unusual, and didn't really pick up on evac coverage. But then, I'm only guessing.   I just thank that it makes sense to confirm.    

[SimplyMarvie]

2 hours ago, ldubs said:

 

Yeah, I'm kinda guessing that the ins company rep was responding to the international coverage for emergency room care, which is not unusual, and didn't really pick up on evac coverage. But then, I'm only guessing.   I just thank that it makes sense to confirm.    

 

I suspect you're right and that this is a case of getting answers from a half-trained teenager in a cubicle. Having worked in health insurance it sounds like she's assuming that you're getting care through an in-network provider who has an agreement with the insurance company to bill them directly. For all other care, both overseas and not, you'd be at an out of network provider and have to pay upfront and then claim reimbursement from your health insurance after the fact (which, alas, can take months or years...)

 

While for certain very high end policies that cover a lot of people overseas (I'm thinking CIGNA's expat plan, and the Federal Plan that's designed for members of the Foreign Service) they will have some contracted providers overseas, those are going to be very limited and generally in major markets to which people would be medically evacuated (Tel Aviv, J'berg, Singapore, Frankfurt, London). It's possible that the person you spoke with assumed that you'd be somewhere that you'd have access to one of those facilities, or that they have a network in Mexico. I'd look specifically for in-network providers outside of the US before you get too excited about those benefits. 

 

Also, it's really hard to find travel insurance that covers only interruption and medical evacuation without adding medical treatment -- MedJetassit is pretty much the only option, and it's more expensive than comprehensive travel policies. 

[Cruiser_1977]

Sorry for my delay in responding. I wanted to have the best answers to provide a complete response. I spoke to both my VP of HR and multiple people at our insurance provider:

The insurance I am covered under:

1) Covers emergencies outside of the USA while on leisure or business travel (Emergency Health Services - "threat to loss of life or limb")

2) Covers the transport whether ambulance or air back to an In Network Provider in the USA when I am stable

3) I would need to pay Out Of Pocket and submit for reimbursement

      a) there is an actual form for this "foreign international claim for reimbursement"

4) I would end up only paying Out Of Netowrk copay ($100)

 

So, to one of the points of this thread. Yes, I (and people with similar insurance) would/do need access to credit and/or cash in the moment. However, when all is said and done I, personally, would only be out the $100 copay.

 

Edited November 20, 2019 by JennyB1977

[klfrodo]

1 hour ago, JennyB1977 said:

Sorry for my delay in responding. I wanted to have the best answers to provide a complete response. I spoke to both my VP of HR and multiple people at our insurance provider:

The insurance I am covered under:

1) Covers emergencies outside of the USA while on leisure or business travel (Emergency Health Services - "threat to loss of life or limb")

2) Covers the transport whether ambulance or air back to an In Network Provider in the USA when I am stable

3) I would need to pay Out Of Pocket and submit for reimbursement

      a) there is an actual form for this "foreign international claim for reimbursement"

4) I would end up only paying Out Of Netowrk copay ($100)

 

So, to one of the points of this thread. Yes, I (and people with similar insurance) would/do need access to credit and/or cash in the moment. However, when all is said and done I, personally, would only be out the $100 copay.

 

another question to ask

Do they pay for repatriation of remains? Mine said No

I also asked if they would send payment upfront if necessary to receive inpatient medical care if the provider demanded payment upfront for major procedure. Mine said No.

 

My employer provided insurance also has an international rider for coverage outside CONUS. However, after speaking with them, I decided that having an additional travel insurance policy for medical, evac, was in my own personal best interest.

Edited November 20, 2019 by klfrodo

[Flatbush Flyer]

1 hour ago, JennyB1977 said:

Sorry for my delay in responding. I wanted to have the best answers to provide a complete response. I spoke to both my VP of HR and multiple people at our insurance provider:

The insurance I am covered under:

1) Covers emergencies outside of the USA while on leisure or business travel (Emergency Health Services - "threat to loss of life or limb")

2) Covers the transport whether ambulance or air back to an In Network Provider in the USA when I am stable

3) I would need to pay Out Of Pocket and submit for reimbursement

      a) there is an actual form for this "foreign international claim for reimbursement"

4) I would end up only paying Out Of Netowrk copay ($100)

 

So, to one of the points of this thread. Yes, I (and people with similar insurance) would/do need access to credit and/or cash in the moment. However, when all is said and done I, personally, would only be out the $100 copay.

 

So, it sounds like you may have Kaiser insurance or some similar health network. 

 

Even then, still uncertain (and worth pursuing) is that gray area of "medical evacuation." Transport from an emergency facility to an in-network hospital (once stable) back in the US is a very different thing then transport to home. 

[Cruiser_1977]

@Flatbush Flyer First, I am healthy. No history of anything and no medications (knock on wood). I was very clear that is was medical transport (whether amubulance or air) from medical facility in another country to an in network facility for additional care. I did not ask if they would cover flying me home. If something catastrophic happens to me while in the Mexican Riviera it would be serious enough that I wouldn't fly to DCA or IAD and drive myself home. I'd get stabilized and transferred to an in network facility. The scenario I described is covered.

 

@klfrodo I have an e-mail in to my new best friend about repatriation.

[HerbertandB]

Many moons ago I worked for a large health insurance company, which has been mentioned in one of the previous responses.   Occasionally we'd get claims from members that lived or were traveling overseas.  We'd look at the bill from the provider or any receipts given to the member and pay the member in US dollars based on the exchange rate for the date the services were rendered.  

 

Which makes me wonder,  if you pay out of pocket up front with a credit card that has foreign transaction fees of 3% will you get reimbursed for the amount you paid or does the insurance company still calculate the payment based on the bill itself?  

[SRF]

I would think you could present a copy of the credit card statement and that they would reimburse you the actual cost in USD.

[ldubs]

13 hours ago, JennyB1977 said:

Sorry for my delay in responding. I wanted to have the best answers to provide a complete response. I spoke to both my VP of HR and multiple people at our insurance provider:

The insurance I am covered under:

1) Covers emergencies outside of the USA while on leisure or business travel (Emergency Health Services - "threat to loss of life or limb")

2) Covers the transport whether ambulance or air back to an In Network Provider in the USA when I am stable

3) I would need to pay Out Of Pocket and submit for reimbursement

      a) there is an actual form for this "foreign international claim for reimbursement"

4) I would end up only paying Out Of Netowrk copay ($100)

 

So, to one of the points of this thread. Yes, I (and people with similar insurance) would/do need access to credit and/or cash in the moment. However, when all is said and done I, personally, would only be out the $100 copay.

 

 

👍👍👍

 

Thanks for the follow up.      

 

I had to see a Doc once in London.  My insurance didn't matter and they didn't even want to know anything about it.  They provided treatment including prescription meds at no cost to me.  I was an outpatient.   I felt kind of like a freeloader but was happy to receive the care.   

 

 

[SRF]

I had to go to the emergency room in Sicily.  They asked for my insurance card, I provided it.  All was good.  I did not hear anything from them or the insurance company.

[Hlitner]

This topic is getting more complex and some of the posted info will prove to be generally wrong.  I guess that 35 years working in the Health Insurance Industry (government) gives me the perspective from the insurance company side and having been a frequent traveler (who had to deal with our own insurance claims and evacuation) gives me a different perspective.

 

So here are some facts.  Most Insurance Plans (be it something from work or even a travel insurance plan) will not generally be able to convince foreign hospitals and physicians to accept "assignment" which means the insurance company directly pays the  provider.  In most cases, medical bills (including hospitals) will have to covered out-of-pocket (generally on major credit cards) until such time as you can file a detailed claim (with your insurance company) and get reimbursed.  There are a few insurance companies that do have International networks (GeoBlue is one example) that may accept insurance assignment (somebody posted such as example regarding a claim in Sicily) but those networks are very spotty and you really need to luck-out in ending up in a network hospital with network physicians.

 

Decent travel insurance providers can be relatively easy to work with assuming you contact them early in the process and have detailed documentation.  Regular insurers who include some International coverage are often a bit "anal" with claims and might even insist that every document (bills and supporting medical records) be first translated into English.   We were really pleased that when we filed a major claim with Geoblue that they accepted lots of documents written in Kanji (Japanese).  Geoblue took on the responsibility of getting more then 50 pages or documents translated.

 

The key to getting reimbursed is having documentation.  So when you are dealing with foreign providers make sure to insist on copies of all the relevant medical records, charges, bills,  X-rays, etc.  We even returned home with DVDs of CT Scans as well as photos of the injury and some of the treatment procedure.

 

Hank

[navybankerteacher]

13 hours ago, ldubs said:

 

👍👍👍

 

Thanks for the follow up.      

 

I had to see a Doc once in London.  My insurance didn't matter and they didn't even want to know anything about it.  They provided treatment including prescription meds at no cost to me.  I was an outpatient.   I felt kind of like a freeloader but was happy to receive the care.   

 

 

You are dating yourself - while that used not to be the case, nowadays non- UK residents are generally charged for medical care.

[new_cruiser]

1 hour ago, Hlitner said:

... Regular insurers who include some International coverage are often a bit "anal" with claims and might even insist that every document (bills and supporting medical records) be first translated into English.   ...

 

The key to getting reimbursed is having documentation.  So when you are dealing with foreign providers make sure to insist on copies of all the relevant medical records, charges, bills,  X-rays, etc.  We even returned home with DVDs of CT Scans as well as photos of the injury and some of the treatment procedure.

 

 

The hospital that treated me in Thailand provided all the documentation in English. I didn't have to insist - they provided a package with all the medical records and expense details including a disk with the X-rays as part of the normal check out process. Perhaps they are very professional on the documentation because of experience with medical tourism. 

 

We have had out of area emergency treatment twice. Once for my husband in the US and the broken wrist in Thailand for me. In both case, our provider handled reimbursement very smoothly. We sent the claim in with the documentation and they sent a check (or paid the bill when we hadn't had to pay before service) without any further interaction. The incident with my husband involved a 1 hour ambulance ride and diagnostics including a CAT scan to diagnose what turned out to be just the combination of a stomach bug and high altitude so I was worried that our insurance would object that the treatment had been unnecessary, but they didn't. In the US case, the hospital billed our insurance but the ambulance company wanted payment up front.

[ldubs]

1 hour ago, navybankerteacher said:

You are dating yourself - while that used not to be the case, nowadays non- UK residents are generally charged for medical care.

 

Well, must have been my good looks, cause it was last year!  😀

 

EDIT:   Oops - make that 2017.  Anyway, not that long ago.  

Edited November 21, 2019 by ldubs