Hospital deposit $12,000 Dominican Republic

[navybankerteacher]

51 minutes ago, 6rugrats said:

When a medical provider is a member of a medical plan (Aetna, Blue Cross, Cigna, etc.) they usually have a contract with that company to be a provider for that specific plan or network. If that’s the case, the ins. company requires the provider to submit claims directly.

What do you mean by “a member of a medical plan”?  I take it to mean that if you have chosen a (lower pemium) “preferred provider” plan, then you are limited to medical providers chosen by your insurer.  That sort of plan can leave you with a problem when traveling - particularly overseas.

Edited March 5 by navybankerteacher

[Hlitner]

6 hours ago, 6rugrats said:

When a medical provider is a member of a medical plan (Aetna, Blue Cross, Cigna, etc.) they usually have a contract with that company to be a provider for that specific plan or network. If that’s the case, the ins. company requires the provider to submit claims directly.

What you are talking about is what we, in the industry, call accepting "assignment."  While that is the norm in the USA (and some other countries) it becomes almost useless outside of the USA.  US Insurance companies do not generally have "provider agreements" with providers in other countries.  And then there is the issue that many countries around the world have mandatory National Health programs to which all (or nearly all) healthcare providers are a party.  So, when you need a hospital in Mexico (where we live at the moment) you will not find hospitals or physicians accepting "assignment" from Aetna, Cigna, etc.  A few will sometimes accept assignment from BC/BS (of which Geoblue is part) but there are only a limited number of providers in that system and there may be other requirements.  

 

The reality is that if you get sick or hurt on a ship, the ship's physician may put you ashore at the next port and send you to a facility/physician.  The reality is that you have little to say where you go, or who you see, and insurance is not in anyone's mind other than your own.

 

The reality is that you will almost always need to settle your bill (for hospital and physicians) before you leave, and later seek reimbursement!  When DW broke her ankle on a MSC ship, the ship's physician arranged for her to go to  Amerimed Hospital  (Cozumel) and see their orthopedic surgeon.  We had little to say about the matter and the ship's physician could have simply tossed us off the ship.  We were ony able to return to the ship because the Mexican physician thought it was OK and sent that info to the ship!  But before we left his care (and hospital) we had to pay the bill (even though we had coverage through both Aetna and Geoblue).  

 

What was interesting was that Amerimed Hospital is part of the GeoBlue network, but would only deal with them for inpatients!  So we had to pay over $1000 for some basic emergency care.  Eventually we were able to get reimbursed, but only after I spent hours putting together a complex claim which included physician reports, hospital reports, X-Rays, etc.  Since I worked in the medical insurance world for over 30 years this was what I call "routine hell."  At the time, DW wondered, "how do most folks know how to do this?"

 

Hank

[CDNPolar]

5 hours ago, Hlitner said:

  At the time, DW wondered, "how do most folks know how to do this?"

 

 

This was not out of country, but cancel before leaving.  It was us - Canadians - working the claim with a US based insurance company.

 

The amount of documentation that was required.  Attending physician statements.  Reports, results, etc., was a lot of work to collect.  We were dealing with physicians inside Canada where we know and understand the system and it was still difficult.  We actually had one physician refuse to fill and sign a statement because in his eyes he was not the diagnosing physician.  His name however was on the report of the diagnosing physician and the insurance company wanted his statement too.  (He never did fill and sign the statement but provided his referring report to the diagnosing physician which the insurance company accepted instead.)

 

I can only imagine what would be required after the fact and after the care to get attending physicians in another country to complete paperwork for the insurance.

 

I would think - correct me if I am wrong - that while all this is going on, and you are in touch with your insurance provider - that you get the forms required and present them to the attending physicians while you are face-to-face with them and pay if necessary for them to complete the forms.  I would think that if I am contacting a doctor anywhere in the world after the fact it would just make the whole process much more difficult and time consuming. 

[Hlitner]

4 hours ago, CDNPolar said:

 

This was not out of country, but cancel before leaving.  It was us - Canadians - working the claim with a US based insurance company.

 

The amount of documentation that was required.  Attending physician statements.  Reports, results, etc., was a lot of work to collect.  We were dealing with physicians inside Canada where we know and understand the system and it was still difficult.  We actually had one physician refuse to fill and sign a statement because in his eyes he was not the diagnosing physician.  His name however was on the report of the diagnosing physician and the insurance company wanted his statement too.  (He never did fill and sign the statement but provided his referring report to the diagnosing physician which the insurance company accepted instead.)

 

I can only imagine what would be required after the fact and after the care to get attending physicians in another country to complete paperwork for the insurance.

 

I would think - correct me if I am wrong - that while all this is going on, and you are in touch with your insurance provider - that you get the forms required and present them to the attending physicians while you are face-to-face with them and pay if necessary for them to complete the forms.  I would think that if I am contacting a doctor anywhere in the world after the fact it would just make the whole process much more difficult and time consuming. 

A few years ago, DW sustained a major leg injury (in a water accident) while we were in Vietnam on a cruise.  It was initially treated at the scene by a Russian tourist/physician, treated onboard our ship, and she finally had to get outpatient surgery and treatment in Osaka, Japan, When I submitted the claim for all of this, the pile of documents was nearly 100 pages plus large x-ray films and even a DVD of a CT Scan.  Even with all that supporting documentation it took over 4 months to resolve the claim!  At the time I posted the story on CC.  And by the way, before we were released from the major teaching hospital in Osaka, our last stop was the accounting department!  And yes, everything had to be paid before we could leave.

 

Hank

[ontheweb]

1 hour ago, Hlitner said:

A few years ago, DW sustained a major leg injury (in a water accident) while we were in Vietnam on a cruise.  It was initially treated at the scene by a Russian tourist/physician, treated onboard our ship, and she finally had to get outpatient surgery and treatment in Osaka, Japan, When I submitted the claim for all of this, the pile of documents was nearly 100 pages plus large x-ray films and even a DVD of a CT Scan.  Even with all that supporting documentation it took over 4 months to resolve the claim!  At the time I posted the story on CC.  And by the way, before we were released from the major teaching hospital in Osaka, our last stop was the accounting department!  And yes, everything had to be paid before we could leave.

 

Hank

And what would they have done if you (or someone else in a similar situation) did not have the combination of cash and available credit to pay the entire bill? Would they have kept your wife a prisoner in one of their hospital rooms? Could they make her not leave the country?

 

It reminds me (on a much lower scale) of leaving Jamaica after our 20th anniversary. There was at the time a tax for leaving the country. The woman in front of us in the line said she had spent all her money in Jamaica and please make her stay. They said instead leave suspending the need for the payment.

[GeezerCouple]

5 hours ago, CDNPolar said:

 

This was not out of country, but cancel before leaving.  It was us - Canadians - working the claim with a US based insurance company.

 

The amount of documentation that was required.  Attending physician statements.  Reports, results, etc., was a lot of work to collect.  We were dealing with physicians inside Canada where we know and understand the system and it was still difficult.  We actually had one physician refuse to fill and sign a statement because in his eyes he was not the diagnosing physician.  His name however was on the report of the diagnosing physician and the insurance company wanted his statement too.  (He never did fill and sign the statement but provided his referring report to the diagnosing physician which the insurance company accepted instead.)

 

I can only imagine what would be required after the fact and after the care to get attending physicians in another country to complete paperwork for the insurance.

 

I would think - correct me if I am wrong - that while all this is going on, and you are in touch with your insurance provider - that you get the forms required and present them to the attending physicians while you are face-to-face with them and pay if necessary for them to complete the forms.  I would think that if I am contacting a doctor anywhere in the world after the fact it would just make the whole process much more difficult and time consuming. 

 

When I was in hospital overseas, we didn't get any other forms from the travel insurer.  I didn't even know they had "forms" of their own. (?)

We've just sent copies of the actual medical records.

 

The overseas records weren't in English, and we really didn't understand what most of it said, in the written form.  So we asked for a complete copy of "all of it", and that was what we submitted to the travel insurer ("all of it"!).  It was a fat stack.  We just fed it into a copy/scanner and forwarded the pdf to the travel insurer along with their own claim form.

We also had two visits to the hotel by a local physician, before he directed the hotel to call an ambulance.  He gave us a handwritten "receipt" for the payment we gave him for each visit.  (We got these receipts at the time; we've never needed to contact any overseas provider later.)f

In the above case, there was no bill for the hospital, although we tried and tried to give them money:  ".... but we have insurance to cover everything..."  They insisted they had "no way to accept any money".

We needed those medical documents to support the considerable costs of changing our trip for about a week.

 

For a US-based medical care, this was always for "before the trip", and was to document the reason for a cancellation.  Because we were still home, no medical costs were paid by the travel insurer.  And yes, in those cases, we did use the relatively short forms from the insurer, but this didn't involve any financial reimbursement for medical care.

 

We've never found the forms to be burdensome.

And we've never had any quarrel with the travel insurer despite having filed several claims, including a couple of large ones.  (We use Travel Insured, which we purchase through TripInsuranceStore.)

 

GC

[CDNPolar]

33 minutes ago, GeezerCouple said:

 

When I was in hospital overseas, we didn't get any other forms from the travel insurer.  I didn't even know they had "forms" of their own. (?)

We've just sent copies of the actual medical records.

 

 

Our insurer insisted that THEIR forms be completed by our doctors.  It was confusing for us and the doctors because many of the questions were confusing and did not make sense to the claim, but they insisted the forms be completed in their entirety. (This was a US travel insurance company.)

[GeezerCouple]

1 minute ago, CDNPolar said:

 

Our insurer insisted that THEIR forms be completed by our doctors.  It was confusing for us and the doctors because many of the questions were confusing and did not make sense to the claim, but they insisted the forms be completed in their entirety. (This was a US travel insurance company.)

 

Well... actually, we never asked!

We just sent in what was a *fat* (if printed out) set of medical records from exams, lab work, xrays/etc.

 

In my case, it may have been easier, because we only needed to "use" the medical records to document that I was "too sick" to continue traveling, etc.  And I think the medical records spoke for themselves, for that.

Point is, there was no reimbursement for medical care needed.  It might have been different if the insurer were paying, so they knew exactly what they were paying *for* AND that the treatment was warranted, etc.? (Just a guess.)

 

 

[clo]

14 hours ago, Hlitner said:

Since I worked in the medical insurance world for over 30 years this was what I call "routine hell."  At the time, DW wondered, "how do most folks know how to do this?"

Agree with both of you. I have a good bit of medical background so I can read all that doo-doo and at the very least fake it. 

[CPT Trips]

DD’s roommate suffered appendicitis on a spring break trip to Punta Cana. Local clinic wanted a sizable deposit. As they had been bargaining with beach vendors for a few days, they decided to try bargaining with the clinic. It worked. 

[navybankerteacher]

4 hours ago, CPT Trips said:

DD’s roommate suffered appendicitis on a spring break trip to Punta Cana. Local clinic wanted a sizable deposit. As they had been bargaining with beach vendors for a few days, they decided to try bargaining with the clinic. It worked. 

I am not sure how long I would want to hold out for a good price if I were suffering from acute appendicitis.

[ontheweb]

9 hours ago, navybankerteacher said:

I am not sure how long I would want to hold out for a good price if I were suffering from acute appendicitis.

I think one thing we can all agree on is that would not be an advantageous bargaining position to be in.

[Charles4515]

18 hours ago, CPT Trips said:

DD’s roommate suffered appendicitis on a spring break trip to Punta Cana. Local clinic wanted a sizable deposit. As they had been bargaining with beach vendors for a few days, they decided to try bargaining with the clinic. It worked. 

That is good info to know. I probably would not think of it though if I had acute appendicitis. 

Edited March 7 by Charles4515

[wcook]

2 hours ago, Charles4515 said:

That is good info to know. I probably would not think of it though if I had acute appendicitis. 

What if you had a not so attractive appendicitis?

Edited March 7 by wcook

[Kristelle]

3 hours ago, wcook said:

What if you had a not so attractive appendicitis?

 

True Story -  I had a cortisone injection in my shoulder for chronic bursitis (very successful)

DH had a torn shoulder muscle at work and why didn't the doctor offer me cortisone injection?

 

Because not a chronic condition, acute injury

 

He got really upset - well you wouldn't think it was so cute if it happened to you!!!

 

Oh dear.😲

[sleepingcat]

On 3/4/2024 at 12:04 AM, Joebucks said:

There is a very common misconception about travel insurance that it moves the sun and the moon, and squashes your every inconvenience. I never travel without my credit card, that includes many travel insurances, 0% foreign exchange fees, reward points, and a sizable credit limit.

I agree with the above, but in fact when we had an emergency, our travel insurance did take care of everything. We did not pay up front. On a world cruise in 2014 on P and O Arcadia, DH required an emergency op (also for kidney stones, coincidentally), which was carried out in Singapore. Liaison between P and O UK, our insurers (for you UK readers, It was Nationwide included travel insurance with your bank account) and the hospital meant that when my husband checked out I was only asked to pay the insurance excess which was £200 British pounds. The operation cost 10,000 Singapore dollars as far as I remember and the hospital was first rate and the care excellent. 

 

Also praise for the customer care of P and O, every day I was on my own in the hotel in Singapore, a lady from P and O phoned me to check if everything was going correctly.  After the operation, with agreement of the ship's doctor, we flew to rejoin the ship in Colombo and did the rest of the cruise back to the UK while DH recuperated. The purser on the ship phoned me also. And in Colombo we stayed in the Hilton from which  P and O 's port agent collected us and took us through the port departure formalities and saw us onto the ship. When we reached our cabin, there were flowers waiting......

 

It was a bad experience, but everyone involved did their best to support us, so it did not spoil the many happy memories of that cruise.