Medicare and Alaska Crusing

[Billthekid]

On our Alaska Cruise on HAL in July I needed to go to the Medial Center one day and a follow-up the next day.  I am on Medicare Part B and my secondary insurance covers me for medical overseas.  Upon return I submitted my claim to my secondary insurance since I knew Medicare would not reimburse the claim.  The med center bill was horrendous and included things like $15 for the finger check for my oxygen level which I had never heard of.  But I digress.  So right away my secondary bounces my claim back saying I have to file with Medicare first since I was on a cruise and Medicare covers cruises that are less then six hours from port.  Here we are in Alaska, part of the United States, but in Glacier Bay with the nearest port more than six hours away, yet within the United States.  The next day we are at sea more than 12 miles from land.  So I am thinking Medicare will pay one visit and not the second visit.  After 90 days Medicare pays a pittance of the claim and state the reason is the ship is not a Medicare participating provider.  So now it is up to my secondary.  I personally do not know of any cruise line that would be a participating provider.  They could care less about processing medical claims because it is up to the individual.  So why does Medicare have that six hour rule if none of the cruise lines are willing to participate?  Strange.  Side note:  The medical center has now become a profit center for HAL

Edited October 24, 2019 by Billthekid

[Shmoo here]

1 hour ago, Billthekid said:

On our Alaska Cruise on HAL in July I needed to go to the Medial Center one day and a follow-up the next day.  I am on Medicare Part B and my secondary insurance covers me for medical overseas.  Upon return I submitted my claim to my secondary insurance since I knew Medicare would not reimburse the claim.  The med center bill was horrendous and included things like $15 for the finger check for my oxygen level which I had never heard of.  But I digress.  So right away my secondary bounces my claim back saying I have to file with Medicare first since I was on a cruise and Medicare covers cruises that are less then six hours from port.  Here we are in Alaska, part of the United States, but in Glacier Bay with the nearest port more than six hours away, yet within the United States.  The next day we are at sea more than 12 miles from land.  So I am thinking Medicare will pay one visit and not the second visit.  After 90 days Medicare pays a pittance of the claim and state the reason is the ship is not a Medicare participating provider.  So now it is up to my secondary.  I personally do not know of any cruise line that would be a participating provider.  They could care less about processing medical claims because it is up to the individual.  So why does Medicare have that six hour rule if none of the cruise lines are willing to participate?  Strange.  Side note:  The medical center has now become a profit center for HAL

If your insurance is secondary coverage, you always have to file with your primary provider (be it Medicare or some other coverage) and be denied before you can file with the secondary insurer.

 

 

 

 

[mamaofami]

I don't understand, Last I checked, Alaska was a state within the US and medicare covers you in the US. Is this because you visited the ship's doctor and not one practicing in Alaska?

[Shmoo here]

Just now, mamaofami said:

I don't understand, Last I checked, Alaska was a state within the US and medicare covers you in the US. Is this because you visited the ship's doctor and not one practicing in Alaska?

Onboard a ship, you are considered "out of the country".  Any doctor visits while in port (off the ship), a US port, would be covered by Medicare.

 

 

[mamaofami]

1 minute ago, Shmoo here said:

Onboard a ship, you are considered "out of the country".  Any doctor visits while in port (off the ship), a US port, would be covered by Medicare.

 

 

Thank you. That explains it.

[RuthC]

Medicare has some obscure rules concerning coverage at sea off Alaska, and while transiting to/from Alaska and the contiguous 48 through Canada. It is always best to submit to Medicare first, let them make the decision, then file a claim with your Medicare supplement. 

[Billthekid]

17 minutes ago, Shmoo here said:

Onboard a ship, you are considered "out of the country".  Any doctor visits while in port (off the ship), a US port, would be covered by Medicare.

 

 

I mentioned that Medicare has a rule which states you are covered on a cruise if you are within six hours of a port.  I assume a US port, but the other half of the problem is the cruise line/ship was be a "Medicare provider" the odds of which are extremely remote.  Ergo, although the Medicare provision is included the coverage, it will never be applied.  Saying that Medicare did pay $34 of my $900 bill.    

[JimnKaren]

But look at the great claim you can make on your federal tax return.

 

Jim

[bluesplayer]

Your secondary insurance must have the denial from Medicare to process your claim.  Send all your receipts to your secondary plan. 

[Mehroswitha]

Did you have a travel insurance policy? Some of them provide PRIMARY medical insurance, which means you file a claim directly with them rather than with Medicare or any other health insurance you may have.

 

The travel insurance company then either pays the provider or reimburses you if you had to pay out of pocket. (I believe they may sometimes recover part or all of the cost from Medicare and your other insurers, but that's hashed out among the companies involved. You've already been paid.)

 

We were covered under such a policy with Travel Guard when we had a large medical claim while touring in Canada a few years ago. We filed directly with TG, which required a bit of paperwork including details of any other medical coverage we had, and we received full payment from them very promptly. 

[Krazy Kruizers]

Even though we are on Medicare and do have secondary insurance, we always buy third party insurance to cover any medical problem no matter whether we are in Alaska or a foreign port.  And I have had to use it twice.

[terrydtx]

33 minutes ago, Krazy Kruizers said:

Even though we are on Medicare and do have secondary insurance, we always buy third party insurance to cover any medical problem no matter whether we are in Alaska or a foreign port.  And I have had to use it twice.

Exactly why I never leave home without travel insurance. There was a recent thread this summer about another Alaska Medicare passenger who had a life threatening medical emergency while cruising the inside passage and had to have emergency surgery in Sitka the next day. His medical bill while on the ship was, I think $9000, and he had no travel insurance. Medicare covered the Sitka surgery but not the medical cost on the ship.

[chengkp75]

11 hours ago, Billthekid said:

I mentioned that Medicare has a rule which states you are covered on a cruise if you are within six hours of a port.  I assume a US port, but the other half of the problem is the cruise line/ship was be a "Medicare provider" the odds of which are extremely remote.  Ergo, although the Medicare provision is included the coverage, it will never be applied.  Saying that Medicare did pay $34 of my $900 bill.    

You are looking at the Medicare coverage from the narrow perspective of the cruise industry.  If you were on the Alaska Marine Highway ferry system, that company would be covered by Medicare for instance, also anything like a whale watching boat or charter fishing vessel.  While the latter would likely not have any trained medical staff, they may incur costs in bringing medical assistance to you, for which they would bill you.

[Mary229]

It may be licensing.   Many of the medical personnel I have met on any cruise are not licensed in the US. They are properly licensed but not US

[DaveOKC]

13 hours ago, Shmoo here said:

Onboard a ship, you are considered "out of the country".  Any doctor visits while in port (off the ship), a US port, would be covered by Medicare.

 

 

My visit to a health clinic in Ketchikan last month was fully covered by Medicare and my Suppliment Insurance.  As was the Rx, which only cost me $5.

[rothbury]

Is it possible than since all HAL ships are foreign flagged they are considered a foreign entity?

[3rdGenCunarder]

9 hours ago, Mehroswitha said:

Did you have a travel insurance policy? Some of them provide PRIMARY medical insurance, which means you file a claim directly with them rather than with Medicare or any other health insurance you may have.

 

The travel insurance company then either pays the provider or reimburses you if you had to pay out of pocket. (I believe they may sometimes recover part or all of the cost from Medicare and your other insurers, but that's hashed out among the companies involved. You've already been paid.)

 

We were covered under such a policy with Travel Guard when we had a large medical claim while touring in Canada a few years ago. We filed directly with TG, which required a bit of paperwork including details of any other medical coverage we had, and we received full payment from them very promptly. 

 

4 hours ago, Krazy Kruizers said:

Even though we are on Medicare and do have secondary insurance, we always buy third party insurance to cover any medical problem no matter whether we are in Alaska or a foreign port.  And I have had to use it twice.

 

I have spent a lot of money with Travel Guard over the years, and until last year I didn't have a claim. But last year, they paid out much more than I've paid them. They paid the bills directly, so I didn't have to wait for reimbursement. 

 

I thought Medicare would cover expenses if the ship is in port in Alaksa because you're physically in the US. But if the ship isn't a "medicare provider, that wouldn't matter. 

 

[DaveOKC]

7 minutes ago, 3rdGenCunarder said:

 

 

I have spent a lot of money with Travel Guard over the years, and until last year I didn't have a claim. But last year, they paid out much more than I've paid them. They paid the bills directly, so I didn't have to wait for reimbursement. 

 

I thought Medicare would cover expenses if the ship is in port in Alaksa because you're physically in the US. But if the ship isn't a "medicare provider, that wouldn't matter. 

 

Thats why I exited the ship and went to a local clinic in AK.

[Billthekid]

I have a great secondary coverage that up to this year always reimbursed the full amount incurred out of the US.  At least 4-5 times without a problem and fast.  I have medical travel insurance, but it is secondary.  Medicare is primary.  This year I am jumping through hoops all because of Medicare rule which states you are covered on a cruise if you are within six hours from a US port and the medical facility is a participating provider the odds of which are totally remote.  So now I have to file with Medicare first, get rejected, secondary second which will reimburse the major portion, and travel insurance third for any residual.  Since July I have only received $34 for a $900 bill incurred on a Holland Alaska cruise.  We were in Glacier Bay and a sea day and not near a port.  All this insurance and nothing to show for it, but frustration.    

Edited October 25, 2019 by Billthekid

[knittinggirl]

In 2016, we visited the ship's medical while in Boston.  We still used Travel Guard. 

 

Medicare sent us a letter asking for our ship's itinerary, and after receiving it, they paid for the visit to medical while we sat in the Boston Harbor tied to the dock.   On the other hand, I also had a trip to medical on the same  cruise.  We had to wait until my primary insurance rejected my claim as out of network sine it was below the deductible.  Then I submitted that to Travel Guard, that DID pay.

 

USAA's travel insured has a Primary Medical upgrade for $25 per person.

 

My most recent experience w/ HAL medical was pretty annoying.  We'd temporarily misplaced my EpiPen and I went to medical to get another.  The nurse told me I'd have to pay $95 for the doctor to write a prescription.  Which I paid, then he would contact the port authority for the prescription.  Unfortunately, I found out later that night, the port authority told him the doctor couldn't write a prescription because he wasn't authorized in the US.   I rang up my cell phone charges calling the pharmacy in Bar Harbor, to learn they didn't have the epi-pen either.  Next stop, try in Canada.  Fortunately, DH found the epi-pen.  

 

Makes a good story to tell the doctor about needing my prescriptions.  Don't count on ship's medical to have any MEDs.

 

I still got charged $95!

Edited October 25, 2019 by knittinggirl

[colbe]

23 hours ago, knittinggirl said:

I still got charged $95!

You still used the Doctors time.

[Billthekid]

10 minutes ago, colbe said:

You still used the Doctors time.

The doctors time now cost $120 for new patient as of July, 2019.  HAL's new profit center.  My July visit had a total of $400 for supplies, and $775 for professional services like taking my oxygen level by finger and using a needle to draw blood.  My previous medical center visit was $85 and no charge for BP or oxygen check.

[colbe]

33 minutes ago, Billthekid said:

The doctors time now cost $120 for new patient as of July, 2019.  HAL's new profit center.  My July visit had a total of $400 for supplies, and $775 for professional services like taking my oxygen level by finger and using a needle to draw blood.  My previous medical center visit was $85 and no charge for BP or oxygen check.

But you agreed to this in the contract that you have with Holland America. Please note the part about independent contractor.

 

All health, medical or other personal services in connection with Your Cruise or ship portion of Your Land + Sea Journey are provided solely for the convenience and benefit of Guests who may be charged for such services. You accept and use medicine, medical treatment and other personal services available on the ship or elsewhere at Your sole risk and expense without liability or responsibility of Carrier whatsoever, and agree to indemnify the Carrier for all medical or evacuation costs or expenses incurred on Your behalf. Doctors, nurses or other medical or service personnel work directly for Guest and shall not be considered to be acting under the control or supervision of Carrier, since Carrier is not a medical provider. We do not undertake to supervise the medical expertise of any such medical personnel and will not be liable for the consequences of any examination, advice, diagnosis, medication, treatment, prognosis or other professional services which a doctor or nurse may or may not furnish You.  Similarly, and without limitation, all spa personnel, instructors, guest lecturers, entertainers and other service personnel shall be considered independent contractors who work directly for the Guest.

[GeezerCouple]

54 minutes ago, Billthekid said:

The doctors time now cost $120 for new patient as of July, 2019.  HAL's new profit center.  My July visit had a total of $400 for supplies, and $775 for professional services like taking my oxygen level by finger and using a needle to draw blood.  My previous medical center visit was $85 and no charge for BP or oxygen check.

 

Keep in mind that a regular "medical center" is staffed during certain hours, and typically can expect a number of patient visits.

 

On the ship, the staff are sort of "stuck there" all the time, and much (most on many cruises?) of the time, they do not have any patients.  Their fees need to spread the costs out over the limited numbers, especially if the medical center is not heavily subsidized.

After all, it is a service that might be VERY necessary at an unexpected time, when the staffing, equipment, and supplies that are otherwise "just there" are now needed.

 

We were among those who called in the wee hours... and they had all of the necessary equipment and supplies, and apparently appropriate training.  Our specialists at our major academic medical center later said that the ship's medical team had "done exactly what we would have done if you had walked into our [major] Emergency/Trauma Center".  We were very fortunate; obviously, the ship's medical center can't have ALL of the specialists and equipment, etc., but we were quite surprised with what they had, and what they grabbed very fast, etc.

 

GC

[Billthekid]

I think they do a very good job and always been pleased with their efforts and results.  They know what they are doing and I have visited them many times.  Holland has switch from visiting doctors on a free cruise to a medical team of full time professionals as part of the crew.  Which negates the provision that states;  Similarly, and without limitation, all spa personnel, instructors, guest lecturers, entertainers and other service personnel shall be considered independent contractors who work directly for the Guest. " 

 

When you become sick at sea, your choices are limited and I am thankful there are professionals to help me.  Unfortunately most personal health insurance does not cover the cost which comes out of your pocket unless you purchase a policy which covers you during travel away from home.      

Edited October 26, 2019 by Billthekid