Emergency in a cash based system even with Travel Insurance

[rimmit]

So my wife unfortunately recently was run over a car in Victoria Falls, Zimbabwe.  We have travel insurance and it will pay out for the air evac and the several surgeries that she has had thus far here.  I am posting here because even with travel insurance, in a cash based system, in an emergency there are still a ton of barriers to getting care quickly and efficiently, which resulted in a nearly full day delay in care for a Level I trauma.  I wrote a mini novella on our blog and for anyone that takes the time to read it, I promise you will be astonished at what transpired and have a new appreciation of the US healthcare system despite all it’s faults.  
 

This is not monetized and there are no ads.
 

http://thesmallworldfamily.com/2022/06/24/so-what-exactly-happened/

 

Edited June 25, 2022 by rimmit

[canadianbear]

Wow….it is unbelievable what you had to go through to get the care your wife needed.  Certainly an eye opener for me.  Very thankful for you sharing your experience and the way you handled everything.  I am not sure how we would deal with this “cash” system.  We travel with insurance but when things go sideways I’m not sure how it would go.  Very scary.

 

Thank you again for sharing and hoping for the best outcome. 

Edited June 25, 2022 by canadianbear

[rimmit]

57 minutes ago, canadianbear said:

Wow….it is unbelievable what you had to go through to get the care your wife needed.  Certainly an eye opener for me.  Very thankful for you sharing your experience and the way you handled everything.  I am not sure how we would deal with this “cash” system.  We travel with insurance but when things go sideways I’m not sure how it would go.  Very scary.

 

Thank you again for sharing and hoping for the best outcome. 

Thanks.  Just thought people should know that just because you have travel insurance doesn’t mean you can get care expediently.  There are still some significant barriers to care if the country is cash based.

[canadianbear]

39 minutes ago, rimmit said:

Thanks.  Just thought people should know that just because you have travel insurance doesn’t mean you can get care expediently.  There are still some significant barriers to care if the country is cash based.

Exactly, and it is very much appreciated that you shared this.  Certainly an eye opener.  
 

I hope your family will be emotionally ok as your kids witnessed something very traumatic.  And of course that your wife makes a good recovery.  

[rimmit]

8 minutes ago, canadianbear said:

Exactly, and it is very much appreciated that you shared this.  Certainly an eye opener.  
 

I hope your family will be emotionally ok as your kids witnessed something very traumatic.  And of course that your wife makes a good recovery.  

My parents took the kids and continued on with the vacation to Botswana.  Per my mom, my youngest, Lucy is apparently very scared of cars now sadly, and is very anxious getting near them.

[klfrodo]

Traumatic experience, glad everyone is finally okay (as much as okay that they can be anyway)

 

However, what are your take aways? What would be your recommendations to others to alleviate some of your challenges that you experienced.?

[canadianbear]

52 minutes ago, rimmit said:

My parents took the kids and continued on with the vacation to Botswana.  Per my mom, my youngest, Lucy is apparently very scared of cars now sadly, and is very anxious getting near them.

I did read that your parents did that but also worried about after.  I can understand why she would be scared of cars now.   

[rimmit]

1 hour ago, klfrodo said:

Traumatic experience, glad everyone is finally okay (as much as okay that they can be anyway)

 

However, what are your take aways? What would be your recommendations to others to alleviate some of your challenges that you experienced.?

My takeaway is that I am not sure what I could do differently other than maybe carry 20,000 dollars on hand at all times.  
 

You can’t not travel only when banks are open so you can do wire transfers, as that is not feasible.   They don’t take checks.  Maybe travel with 5 different credit cards with high credit lines to improve the chances of one going through. 
 

I think maybe buying an international phone plan could help, but even when I could make international calls it didn’t make a difference.

 

That’s the hard part of all this.  I honestly don’t know what we could do to prepare differently.  My wife was walking about 5 ft from the road, so she really couldn’t walk much safer.  The police want to press charges.  We don’t think that will accomplish anything. 
 

Maybe not forget contact solution?  Ultimately,  that’s what’s so hard to process.  I am not sure what we could do differently to expedite the process of getting her transferred.  Wire transfers on weekends just aren’t possible.   I left out some details for brevity, but we even attempted to contact the embassy but being a weekend that got us nowhere.  They did get back to us though two days later and took the info of the evac company so they could try and prevent this from happening again.

 

Really travel with more cash I guess in 3rd world cash based companies. Cash is king and the only thing people want.   They avoid “swipe” (that’s what they call it here) like the plague.  Traveling with 20k in pocket is dangerous though and not something I’d recommend on a regular basis. 

[btc1951]

What an absolutely horrific story! Thank you for sharing it with us. I wonder what other countries are cash-based?

[mauimary]

With Travel Insurance (primary policy) if you can get hold of the company on a weekend are they in a position to wire transfer funds up front for you to make these large payments that are demanded.     I can see where getting receipts and copies of records could be a real challenge to boot!  
 

We will be in Africa later in the year. Zimbabwe (a remote camp as well as a camp in Victoria Falls).  Just reading your blog is terrifying.  Thank goodness you are in the Medical Field as I am definitely sure that really helped you to be able to advocate on your wife’s behalf.  

[Jersey42]

50 minutes ago, mauimary said:

With Travel Insurance (primary policy) if you can get hold of the company on a weekend are they in a position to wire transfer funds up front for you to make these large payments that are demanded.     I can see where getting receipts and copies of records could be a real challenge to boot!  

A policy that pays medical claims as "primary" means that you do not have to file with other insurance first before they will pay.  A "secondary" policy means it will only considering covering amounts not paid by the primary policy. With most travel insurance policies, you have to pay upfront and gather records and receipts, then file with the insurance company for reimbursement. 

 

GeoBlue (medical and evacuation) is one company that says they will pay the provider directly if you use one of their (limited) network of worldwide providers.  Chances are you will not go to a network doctor in an emergency.  Maybe there are other insurance companies that offer networks as well, but I have not run across one. 

 

Most people recommend carrying a credit card with a large unused limit.  Of course, that didn't do the OP much good in his case.

[mauimary]

1 hour ago, Jersey42 said:

A policy that pays medical claims as "primary" means that you do not have to file with other insurance first before they will pay.  A "secondary" policy means it will only considering covering amounts not paid by the primary policy. With most travel insurance policies, you have to pay upfront and gather records and receipts, then file with the insurance company for reimbursement. 

 

GeoBlue (medical and evacuation) is one company that says they will pay the provider directly if you use one of their (limited) network of worldwide providers.  Chances are you will not go to a network doctor in an emergency.  Maybe there are other insurance companies that offer networks as well, but I have not run across one. 

 

Most people recommend carrying a credit card with a large unused limit.  Of course, that didn't do the OP much good in his case.

Thank you. I understand it all but would like to know what a solution would be.  We’re thinking about adding Geo Blu but sort of doubt there is a network provider in either Zimbabwe or South Africa.  We will be in both countries as well as Botswana.  We do have a primary travel policy with the well known Safari Company but looking at it only has 50k medical but does cover evacuation.  
 

This whole ordeal with the credit card is an absolute nightmare. 

[Suzanne123]

In fact, GeoBlue does have facilities in Botswana, South Africa and Zimbabwe.  Here are are few 

 

 

Edited July 1, 2022 by Suzanne123

[Jersey42]

9 minutes ago, mauimary said:

Thank you. I understand it all but would like to know what a solution would be.  We’re thinking about adding Geo Blu but sort of doubt there is a network provider in either Zimbabwe or South Africa.  We will be in both countries as well as Botswana.  We do have a primary travel policy with the well known Safari Company but looking at it only has 50k medical but does cover evacuation.  
 

This whole ordeal with the credit card is an absolute nightmare. 

I guess I misunderstood your question.  I thought you wanted to know if a travel insurance company would wire the money to pay for the medical expenses upfront. I answered that one. So what are you actually asking?

 

From the wording of your question, I had a feeling that you thought "primary" meant the insurance company would pay the provider directly.  Sorry for my misunderstanding.

 

I also agree the OP's situation was a nightmare.  But I am not sure if there is a good solution in a "no credit card" situation.  The OP talked about it a little bit in post #8, with no good answer besides carrying lots of cash. I just saw @Suzanne123's post.  Perhaps that might work for your trip, depending on the situation, especially if you have the time to get to one of GeoBlue's providers.

[Suzanne123]

I was wondering if MedJet would have been able to rescue OP’s wife from the first “hospital.”  MedJet’s Emergency Medical Cash Advance is $60k.

NetCare Millpark ( the good hospital) in Johannesburg is on GeoBlue’s list of providers.

Also, it seems like the family all used Capital One which wasn’t much help.  Would Chase or AmEx have been any better?

Lots to consider about visiting any third world country, for sure.

[mauimary]

8 minutes ago, Jersey42 said:

I guess I misunderstood your question.  I thought you wanted to know if a travel insurance company would wire the money to pay for the medical expenses upfront. I answered that one. So what are you actually asking?

 

From the wording of your question, I had a feeling that you thought "primary" meant the insurance company would pay the provider directly.  Sorry for my misunderstanding.

 

I also agree the OP's situation was a nightmare.  But I am not sure if there is a good solution in a "no credit card" situation.  The OP talked about it a little bit in post #8, with no good answer besides carrying lots of cash. I just saw @Suzanne123's post.  Perhaps that might work for your trip, depending on the situation, especially if you have the time to get to one of GeoBlue's providers.

No I agree I was not clear.   Looking at those clinics The ones in Botswana are no where reasonable close to where we are.  So in any event for us it would be a non network with Geo Blu. 

I understand primary insurance as well as the process. but on a weekend in Victoria Falls or any other medical which is not near a preferred provider or any real clinic or hospital for that matter and when they are demanding cash for what tx currently has been provided along with refusal of any more tx until they get payment 

…one cannot get any cash out of machine

…cannot get $$ wired from credit card company 

…does not have cell service in that country and needs a code sent via message 

…refuses any credit card payment 

 

The Big Question ?? will travel insurance wire the clinic or ambulance provider $$ to satisfy their demand for tx that has been delivered.  Huge problem when clinic keeps you hostage until they get their $$ and are refusing any more care in an emergency.    
 

Africa is not a place you want to carry a lot of cash.   

[mauimary]

18 minutes ago, Suzanne123 said:

I was wondering if MedJet would have been able to rescue OP’s wife from the first “hospital.”  MedJet’s Emergency Medical Cash Advance is $60k.

NetCare Millpark ( the good hospital) in Johannesburg is on GeoBlue’s list of providers.

Also, it seems like the family all used Capital One which wasn’t much help.  Would Chase or AmEx have been any better?

Lots to consider about visiting any third world country, for sure.

Good to know Millpark is on the Geo Blu list. Thanks. 

[Suzanne123]

8 minutes ago, mauimary said:

No I agree I was not clear.   Looking at those clinics The ones in Botswana are no where reasonable close to where we are.  So in any event for us it would be a non network with Geo Blu. 

I understand primary insurance as well as the process. but on a weekend in Victoria Falls or any other medical which is not near a preferred provider or any real clinic or hospital for that matter and when they are demanding cash for what tx currently has been provided along with refusal of any more tx until they get payment 

…one cannot get any cash out of machine

…cannot get $$ wired from credit card company 

…does not have cell service in that country and needs a code sent via message 

…refuses any credit card payment 

 

The Big Question ?? will travel insurance wire the clinic or ambulance provider $$ to satisfy their demand for tx that has been delivered.  Huge problem when clinic keeps you hostage until they get their $$ and are refusing any more care in an emergency.    
 

Africa is not a place you want to carry a lot of cash.   

I don’t want to mislead you re: hospitals in Botswana.  If you have a GeoBlue policy, you can go on their website and choose any country to find medical providers, but you must also have a city, and I only knew the capital, so it’s quite possible there are more GeoBlue related doctors or facilities available. If you know a particular city, I can look it up.

[Jersey42]

20 minutes ago, mauimary said:

The Big Question ?? will travel insurance wire the clinic or ambulance provider $$ to satisfy their demand for tx that has been delivered.  Huge problem when clinic keeps you hostage until they get their $$ and are refusing any more care in an emergency.  

Unfortunately, unless I am totally misinformed, the answer is pretty much NO.  Travel insurance is normally reimbursement only, with the exception of the GeoBlue network being discussed.  Now, if I were in that situation I would definitely call the insurance company and plead my case.  You have nothing to lose. Perhaps a provider might take a deposit and bill the balance if the insurance company could provide something to show medical coverage up to $X.  But I am only speculating and I would not count on it.

 

If you have the time, you might want to pose this question to your safari company and their insurer.  I am sure they have run into this before.  I would be curious if they give you any good insights.

Edited July 1, 2022 by Jersey42

[Hlitner]

I finally got around to reading the OP's link (saga in Africa) and I could almost cry imagining the frustration of the OP.  When we had our own major medical situation (in Vietnem) we were lucky that we were able to get decent emergency care on our ship (South African physician) and get her to Osaka, Japan in two days where DW could get worldclass care/outpatient surgery.   We did not face anything nearly as horrid as the situation in Zimbawe.

 

But reading some of the posts just reinforces my belief that most folks have little clue when it comes to dealing with Travel and related travel medical insurance.   The reality is that very few insurance companies are going to authorize direct of immediate payments.  And in a situation like the OP where he could not even communicate with the insurance company the situation is even worse.

 

The way most travel insurance works is that you must first handle the payments (or at least have available credit) and then later resolve the financial end with the insurer.  To do this you must be able to document everything including having detailed medical records.  This is not always easy to get and folks need to often become somewhat assertive in their demands for copies of records.  In nearly all cases, Medical Evacuation insurance requires the ability to communicate, and the cooperation of the attending physician, insurance company, claimant, and often a receiving hospital.   This can be very complicated and having an insurance company that truly acts in good faith is very helpful.  The best insurance companies will have medical case managers that can get immediately involved and help (or hinder) resolution.  The injured or ill claimant's life and/or future health may well depend on having a capable advocate on the scene.  In the case of the OP the advocate was a physician which is very helpful.  In the  case of DW she had me who had once been a Paramedic and had spent over 30 years working in the medical insurance industry.  Like with the OP, it was my background that really helped work through the many problems.    I have long wondered how folks manage without a capable (and calm) advocate.  Many folks do not function well when under lots of stress and in a medical situation.

 

As we have previously posted (back when we told our tale of medical woe), we think a very important step is to contact the insurance company and open communications and a case file.   The earlier this is done the better.  In fact, medical evacuation reimbursement is often dependent on getting approvals before evacuation (or you may never get reimbursed).  

 

In our case we did have GeoBlue and they did earn my thanks for their professionalism, case management help, and relatively fast reimbursement.  But expecting assignment (direct reimbursement from GeoBlu to the hospital and physicians) is one of those things that does require some luck and the agreement of the hospital/physician.   There is never a guarantee that a foreign entity will accept immediate assignment and in a medical emergency you will not often have the chance or opportunity to choose participating folks.  You will generally go to the nearest provider or, in our case, to where arrangments could be made by the ship's Agent in Osaka.  DW was taken to the best teaching hospital in that large city and it turned out they had no agreement with GeoBlu.  My goal was to get her the best care and money/assignment was low on my list of priorities.  I suspect that the OP would say the same.  When you have a real medical emergency, you do what you must do to get the best treatment as fast as possible and worry about the money later!

 

Hank

 

Hank

[mauimary]

Hank thank you for your informative post.  I understand how travel insurance works as we have been there ourselves with a very expensive claim so we know what is involved.

We realize getting the insurance company involved from the beginning is extremely important.  
What I would like to know is what is a person suppose to do when your in a totally cash country like Zimbabwe and you have limited cash on you and can only get x per day cash?  You need a wire transfer from a US bank and they are closed on a three day weekend (like this family faced).  The Company would not accept a credit card or the charge is too large your card gets denied. Having multiple cards helps.  Not having a cell coverage to get a CODE is a huge problem.  Time was of the essence here.  What do you do?   Hope and pray the insurance company will wire a payment when your out of options to secure care and transfer. 

Im only asking as we too will be in Zimbabwe ourselves in a few months. Heaven forbid anything happens here. Not only is care horrible but the demand for cash can be a problem. Definitely do not want to carry thousands of $$ in cash as a precaution.  

[Hlitner]

On 7/6/2022 at 12:28 PM, mauimary said:

Hank thank you for your informative post.  I understand how travel insurance works as we have been there ourselves with a very expensive claim so we know what is involved.

We realize getting the insurance company involved from the beginning is extremely important.  
What I would like to know is what is a person suppose to do when your in a totally cash country like Zimbabwe and you have limited cash on you and can only get x per day cash?  You need a wire transfer from a US bank and they are closed on a three day weekend (like this family faced).  The Company would not accept a credit card or the charge is too large your card gets denied. Having multiple cards helps.  Not having a cell coverage to get a CODE is a huge problem.  Time was of the essence here.  What do you do?   Hope and pray the insurance company will wire a payment when your out of options to secure care and transfer. 

Im only asking as we too will be in Zimbabwe ourselves in a few months. Heaven forbid anything happens here. Not only is care horrible but the demand for cash can be a problem. Definitely do not want to carry thousands of $$ in cash as a precaution.  

An awful scenario for which I doubt anyone has a good answer.  You do everything possible to deal with the situation, somehow manage to keep your cool, and then pray.  I know this is really a non-answer but traveling to third world countries always involves some extra risk.  And carrying a lot of cash comes with its own risks.  For those of us who are long time independent travelers (we try to avoid group tours like the plague) it is even worse.  If you are part of a tour group there may be other resources (within the group) that can be very helpful.  If on your own it is more of a challenge and the outcome may not be good.  Like many experienced independent travelers, we try to anticipate problems and have some ideas in the back of our minds.   At times the options are so bad one might decide not to even go forward with their trip.  

 

I do not think you can ever depend on an insurance company to come to the rescue in a situation where time is of the essence.  Insurance companies are not set up for that kind of quick decision making.  And if you do not even have communications that is not even relevant.  Without good communications your options are all lousy.  If you do have a phone connection, having a very good friend or family member who can become an advocate and work on your behalf can be a lifesaver.  You do the best to make your own luck and sometimes all the luck runs out :(.

 

Hank

 

[klfrodo]

Rent a satellite phone for the trip might be an idea to consider.

[Ashland]

I'm also interested in the question if Med Jet would have taken the patient to a GeoBlue contracted hospital? 

[GeezerCouple]

17 minutes ago, Ashland said:

I'm also interested in the question if Med Jet would have taken the patient to a GeoBlue contracted hospital? 

 

 

Is the patient admitted to a hospital as an inpatient?

Is there an airfield nearby for fixed wing aircraft?

And of course, is the patient stable enough for a full medevac aircraft?

 

If yes, then why not?  They let the client select the hospital, but it might need to be in home country... but if one has MJA, isn't that what one would want?

 

GC