Medical visit onboard need Addl Dox !

[CaptainSailPants]

Okay , hoping one of you can help me out here . Heres the short version . Went on a cruise out of Tampa back in February with a few neighbors . On the way into the cruise port building one of the Older Women tripped and fell . Once on board after leaving port she went to the medical bay because Her ribs hurt . After a number of tests it was determined she cracked a rib.  Charged Her on the Spot $2500 US .

Came home with basic paperwork describing the incident and procedures from the Doctor ... Now trying for a couple Months to get BlueCross  / Medicare to reimburse  . They want all the medical codes or they cant do anything . Who should I contact at NCL ?

Not having an easy time  ..

 

Thanks in advance to anyone with previous experience . 

[RocketMan275]

I would start with this:

https://www.ncl.com/case-submission

 

 

[jackieodonnell]

Did you have trip insurance? Trip insurance pays for medical needs outside of the country. I don't know if your insurance covers you outside of the country. 

 

I do not think NCL can provide you with medical codes because their medical team on ships is not registered with the US. But perhaps someone else has more information. 

[omahabob]

ICD and CPT codes are international. NCL should be able to provide those, but I have no idea what department you'd ask about that. However, Aon Affinity administers their travel insurance program, and whether you had insurance or not, they might know who to call. You can contact them at 800-722-5672.

[swmichigan cruiser]

This is our experience. We were on the Joy in April when I got dehydrated and had to go to the medical center for tests and an IV. Bill was over $1800 and we had to pay then. We have trip insurance and also Blue Cross Medicare coverage we filed first with the trip insurance but found out we needed to file with Blue Cross first because they are primary and the trip insurance should pay anything that wasn't covered. The Blue Cross advantage plan we have has a $50,000 lifetime coverage for urgent/emergency for outside the US. Just got word a few days ago that out claim has been approved by Blue Cross now waiting to get the check and will if anything wasn't covered we with get will trip insurance. I just looked at the paperwork we left the ship with and it was very detailed. Not sure this helps you.

[fredflint]

6 hours ago, CaptainSailPants said:

Okay , hoping one of you can help me out here . Heres the short version . Went on a cruise out of Tampa back in February with a few neighbors . On the way into the cruise port building one of the Older Women tripped and fell . Once on board after leaving port she went to the medical bay because Her ribs hurt . After a number of tests it was determined she cracked a rib.  Charged Her on the Spot $2500 US .

Came home with basic paperwork describing the incident and procedures from the Doctor ... Now trying for a couple Months to get BlueCross  / Medicare to reimburse  . They want all the medical codes or they cant do anything . Who should I contact at NCL ?

Not having an easy time  ..

 

Thanks in advance to anyone with previous experience . 

You should determine if they will cover out of the country expenses if not you are just spending a lot of time for nothing.

This may or may not apply to their coverage but in general it seems it would not be covered.

 

https://www.medicare.gov/Pubs/pdf/11037-Medicare-Coverage-Outside-United-States.pdf

Medicare Coverage Outside the United States January 2023 Medicare coverage outside the United States is limited. In most situations, Medicare won’t pay for health care or supplies you get outside the U.S. The term “outside the U.S.” means anywhere other than the 50 states of the U.S., the District of Columbia, Puerto Rico, the U.S. Virgin Islands, Guam, American Samoa, and the Northern Mariana Islands. There are some exceptions that would allow you to get coverage outside the U.S. under Medicare Part A (Hospital Insurance) and/or Part B (Medical Insurance)

[omahabob]

Her injury occurred inside the US, and she received treatment within 6 hours of a US port, so Medicare should cover it (same link). But even if Medicare doesn't cover something, the travel insurance likely needs a denial decision from Medicare before they'll pay. That means she still needs the codes.

[Smitheroo]

23 hours ago, fredflint said:

You should determine if they will cover out of the country expenses if not you are just spending a lot of time for nothing.

This may or may not apply to their coverage but in general it seems it would not be covered.

 

https://www.medicare.gov/Pubs/pdf/11037-Medicare-Coverage-Outside-United-States.pdf

Medicare Coverage Outside the United States January 2023 Medicare coverage outside the United States is limited. In most situations, Medicare won’t pay for health care or supplies you get outside the U.S. The term “outside the U.S.” means anywhere other than the 50 states of the U.S., the District of Columbia, Puerto Rico, the U.S. Virgin Islands, Guam, American Samoa, and the Northern Mariana Islands. There are some exceptions that would allow you to get coverage outside the U.S. under Medicare Part A (Hospital Insurance) and/or Part B (Medical Insurance)

I think most of the Advantage plans have  some kind of coverage outside the US. With original medicare, your supplemental plan covers. But there is a limit, I know mine has a $50,000 lifetime limit which is laughable. 

[LloydJr]

2 hours ago, Smitheroo said:

I think most of the Advantage plans have  some kind of coverage outside the US. With original medicare, your supplemental plan covers. But there is a limit, I know mine has a $50,000 lifetime limit which is laughable. 

Laughable?  Are you suggesting that most people need much more than $50K coverage for medical expenses outside of the US?  

[omahabob]

Maybe it's the 'lifetime' thing they consider laughable. If you travel a lot, you could exceed that with just a few medical problems. Then again, if you're old enough to qualify for Medicare, how much "lifetime' do you really have left to reach that limit?

[Smitheroo]

2 minutes ago, LloydJr said:

Laughable?  Are you suggesting that most people need much more than $50K coverage for medical expenses outside of the US?  

Yes, they do if they have  chronic issue   $50,000 is a *lifetime* limit   Some people have posted on here that they get way more than that for medical insurance traveling internationally

[Smitheroo]

1 minute ago, omahabob said:

Maybe it's the 'lifetime' thing they consider laughable. If you travel a lot, you could exceed that with just a few medical problems. Then again, if you're old enough to qualify for Medicare, how much "lifetime' do you really have left to reach that limit?

You're eligible for medicare at age 65 so there's a few years left for travel.  Some people on here cruise frequently.

[LloydJr]

5 minutes ago, Smitheroo said:

Yes, they do if they have  chronic issue   $50,000 is a *lifetime* limit   Some people have posted on here that they get way more than that for medical insurance traveling internationally

Obviously, if a person has a chronic issue that can somehow and surprisingly generate large unexpected medical expenses while they're outside of the US, they might just need to buy some added insurance.  Why do you think that Medicare Advantage plans should provide this to avoid the "laughable?"

 

ETA: Medicare Advantage is a competitive system of private insurance companies.  Have you challenged your insurance company to up their game?

Edited July 7, 2023 by LloydJr

[omahabob]

7 minutes ago, Smitheroo said:

You're eligible for medicare at age 65 so there's a few years left for travel.  Some people on here cruise frequently.

 

Yeah, I'm on Medicare, so I'm familiar with it.

[julig22]

15 minutes ago, Smitheroo said:

Yes, they do if they have  chronic issue   $50,000 is a *lifetime* limit   Some people have posted on here that they get way more than that for medical insurance traveling internationally

I have an advantage plan through my former employer.  No lifetime limit - which is why I selected that specific plan.  But $50,000 lifetime for international seems to be pretty standard.

[Smitheroo]

1 hour ago, julig22 said:

I have an advantage plan through my former employer.  No lifetime limit - which is why I selected that specific plan.  But $50,000 lifetime for international seems to be pretty standard.

I guess that's why people take out big travel insurance plans if they have a lot to lose if hit by a huge medical expense

[Smitheroo]

1 hour ago, LloydJr said:

Obviously, if a person has a chronic issue that can somehow and surprisingly generate large unexpected medical expenses while they're outside of the US, they might just need to buy some added insurance.  Why do you think that Medicare Advantage plans should provide this to avoid the "laughable?"

 

ETA: Medicare Advantage is a competitive system of private insurance companies.  Have you challenged your insurance company to up their game?

Yes, they should take out travel insurance because $50,000 for a lifetime limit is not enough    The cost to move you  to a hospital closer to your home would use up a lot of that.  Air Flights are very expensive.   It was close to $100,000 to fly my daughter a distance that would take about 3 hrs to drive. But that was the US  Still, air flights anywhere are expensive. 

Edited July 7, 2023 by Smitheroo

[omahabob]

Medical care and medical flights are two very different things. Your advantage plan probably doesn't cover medical flights at all. Most only cover transportation to the nearest medical facility, so your $50,000 limit would not even apply for flights. The only exceptions usually allowed are if the trip is deemed medically necessary. So, you stay right where you are unless you can't get treatment there. I purchased medical flight insurance for $260 for both my wife and myself, for a 15 day period covering our cruise. It covers a flight back home for any reason, and that's probably less than any insurance premiums I'd pay for a permanent policy that allows that. Most travel insurance plans don't even allow that. The ones that do cost more than $260.

 

By the way, NCL insurance covers evacuation to the nearest medical facility if necessary. So your insurance plan is not needed for that.

[brer111]

Here is our experience - My husband woke up one morning complaining about arm pain. To be safe we went to the medical center and many test were run. That evening we had a bill for around 2,000 that we paid up front when we left the cruise. Since we never had done this before I went to see a customer service supervisor. She was quite helpful and even made a call for me to speak to travel insurance to find out what we needed to do. Medicare does not pay out of the US at all. They told me I had to get refusal of payment by Medicare and then file the claim on our travel insurance. I decided to instead fill the claim with my supplemental insurance expecting them to deny my claim since Medicare would not cover it. To my surprise my supplemental paid almost the entire amount. So I filed with the travel insurance for the balance and they paid very quickly to us. Our travel insurance was thru NCL. Hope this helps!

[uneamie]

7 hours ago, brer111 said:

Here is our experience - My husband woke up one morning complaining about arm pain. To be safe we went to the medical center and many test were run. That evening we had a bill for around 2,000 that we paid up front when we left the cruise. Since we never had done this before I went to see a customer service supervisor. She was quite helpful and even made a call for me to speak to travel insurance to find out what we needed to do. Medicare does not pay out of the US at all. They told me I had to get refusal of payment by Medicare and then file the claim on our travel insurance. I decided to instead fill the claim with my supplemental insurance expecting them to deny my claim since Medicare would not cover it. To my surprise my supplemental paid almost the entire amount. So I filed with the travel insurance for the balance and they paid very quickly to us. Our travel insurance was thru NCL. Hope this helps!

Wow....we have Medicare and a supplement with Bankers LIfe. It is my understanding that supplemental insurance only pays the 20% that Medicare does not cover. Medcare covers 80% of all cost and the supplemental pays the rest. That said, the supplemental will only cover what Medicare covers. So if Medicare does not cover anything outside the US then neither will the supplemental. I am wondering if you have "Medicare Advantage" and not the basic Medicare with a supplemental? Medicare Advantage pays more in many situations. 

Edited July 7, 2023 by uneamie

[njhorseman]

5 minutes ago, uneamie said:

Wow....we have Medicare and a supplement with Bankers LIfe. It is my understanding that supplemental insurance only pays the 20% that Medicare does not cover. Medcare covers 80% of all cost and the supplemental pays the rest. That said, the supplemental will only cover what Medicare covers. So if Medicare does not cover anything outside the US then neither will the supplemental. I am wondering if you have "Medicare Advantage" and not the basic Medicare with a supplemental? Medicare Advantage pays more in many situations. 

There are about 6 of the standard Medicare supplement plans that cover 80% of foreign medical emergency costs, up to a lifetime policy limit, which if IIRC is $50,000, despite Medicare not providing coverage outside the USA.  One of them is Plan F, which is the one we have.

[brer111]

26 minutes ago, uneamie said:

Wow....we have Medicare and a supplement with Bankers LIfe. It is my understanding that supplemental insurance only pays the 20% that Medicare does not cover. Medcare covers 80% of all cost and the supplemental pays the rest. That said, the supplemental will only cover what Medicare covers. So if Medicare does not cover anything outside the US then neither will the supplemental. I am wondering if you have "Medicare Advantage" and not the basic Medicare with a supplemental? Medicare Advantage pays more in many situations. 

We have Medicare - not advantage and a very good plan f supplement

 

[omahabob]

Standard Medicare will cover you within six hours of a US port, but they don't specify what cruising speed they use to determine the six hours.

[uneamie]

4 hours ago, njhorseman said:

There are about 6 of the standard Medicare supplement plans that cover 80% of foreign medical emergency costs, up to a lifetime policy limit, which if IIRC is $50,000, despite Medicare not providing coverage outside the USA.  One of them is Plan F, which is the one we have.

Wow...I was unaware of that. I will have to speak to our insurance agent who never told us about this plan when she sold us Bankers Life. The only thing she kept mentioning was that if Medicare does not cover neither does the supplement plans. Thanks for sharing that. 

[njhorseman]

28 minutes ago, uneamie said:

Wow...I was unaware of that. I will have to speak to our insurance agent who never told us about this plan when she sold us Bankers Life. The only thing she kept mentioning was that if Medicare does not cover neither does the supplement plans. Thanks for sharing that. 

Bankers Life appears to offer all the standard Medicare Supplement plans including those that provide coverage for emergency medical care when outside the USA.

https://www.bankerslife.com/medicare-supplement-insurance/