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Medicare and getting sick onboard a cruise ship


MB2014
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My husband and I went on an Alaska cruise August 2016-the first 4 days I was fine, on the 4th day I developed a 104.8 temp, severe vomiting and was taken to the medical facility onboard the ship. After 8 hrs of IV fluids they let me go back to the cabin only to return back to medical the next morning to be checked. This time they admitted me, said that I was a very sick woman and had to stay there so they could care for me properly. The bottom line was I was near organ failure, they were ready to transport me to Juno Hospital had the medications they were given me did not work. My final diagnosis was SEPSIS, they told my husband I was a very sick woman. Thank God the meds worked and I did not need to go to Juno hospital. Our bill was $2250.00 that was paid out of our pocket. Then came the joy and fun of dealing with Medicare. I submitted everything to Medicare only to be told it had been denied..Reasons: Ship not registered to US, Dr. not licensed to practice in US and we were not in US waters. Today is Nov. 21st and I am still waiting on Medicare to send me my denial letter so that I can submit it to Anon Travel Insurance for reimbursement. This type of info should be made known to cruise folks so that they don't go into this blind sided. Not everyone is well versed in the cruise industry and not everyone understands the in and outs of getting ill onboard ship. I guess had my husband not taken me to Medical, it would not be a problem, I would be dead by now. Can't they make some kind of booklet "if you get sick on board the cruise ship" with all the important points listed so that folks don't go into this blind sided.

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My husband and I went on an Alaska cruise August 2016-the first 4 days I was fine, on the 4th day I developed a 104.8 temp, severe vomiting and was taken to the medical facility onboard the ship. After 8 hrs of IV fluids they let me go back to the cabin only to return back to medical the next morning to be checked. This time they admitted me, said that I was a very sick woman and had to stay there so they could care for me properly. The bottom line was I was near organ failure, they were ready to transport me to Juno Hospital had the medications they were given me did not work. My final diagnosis was SEPSIS, they told my husband I was a very sick woman. Thank God the meds worked and I did not need to go to Juno hospital. Our bill was $2250.00 that was paid out of our pocket. Then came the joy and fun of dealing with Medicare. I submitted everything to Medicare only to be told it had been denied..Reasons: Ship not registered to US, Dr. not licensed to practice in US and we were not in US waters. Today is Nov. 21st and I am still waiting on Medicare to send me my denial letter so that I can submit it to Anon Travel Insurance for reimbursement. This type of info should be made known to cruise folks so that they don't go into this blind sided. Not everyone is well versed in the cruise industry and not everyone understands the in and outs of getting ill onboard ship. I guess had my husband not taken me to Medical, it would not be a problem, I would be dead by now. Can't they make some kind of booklet "if you get sick on board the cruise ship" with all the important points listed so that folks don't go into this blind sided.

 

Apparently this long delay for the denial from Medicare is well known among many, either from experience or reading here/elsewhere.

 

One thing to consider in the future is to see if there is a travel insurance plan that would offer PRIMARY coverage, so it is the "first payor", and there would be no need for any other insurer to decline initially.

 

You might want to discuss this particular concern with Steve at

http://www.TripInsuranceStore.com

 

He is familiar with this problem, of course, and could guide you to a policy that might work better in the future.

 

This is indeed annoying with Medicare, as in most out-of-country medical care situations, there is absolutely no way Medicare would pay.

So waiting for the denial when the care is in a distant foreign location seems useless.

 

Note: Your cruise was in Alaska, so this could well be different.

For example, if you were in a USA port or perhaps near such a port, then Medicare would probably cover it, so in this case (Alaska), at least it makes a little sense for the travel insurer to need to make sure that Medicare really isn't going to pay.

 

You are very fortunate to have recovered so quickly on a cruise ship from sepsis. The outcome might have been much worse, so that is something to be grateful for!

(Also, the bill could have been far more, so that's good, too!)

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So glad you are recovering, sounds like a close one.

 

As for Medicare, long time members of CC know the limitations it holds and, like you, buy insurance to cover possible medical expenses.

 

As for the denial list, I think it is next to impossible to do an Alaskan cruise and not be in US waters for most of the time.

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I don't think it is the responsibility of the ship to make cruisers aware--they would then be accepting liability for every different possible health insurance scenario out there. It is the responsibility of the cruiser to know how and for what they are or are not covered and buy secondary insurance accordingly.

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We are in the process of medical claims. I was in American Samoa so Medicare should cover it (it is listed as a place where they do) and my DH was "at sea". For his we are sending the info to our secondary insurance (not travel insurance). Medicare is primary for him. The secondary (Aetna) told us that we just needed to send a copy from the Medicare and You book showing that it is not covered by them so we don't have to wait for them to deny it first. In that book it actually states that they cover it as long as you are within 6 hours of the US. I would think being in Alaska you would be within 6 hours. I would look it up to see the actual wording. Your might have to contact Medicare again.

 

Glad though that you pulled through!

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The "6 hour rule" is a mystery to many Medicare claims processors :). I went through this rule in another post so will not do it again. But interpretation of the 6 hour rule is tricky and seldom honored unless one can really document the situation (hard to do after a cruise). And then you might get a claims processor who will not accept the non-Medicare forms (and codes) given by the ship, the issue of a physician not licensed in the USA, etc. It is so darn complicated and our government does not normally make claims easy.

 

That is why we always "preach" that folks need to document everything (in as much detail as possible) and be prepared for a long process. But do not give up..because eventually you will probably prevail...although the reimbursement will likely come from your secondary travel policy (if you have one) rather then Medicare.

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I'm happy that your are on the road to recovery. I hope that all those who denigrate travel insurance as some kind of industry "rip off" will read of your experience. Some decide to self-insure, which is fine. But others need to check their coverage and decide if they can write some hefty checks if the "IF" happens.

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I'm happy that your are on the road to recovery. I hope that all those who denigrate travel insurance as some kind of industry "rip off" will read of your experience. Some decide to self-insure, which is fine. But others need to check their coverage and decide if they can write some hefty checks if the "IF" happens.

 

We do not necessarily think Trip Insurance is a "rip off" but do think it is generally an overpriced product (often costing 7-10%+ of trip costs). However, we do purchase an Annual Travel Medical Policy which provides $250,000 of Medical Coverage (as compared to the inadequate $10,000 of many Trip Insurance policies). And our annual policy costs $450 a year which is the total cost for DW and me....and covers the first 70 days of EVERY trip we take throughout the entire year. In our case that one policy gave us coverage for 103 days of cruising and 2 months in Mexico.....during the current year.

 

If one really wants to get some trip cancellation coverage it is easy to get one of the Credit Cards (such as Chase Sapphire) that gives you cancellation coverage (in the case of Chase it is $10,000 per trip).

 

Hank

Edited by Hlitner
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...This type of info should be made known to cruise folks so that they don't go into this blind sided...
I believe Medicare documents what they cover. My health insurance documents what it covers, the British health care documents what it covers, etc, etc.

 

I would argue that it *is* made known to cruise folks. And to anyone else that cares. Just not in a pre-digested form easy for consumption by our Tweet-additcted society. The world would be so much nicer without the fine print.

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We do not necessarily think Trip Insurance is a "rip off" but do think it is generally an overpriced product (often costing 7-10%+ of trip costs). However, we do purchase an Annual Travel Medical Policy which provides $250,000 of Medical Coverage (as compared to the inadequate $10,000 of many Trip Insurance policies). And our annual policy costs $450 a year which is the total cost for DW and me....and covers the first 70 days of EVERY trip we take throughout the entire year. In our case that one policy gave us coverage for 103 days of cruising and 2 months in Mexico.....during the current year.

 

If one really wants to get some trip cancellation coverage it is easy to get one of the Credit Cards (such as Chase Sapphire) that gives you cancellation coverage (in the case of Chase it is $10,000 per trip).

 

Hank

 

 

 

If you buy through the cruise line, it is a rip off as they add their mark up to it. I just bought a policy through insuremytrip.com for $117 for two people, 10 days in Ireland next spring. It includes $50k as primary medical and $250k medical evacuation. For two adults in their 50's. The only policy I have ever purchased that I felt was a little pricey was French Polynesia, but that included $500k medical evacuation.

 

 

Sent from my iPad using Tapatalk

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If you buy through the cruise line, it is a rip off as they add their mark up to it. I just bought a policy through insuremytrip.com for $117 for two people, 10 days in Ireland next spring. It includes $50k as primary medical and $250k medical evacuation. For two adults in their 50's. The only policy I have ever purchased that I felt was a little pricey was French Polynesia, but that included $500k medical evacuation.

 

 

Sent from my iPad using Tapatalk

 

The 50K is sure better then the cruise line policies although we prefer policies with at least $100k med. The Trip Evacuation issue has become a real con...that is used by darn near all the companies. The reality is that its almost impossible for a company to spend over $50K on any med evac (even a chartered private medical evac jet costs less). So most companies are now marketing real high numbers (ours has $500k), but not providing the very high medical limits.

 

What we find outrageous are the low medical limits sold by the cruise lines! A $10K Medical policy might not even cover a single day in some medical facilities. And a passenger that suffers some type of major cardiac or CVA (stroke) event can easily find themselves with 10s or thousands of dollars in Medical bills...without the possibility of being evacuated due to being too unstable.

 

The BIG CON is that cruise lines have convinced folks (through good marketing) to spend hundreds of dollars for policies that primarily cover cancelation...which limits their liability to the cost of a cruise. And yet, that same passenger is underinsured for Medical that has a potential liability that is nearly unlimited. Its akin to insuring the bumper on your car...and not worrying about the rest of the car (for lack of a better analogy)

Hank

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The 50K is sure better then the cruise line policies although we prefer policies with at least $100k med. The Trip Evacuation issue has become a real con...that is used by darn near all the companies. The reality is that its almost impossible for a company to spend over $50K on any med evac (even a chartered private medical evac jet costs less). So most companies are now marketing real high numbers (ours has $500k), but not providing the very high medical limits.

 

 

 

What we find outrageous are the low medical limits sold by the cruise lines! A $10K Medical policy might not even cover a single day in some medical facilities. And a passenger that suffers some type of major cardiac or CVA (stroke) event can easily find themselves with 10s or thousands of dollars in Medical bills...without the possibility of being evacuated due to being too unstable.

 

 

 

The BIG CON is that cruise lines have convinced folks (through good marketing) to spend hundreds of dollars for policies that primarily cover cancelation...which limits their liability to the cost of a cruise. And yet, that same passenger is underinsured for Medical that has a potential liability that is nearly unlimited. Its akin to insuring the bumper on your car...and not worrying about the rest of the car (for lack of a better analogy)

 

Hank

 

 

 

We have insurance that will cover us out of network to a certain amount, and then full coverage after that threshold it hit. If we had medical bills over $50k, we would be out about $10K. We are comfortable with that risk.

 

I beg to differ on the cost of a private medivac charter. $100k is about right from Europe, from Tahiti it could be $250K to LA, at least an additional $50K to our home in Orlando. I know someone who was flown air ambulance from Myrtle Beach to Chicago after a catastrophic injury, and the cost was $50K. My cousin was just medivaced from the west coast to NYC, no idea on the cost, and obviously this isn't the time to ask, but I will eventually find out.

 

 

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Medicare supplement policies are identified by letters (A,F, etc) which define their benefits. They are identical across all providers except in cost. SOME cover out of country medical benefits, but many do not. Be very careful!

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Medicare supplement policies are identified by letters (A,F, etc) which define their benefits. They are identical across all providers except in cost. SOME cover out of country medical benefits, but many do not. Be very careful!

 

Follow up question. DH is on Medicare with a suplllement F (which has limited out of the country benefits - not enough). If we ever had a large medical claim, would it have to go through Medicare first to refuse, then the supplemental policy and then the medical travel insurer (we usually buy Geoblu, which is secondary)?

 

I'm beginning to see the wisdom of buying a primary medical policy for cruises (one where I can put the value of the trips $1 and forego cancellation insurance and doesn't require full cost of trip insured). For overseas land trips, I might continue with Geoblu, if Medicare, does in fact accept a copy of there own words from the Medicare and You book, for a quick denial. This thread definitely has me rethinking our medical travel insurance strategies.

 

In fact, I might be giving Steve at the trip insurance store a call for our next trip which is land Vietnam. I haven't bought the medical yet. If a primary medical policy for DH isn't very expensive, I might go that route for him. For me, I'm in the same situation as ducklite, I just need to have insurance to underwrite a very high out of network deductible. (I'll know how much this deductible is on Monday, when I meet with the agent who sells our company's yearly health insurance...it looks like we're changing plans once again and I'm in charge of that purchase for our small group.)

Edited by buggins0402
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Follow up question. DH is on Medicare with a suplllement F (which has limited out of the country benefits - not enough). If we ever had a large medical claim, would it have to go through Medicare first to refuse, then the supplemental policy and then the medical travel insurer (we usually buy Geoblu, which is secondary)?

 

I'm beginning to see the wisdom of buying a primary medical policy for cruises (one where I can put the value of the trips $1 and forego cancellation insurance and doesn't require full cost of trip insured). For overseas land trips, I might continue with Geoblu, if Medicare, does in fact accept a copy of there own words from the Medicare and You book, for a quick denial. This thread definitely has me rethinking our medical travel insurance strategies.

 

In fact, I might be giving Steve at the trip insurance store a call for our next trip which is land Vietnam. I haven't bought the medical yet. If a primary medical policy for DH isn't very expensive, I might go that route for him. For me, I'm in the same situation as ducklite, I just need to have insurance to underwrite a very high out of network deductible. (I'll know how much this deductible is on Monday, when I meet with the agent who sells our company's yearly health insurance...it looks like we're changing plans once again and I'm in charge of that purchase for our small group.)

 

We have our secondary insurance through dh former employer instead of a Medigap policy. Dh had to see dr while at sea. Aetna said we just needed to show them the page in the Medicare and you book that says Medicare won't cover it and just submit to Aetna. We will see if they are right or not. My hunch is they will say to send to Medicare first. Time will tell.

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Follow up question. DH is on Medicare with a suplllement F (which has limited out of the country benefits - not enough). If we ever had a large medical claim, would it have to go through Medicare first to refuse, then the supplemental policy and then the medical travel insurer (we usually buy Geoblu, which is secondary)?

 

I'm beginning to see the wisdom of buying a primary medical policy for cruises (one where I can put the value of the trips $1 and forego cancellation insurance and doesn't require full cost of trip insured). For overseas land trips, I might continue with Geoblu, if Medicare, does in fact accept a copy of there own words from the Medicare and You book, for a quick denial. This thread definitely has me rethinking our medical travel insurance strategies.

 

In fact, I might be giving Steve at the trip insurance store a call for our next trip which is land Vietnam. I haven't bought the medical yet. If a primary medical policy for DH isn't very expensive, I might go that route for him. For me, I'm in the same situation as ducklite, I just need to have insurance to underwrite a very high out of network deductible. (I'll know how much this deductible is on Monday, when I meet with the agent who sells our company's yearly health insurance...it looks like we're changing plans once again and I'm in charge of that purchase for our small group.)

Check out the Geoblue app. It list all of there world wide Dr's and hospitals with english speaking staff. it also list the ones that are part of their network which they is primary coverage if you use them. A quick call to Geoblue can confirm this and correct any errors in my statement. This is what I use to have a list of the providers in each country were visiting ahead of time. In the event of emergancy I have the info instantly to look at on my phone or tablet. Hope this info is helpful for you and everyone else on CC.
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Follow up question. DH is on Medicare with a suplllement F (which has limited out of the country benefits - not enough). If we ever had a large medical claim, would it have to go through Medicare first to refuse, then the supplemental policy and then the medical travel insurer (we usually buy Geoblu, which is secondary)?

 

.............

 

)

 

 

You ask a complex question. In the industry many of us call it Third-Party Liability. But the consumer question is more generally referred to as "coordination of benefits" and how its handled does vary from company to company and policy to policy. Unfortunately, most travel insurance companies prefer to dump most of the burden on the customer (the insured). So in most cases you would first have to pay the medical bill (or try to stall the payment) and first submit the claim information to your primary insurer (which could be your Medicare plan). You then must wait to get your "EOB" which shows what will be paid/covered and what is denied. You would then submit that, along with the appropriate form and all the billing info, to your secondary company (travel insurance) and again wait.

 

The process does suck and it can take many months to get your reimbursement. And that assumes there are no further issues. One big problem is that many foreign hospitals/physicians do not provide enough billing detail to satisfy US insurers. So before you even leave a hospital it is wise to try to get as much detailed info as possible..

 

Another issue is that some insurers want all the billing info in English and converted to US Dollars (usually based on the exchange rate at the time of the services). Some insurance providers are very good at finding "innovative" ways to delay reimbursement...sometimes for months or even years. One thing that attracted to us to GeoBlue is that they actually utilize an international netwok of BC/BS Providers. If you are able to use one of their providers you might be able to avoid having to pay most of the bill out-of-pocket.

 

And finally we add another comment about Medical Evacuation. Not all evacuation coverage will evacuate you to your home country...or home town (MedjetAssist is one exception). If you need evacuation from a place like Egypt, you might well end up in a European hospital or possibly nearby Israel. Many policies simple say they will evacuate you to the nearest "suitable hospital". That is one way the insurers keep their cost down (and also annoy customers). So most policies will not evacuate you from Europe to the USA....but rather to a "suitable" European hospital. This is why many frequent travelers pay the extra money for a Medjetassist Policy.....which will actually evacuate you (if medically necessary) to a suitable hospital (or your choice) near home.

 

Hank

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So Hank

Happy Thanksgiving by the way to you and your family.

 

Would love to become a GeoBlue member however, I live in Washington State.

 

I wrote to my Insurance Commissioner about this and they stated something along the lines of ,,, GeoBlue and companies who sell these types of policies are allowed to sell them in Washington State, they just choose not to.

 

I don't even know what the hell that means.

GeoBlue says they can't sell here, Washington says sure they can, they just choose not to.....

 

 

Anyway,,, I have family that live in another State, What would be the ramifications if I were to just say I live there, instead of Washington on my application?

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You ask a complex question. In the industry many of us call it Third-Party Liability. But the consumer question is more generally referred to as "coordination of benefits" and how its handled does vary from company to company and policy to policy. Unfortunately, most travel insurance companies prefer to dump most of the burden on the customer (the insured). So in most cases you would first have to pay the medical bill (or try to stall the payment) and first submit the claim information to your primary insurer (which could be your Medicare plan). You then must wait to get your "EOB" which shows what will be paid/covered and what is denied. You would then submit that, along with the appropriate form and all the billing info, to your secondary company (travel insurance) and again wait.

 

The process does suck and it can take many months to get your reimbursement. And that assumes there are no further issues. One big problem is that many foreign hospitals/physicians do not provide enough billing detail to satisfy US insurers. So before you even leave a hospital it is wise to try to get as much detailed info as possible..

 

Another issue is that some insurers want all the billing info in English and converted to US Dollars (usually based on the exchange rate at the time of the services). Some insurance providers are very good at finding "innovative" ways to delay reimbursement...sometimes for months or even years. One thing that attracted to us to GeoBlue is that they actually utilize an international netwok of BC/BS Providers. If you are able to use one of their providers you might be able to avoid having to pay most of the bill out-of-pocket.

 

And finally we add another comment about Medical Evacuation. Not all evacuation coverage will evacuate you to your home country...or home town (MedjetAssist is one exception). If you need evacuation from a place like Egypt, you might well end up in a European hospital or possibly nearby Israel. Many policies simple say they will evacuate you to the nearest "suitable hospital". That is one way the insurers keep their cost down (and also annoy customers). So most policies will not evacuate you from Europe to the USA....but rather to a "suitable" European hospital. This is why many frequent travelers pay the extra money for a Medjetassist Policy.....which will actually evacuate you (if medically necessary) to a suitable hospital (or your choice) near home.

 

Hank

 

I can't even imagine three layers of insurance policies - ugh!

 

Question about deadlines: If one files the claim with the company that one expects to pay eventually (call it A), but needs to first get denial of payment from B and perhaps another company C, this takes time. And more time. Etc.

 

So would making that initial filing prior to any filing deadline be sufficient, even if the other companies take longer (alone or sequentially) to determine what, if anything, they would pay?

 

Thanks.

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So Hank

Happy Thanksgiving by the way to you and your family.

 

Would love to become a GeoBlue member however, I live in Washington State.

 

I wrote to my Insurance Commissioner about this and they stated something along the lines of ,,, GeoBlue and companies who sell these types of policies are allowed to sell them in Washington State, they just choose not to.

 

I don't even know what the hell that means.

GeoBlue says they can't sell here, Washington says sure they can, they just choose not to.....

 

 

Anyway,,, I have family that live in another State, What would be the ramifications if I were to just say I live there, instead of Washington on my application?

 

You don't really want to do that, if you don't actually live there.

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In the event of emergancy I have the info instantly to look at on my phone or tablet. Hope this info is helpful for you and everyone else on CC.

 

A very good point...make sure your insurance is easily accessible. I just left the PDF of the Geoblu info on my email. Last year, I fell while out for a run in Madrid. When I got back to the hotel room, with my arm hurting and bleeding, I didn't have the patience to work my way through the Spanish version of Yahoo to get into my mailbox. I should have hardcopied the information right to the tablet so even my non techy DH could find it with some help from me.

 

It all came out ok...Spanish hospital ended up not charging us anything for the stitches and tetanus shot. And, that was after a pharmacist clean and dressed the wound a bit (we had gone into the nearest pharmacia after I fell to buy some first aid supplies). She also didn't charge us, but told us it needed stitches. Then we went to a local clinic, which cleaned and dressed it again (again for free), but sent us to a hospital for the stitches. All this would have probably ran into the thousands in the US.:)

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I can't even imagine three layers of insurance policies - ugh!

 

Question about deadlines: If one files the claim with the company that one expects to pay eventually (call it A), but needs to first get denial of payment from B and perhaps another company C, this takes time. And more time. Etc.

 

So would making that initial filing prior to any filing deadline be sufficient, even if the other companies take longer (alone or sequentially) to determine what, if anything, they would pay?

 

Thanks.

 

Wish I had thought of that when I was working. Simply put a time limit on filing, make the customer go to their primary insurance first, and by the time they are able to file with the secondary..simply say, "oops, you are too late."

 

But seriously, you do ask a good question. My advice is that if you get into the situation where you do file a claim, go ahead and call your secondary company and ask their procedures and filing deadlines (and then ask to see it in writing). As I said earlier, the biggest problem is getting the foreign medical provider to give you enough detailed info so that the insurance company can figure out how to code the details of the claim. Most of the secondary policies do give you a long time to file (sometimes up to a year) but its just smart to find out their current procedures and deadlines...at the time you have a real claim.

 

Hank

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