Air/Medical evac

[Hlitner]

1 hour ago, new_cruiser said:

 

The hospital that treated me in Thailand provided all the documentation in English. I didn't have to insist - they provided a package with all the medical records and expense details including a disk with the X-rays as part of the normal check out process. Perhaps they are very professional on the documentation because of experience with medical tourism. 

 

We have had out of area emergency treatment twice. Once for my husband in the US and the broken wrist in Thailand for me. In both case, our provider handled reimbursement very smoothly. We sent the claim in with the documentation and they sent a check (or paid the bill when we hadn't had to pay before service) without any further interaction. The incident with my husband involved a 1 hour ambulance ride and diagnostics including a CAT scan to diagnose what turned out to be just the combination of a stomach bug and high altitude so I was worried that our insurance would object that the treatment had been unnecessary, but they didn't. In the US case, the hospital billed our insurance but the ambulance company wanted payment up front.

We have heard the care is very good in Thailand.  In our situation, DW was injured in Vietnam but I refused ambulance transportation (from a beach resort) to a local hospital and got her back to the ship via a taxi.  She was treated onboard for several days (thousands of dollars) and then was referred to a major teaching hospital in Osaka during a long port day.  That hospital did outpatient surgery and recommended she be evacuated home or spend weeks in Japan for further treatment.  Since our travel medical insurance company covered both medical and evacuation it was in their best interest (and ours) to arrange to get her home (which got them off the hook for further medical treatment).  The Japanese hospital treated us like royalty but would not deal with our insurance company (Geoblue).  We settled all the medical bills on a major credit card and later received full reimbursement.  The cost of her treatment in Japan was a fraction of what the same treatment would have cost in the USA but the quality was world-class.  Our main concern was that Delta Airlines (who flew us home) would refuse to take DW because  of her condition.  The pilot actually stopped to chat, prior to the flight, and was obviously checking out the situation.  There are cases where commercial airlines will refuse a medical case because they do not want to risk having to interrupt the flight in case of further medical issues.   The final decision rests with the pilot and ours turned out to be a really nice guy.

 

If Delta had refused the transport the situation would have become quite interesting.  The insurance company could have either insisted we stay in Japan for further treatment or arranged for a private air medical evacuation which would have cost them big bucks (we are talking about a 6700 mile evacuation).

 

Hank

[Joebucks]

On 11/17/2019 at 4:09 PM, navybankerteacher said:

Intelligent people will insure themselves against risks which they could not cover out of pocket.  If you own a house, you will most likely insure it so you would not be homeless if there were a fire.  If you own a valuable car, you will likely have collision insurance (subject to whatever deductible you would be happy to pay out of pocket to save a bit on the premium), and if you travel you should be aware of the awesome expenses (probably $50,000 and up) involved in flying you home if you should suffer serious illness/injury.  While the costs being insured against are huge, the likelihood of incurring them is so slight that the cost of insurance to cover a $100,000 repatriation is far less than the collision insurance you might have on a $20,000 car.

 

I would change that to intelligent people would at least seek to understand the fine prints, coverages they already have, options out there, etc.

 

People think they are so smart for buying insurance. The truly smart people will tell you that the average person loses their ass in insurance throughout their life. There are so many buying duplicate and worthless coverages. Just because you are traveling out of country, does not mean your health insurance will or won't work. That is good to at least know your options. Some credit cards may also cover certain things as well. If you travel a lot, they may prove to be a good investment.

 

MedJetAssist is probably one of the best "insurances" I would recommend, because that is truly a catastrophic charge if needed, and it's useful if you travel a lot. CFAR insurance and the likes, are largely pointless. For everything else, you may want to do your homework. I'd say if you are a health risk and/or traveling to a remote location, the need for better coverage may increase vs being a healthy person going to Mexico.

[sparks1093]

12 hours ago, Joebucks said:

 

I would change that to intelligent people would at least seek to understand the fine prints, coverages they already have, options out there, etc.

 

People think they are so smart for buying insurance. The truly smart people will tell you that the average person loses their ass in insurance throughout their life. There are so many buying duplicate and worthless coverages. Just because you are traveling out of country, does not mean your health insurance will or won't work. That is good to at least know your options. Some credit cards may also cover certain things as well. If you travel a lot, they may prove to be a good investment.

 

MedJetAssist is probably one of the best "insurances" I would recommend, because that is truly a catastrophic charge if needed, and it's useful if you travel a lot. CFAR insurance and the likes, are largely pointless. For everything else, you may want to do your homework. I'd say if you are a health risk and/or traveling to a remote location, the need for better coverage may increase vs being a healthy person going to Mexico.

Very true and more people should know what their options are, but unfortunately human nature being what it is they don't. I know that my health plan will cover me overseas, as long as I'm using a preferred provider and if I'm using a preferred provider all they can charge me up front is the copay (which the insurance company might actually waive depending on the circumstances). I am not responsible for anything else and they have to submit a claim to get their share. I still obtain coverage just in case I can't use a preferred provider, but mostly to have medical evacuation insurance. Thanks to this thread I'll be researching other options for our next trip.

[Hlitner]

2 hours ago, sparks1093 said:

Very true and more people should know what their options are, but unfortunately human nature being what it is they don't. I know that my health plan will cover me overseas, as long as I'm using a preferred provider and if I'm using a preferred provider all they can charge me up front is the copay (which the insurance company might actually waive depending on the circumstances). I am not responsible for anything else and they have to submit a claim to get their share. I still obtain coverage just in case I can't use a preferred provider, but mostly to have medical evacuation insurance. Thanks to this thread I'll be researching other options for our next trip.

Your thinking is good but the reality is not nearly as good.  Several healthcare plans (such as the Blues) do have "preferred" (sometimes referred to as network) providers in other countries.  But they can be few and far between when one travels in many parts of the world.  When a traveler is faced with a genuine emergency in a foreign land there is usually insufficient time (not to mention one's state of mind) to try and find "preferred providers" not to mention the ability to get to those providers in real time (we are talking emergency and urgent situations).  When DW was injured in Vietnam my only thought was to get her to the best facility (and surgeon) as quickly as possible.  or  Consider somebody having severe chest pains or breathing difficulties in a country where they do not speak the language.  In most cases you are going to end up in the nearest medical facility or wherever a summoned ambulance takes the patient.  Under these circumstances it might be impossible to get into software (or directly contact an insurance provider) and negotiate with local emergency providers to get you to a "preferred" provider.  One thing I learned when working in emergency medicine is that even the smartest consumers can (and often do) make very bad decisions when under extreme stress.

 

Also beware of medical evacuation insurance which generally has lots of "fine print."  For example, most will only consider an evacuation when you are an "inpatient" at a recognized medical facility...and this will happen ONLY after consultations with the attending physician (who usually must interact with your insurance company case manager).  When DW was medically evacuated from Japan it was only after 5 phone calls (some quite lengthy) with our insurance company's case manager) and several days of negotiation (which involved the Japanese hospital, the cruise ship's physician, and myself).  All this is happening during a period of extreme stress and fear.  And consider that I had over 35 years experience working in the medical insurance industry not to mention a previous life as a Paramedic.  Most folks do not have that kind of experience or knowledge and find themselves at the mercy of others.

 

The bottom line is that the system usually works, but not without some difficulties and lots of stress.  While your immediate goal is to seek the best medical treatment ASAP, the insurance companies may well have other motivations (such as saving money).

 

I will add a final comment.  When we had that bad situation (in Vietnam) our ship's physician (he was a South African physician working on a Princess ship) was outstanding!  He not only served as DW's attending physician, but was an excellent counselor/advisor and took an active role in dealing with our insurer.  And unlike many physicians, this particular doctor realized when the situation was stretching his own abilities (and facilities) and pushed us to seek a much higher level of medical care then can be provided in a ship setting.  Physician's who are able to accept the limitations of their knowledge and abilities are valuable and perfect for working on ships.

 

Hank

[Flatbush Flyer]

2 hours ago, sparks1093 said:

.....if I'm using a preferred provider all they can charge me up front is the copay.....

Though BC/BS Global (for example) has a relatively broad hospital network in major metro areas abroad, remember that some situations may find you dealing with their ER docs who may be non-network contractors and whose billing (and expectations of upfront payment) is a separate entity.

[sparks1093]

49 minutes ago, Hlitner said:

Your thinking is good but the reality is not nearly as good.  Several healthcare plans (such as the Blues) do have "preferred" (sometimes referred to as network) providers in other countries.  But they can be few and far between when one travels in many parts of the world.  When a traveler is faced with a genuine emergency in a foreign land there is usually insufficient time (not to mention one's state of mind) to try and find "preferred providers" not to mention the ability to get to those providers in real time (we are talking emergency and urgent situations). 

 

Hank

 

17 minutes ago, Flatbush Flyer said:

Though BC/BS Global (for example) has a relatively broad hospital network in major metro areas abroad, remember that some situations may find you dealing with their ER docs who may be non-network contractors and whose billing (and expectations of upfront payment) is a separate entity.

Appreciate the info but I did say "I still obtain coverage just in case I can't use a preferred provider". (And yes, I understand that is still something that may not cover every conceivable circumstance.)

[Hlitner]

52 minutes ago, sparks1093 said:

 

Appreciate the info but I did say "I still obtain coverage just in case I can't use a preferred provider". (And yes, I understand that is still something that may not cover every conceivable circumstance.)

The "bummer" about all this is that travelers are often required to pay all the medical bills upfront and later seek reimbursement. This can be a major problem for folks who do not have credit cards with high credit limits (of even worse...for those who do not have a major credit card).  In fact, in Mexico where we live part of the year it is pretty normal for some hospitals to demand a credit card as you enter the hospital (before you are even checked-in) as proof of your ability to pay.   In our situation in Japan (which was in a major teaching hospital with more than 500 beds) the cruise line arranged for our visit so admission was quite easy and they even provided us with an English speaking translator (who stayed with us during our entire 8 hour visit).  But the last step at discharge was that we had to go through the Accounting department where we were required to pay the entire bill before we left the hospital.  For us this was not a problem but I have often wondered what happens to folks who do not have the ability to make that payment.  

 

I should add that it was the same on the ship where we had several thousand dollars in Medical bills.  The entire balance was put on our onboard cruise account which had to be settled to a major credit card prior to our medical disembarkation.   Again, it was not a problem for us and we were actually grateful for all the help and support we received from the onboard medical center.  But this could cause some grief for those with low credit limits.

 

We were fortunate that our insurance company quickly (about 2 weeks after we filed the very detailed claim) reimbursed our medical expenses.  Further reimbursement from our Chase credit card (which had $10,000 of coverage as a benefit) was much more difficult and took several months of back and forth.  In fact, when I finally (months later) received a big check from Chase it was an occasion to open a nice bottle of Champagne (and we are not talking about the cheap faux Champagne served at the art auctions).

 

I detailed much of this "adventure" on CC under the cruise insurance blog at the time we finally resolved all the issues.  

 

Hank

[pacruise804]

@Hlitner do you know if the hospitals would also accept a debit card with the Visa or MC logo?  I know some car rental agencies won't, but that is the only place we ever ran into difficulty.  We can easily have access to mid 5 figure funds to put against the card, but do not actually have credit.

 

 

[Hlitner]

13 minutes ago, pacruise804 said:

@Hlitner do you know if the hospitals would also accept a debit card with the Visa or MC logo?  I know some car rental agencies won't, but that is the only place we ever ran into difficulty.  We can easily have access to mid 5 figure funds to put against the card, but do not actually have credit.

 

 

I have no clue.  Also keep in mind that in the USA we have excellent credit card protections under Federal Law/Regulations but some of these protections do not apply to debit cards.  These protections, especially those related to disputes and fraud, can be invaluable when something goes amiss with a card.  Because we spend a lot of time out of the country we must rely on our debit cards...especially as our primary means of obtaining cash.  In order to protect ourselves we have several debit cards, each drawn on a separate account in different institutions (chosen for lack of fees and related foreign exchange fees).  We generally avoid using our Debit card that links directly to our major account.  We normally transfer smaller amounts of money to a secondary Debit/ATM account which is the one we primarily use to obtain funds when out of the country.    I should add that over the years we have had several attempts to defraud both our credit cards and debit cards.  It does happen and can be a real pain....especially when a bank immediately shuts down a card while you are traveling.  Hence the necessity to have multiple cards/accounts as a means of back-up.

 

Hank

[pacruise804]

We also travel with multiple debit.  My understanding with fraud protection is that if it has the Visa logo and is processed as a Visa charge that Visa provides the protection, but if it is processed as point-of-sale/debit with PIN only the protections are only what is offered by the issuing financial institution.

[DRS/NC]

Several of you have stated that one needs "five digits" of credit available on a credit card(s) in an emergency.  PLEASE be more specific!

 

I have cards that have $12,000 or $15,000 limits available.  I seriously doubt those 5 digits would be sufficient in a medical emergency overseas.

 

Are we talking about $25,000 or more available credit?  What should the "average" traveler have if needed? 

[Knock wood] I've never needed my insurance while traveling, but the older I get (70+), the more concerned I become.

 

Thanks!

[Flatbush Flyer]

34 minutes ago, DRS/NC said:

Several of you have stated that one needs "five digits" of credit available on a credit card(s) in an emergency.  PLEASE be more specific!

 

I have cards that have $12,000 or $15,000 limits available.  I seriously doubt those 5 digits would be sufficient in a medical emergency overseas.

 

Are we talking about $25,000 or more available credit?  What should the "average" traveler have if needed? 

[Knock wood] I've never needed my insurance while traveling, but the older I get (70+), the more concerned I become.

 

Thanks!

There was a thread about credit limits several weeks ago where some folks appeared to be surprised at the data showing a significant percentage of Americans who have credit card limits exceeding $25k per active credit card.

 

 IMO, when traveling internationally, one should have a total of available credit and easily accessible liquid assets exceeding SIX figures. And how much of that should be credit card(s) limits should be closer to six figures than to four figures.

[Elaine5715]

On 11/21/2019 at 3:03 PM, Hlitner said:

We have heard the care is very good in Thailand.  In our situation, DW was injured in Vietnam but I refused ambulance transportation (from a beach resort) to a local hospital and got her back to the ship via a taxi.  She was treated onboard for several days (thousands of dollars) and then was referred to a major teaching hospital in Osaka during a long port day.  That hospital did outpatient surgery and recommended she be evacuated home or spend weeks in Japan for further treatment.  Since our travel medical insurance company covered both medical and evacuation it was in their best interest (and ours) to arrange to get her home (which got them off the hook for further medical treatment).  The Japanese hospital treated us like royalty but would not deal with our insurance company (Geoblue).  We settled all the medical bills on a major credit card and later received full reimbursement.  The cost of her treatment in Japan was a fraction of what the same treatment would have cost in the USA but the quality was world-class.  Our main concern was that Delta Airlines (who flew us home) would refuse to take DW because  of her condition.  The pilot actually stopped to chat, prior to the flight, and was obviously checking out the situation.  There are cases where commercial airlines will refuse a medical case because they do not want to risk having to interrupt the flight in case of further medical issues.   The final decision rests with the pilot and ours turned out to be a really nice guy.

 

If Delta had refused the transport the situation would have become quite interesting.  The insurance company could have either insisted we stay in Japan for further treatment or arranged for a private air medical evacuation which would have cost them big bucks (we are talking about a 6700 mile evacuation).

 

Hank

An acquaintance was injured in Hong Kong and needed to return to the US but was unable to sit upright.  He was able to secure a flight in First Class so he could lie flat.  That was a pricy ticket but way less than air evac.  

[sparks1093]

11 hours ago, Flatbush Flyer said:

There was a thread about credit limits several weeks ago where some folks appeared to be surprised at the data showing a significant percentage of Americans who have credit card limits exceeding $25k per active credit card.

 

 IMO, when traveling internationally, one should have a total of available credit and easily accessible liquid assets exceeding SIX figures. And how much of that should be credit card(s) limits should be closer to six figures than to four figures.

I'm sorry, "traveling internationally" is too broad a term. I can travel internationally by taking a left turn out of my driveway and driving 8 miles. A three day cruise to Nassau is traveling internationally. We've already established that it's a relative thing and certainly each traveler should do their best to cover all of their bases, but if travelers needed to wait to have the assets that you deem necessary then I stand by what I've said before- it would cripple the travel industry. We also have to remember that we're talking worse case scenarios here so the risk is low.

[Flatbush Flyer]

2 hours ago, sparks1093 said:

I'm sorry, "traveling internationally" is too broad a term. I can travel internationally by taking a left turn out of my driveway and driving 8 miles. A three day cruise to Nassau is traveling internationally. We've already established that it's a relative thing and certainly each traveler should do their best to cover all of their bases, but if travelers needed to wait to have the assets that you deem necessary then I stand by what I've said before- it would cripple the travel industry. We also have to remember that we're talking worse case scenarios here so the risk is low.

Please- you know exactly what I mean about "internationally" in the context of this discussion. But, if you somehow don't, let's change it to "intercontinental" (and I don't just mean the hotel chain).  

 

In addition, you seem to keep missing the clear distinction between "should" and "shall" when it comes to my (and other) posts on this topic. A previous poster asked "What should the "average" traveler have if needed?" S/he asked for a recommendation and I gave one.

 

Nowhere has it been suggested that the entire travel industry in general (cruising in particular) bar anyone who makes irrational financial decisions.(like not being financially prepared for emergencies). But, it is worth mentioning that an ever increasing number of travel organizers/purveyors are requiring proof of adequate insurance (particularly true in the realm of adventure travel).

 

That said, perhaps there would be a silver lining to your predicted collapse of some cruise companies if there existed an industry-wide requirement for its travelers to have adequate insurance, a minimum credit line and a passport (which is already a requirement of, at least, the premium/luxury cruise industry segment).

 

Wouldn't it be nice to no longer have the mass market behemoth ships currently under attack for their various negative impacts (environmental and otherwise) on ports, including their thundering herds of refrigerator magnet/tee shirt shoppers who have ruined the charm and allure of so many once unique locations?

 

Maybe it's time for a cruise industry "course correction" and the righteous downsizing that would result from "doing the right thing." But, that's a whole other discussion.

[RocketMan275]

On 11/18/2019 at 4:17 PM, ducklite said:

Actually in every single state in the US it is mandatory to have at least a minimum amount of auto insurance, and the insurers report it to the State when coverage is dropped.  In some states this will land you in jail.

 

Likewise when you have a mortgage, if you are dropped the mortgage company is alerted and they will obtain insurance for you at high rates and add it to what you owe them.  

If you have a car loan,  some states require the loan company to purchase insurance if you drop your coverage.  This type of coverage is very expensive and the loan company can add the cost to your payments.

[sparks1093]

21 hours ago, Flatbush Flyer said:

Please- you know exactly what I mean about "internationally" in the context of this discussion. But, if you somehow don't, let's change it to "intercontinental" (and I don't just mean the hotel chain).  

 

In addition, you seem to keep missing the clear distinction between "should" and "shall" when it comes to my (and other) posts on this topic. A previous poster asked "What should the "average" traveler have if needed?" S/he asked for a recommendation and I gave one.

 

Nowhere has it been suggested that the entire travel industry in general (cruising in particular) bar anyone who makes irrational financial decisions.(like not being financially prepared for emergencies). But, it is worth mentioning that an ever increasing number of travel organizers/purveyors are requiring proof of adequate insurance (particularly true in the realm of adventure travel).

 

That said, perhaps there would be a silver lining to your predicted collapse of some cruise companies if there existed an industry-wide requirement for its travelers to have adequate insurance, a minimum credit line and a passport (which is already a requirement of, at least, the premium/luxury cruise industry segment).

 

Wouldn't it be nice to no longer have the mass market behemoth ships currently under attack for their various negative impacts (environmental and otherwise) on ports, including their thundering herds of refrigerator magnet/tee shirt shoppers who have ruined the charm and allure of so many once unique locations?

 

Maybe it's time for a cruise industry "course correction" and the righteous downsizing that would result from "doing the right thing." But, that's a whole other discussion.

Even for your "average" traveler your suggestions/recommendations for what they should have are unreachable for many. I didn't suggest that the cruise lines should bar anyone or that they establish minimum standards of wealth, I just pointed out that if most people followed your suggestions/recommendations what the affect would be.  

[Flatbush Flyer]

4 hours ago, sparks1093 said:

Even for your "average" traveler your suggestions/recommendations for what they should have are unreachable for many. I didn't suggest that the cruise lines should bar anyone or that they establish minimum standards of wealth, I just pointed out that if most people followed your suggestions/recommendations what the affect would be.  

Actually what you said was "....if travelers needed to wait to have the assets that you deem necessary .....  it would cripple the travel industry."

"Needing" (i.e., required)  to do something is different than "choosing" (e.g., per recommendation). 

However, I understand your intent as do you understand my intent about "international" (vs "intercontinental").

So, Happy Thanksgiving! 🦃

[Charles4515]

On 11/22/2019 at 12:51 PM, pacruise804 said:

We also travel with multiple debit.  My understanding with fraud protection is that if it has the Visa logo and is processed as a Visa charge that Visa provides the protection, but if it is processed as point-of-sale/debit with PIN only the protections are only what is offered by the issuing financial institution.

 

I think that is correct. But you have to consider though that your card limit is the funds in your bank account that are not on hold. If you use a debit card for your cruise the cruise line puts a hold on some of your funds every day and so all your whole bank balance won't be available. Also if there is fraud the fraudster can empty out your account. So while Visa gives you zero liability protection it may take some time to be made whole. 

[Charles4515]

2 minutes ago, gpgal said:

 

Just saw on the news within the last day or two, a couple were on a cruise and the man had a medical emergency. Was taken to a hospital, had surgery and medical bills of $14k. Their insurance wouldn't pay it and their credit card limit wasn't that high. What was noteworthy to me was the woman, quoted on tv, as saying "I can't imagine anyone having a $14,000 credit card limit."  What made it on the news was that Tyler Perry heard about it and paid it for them.

 

I read in some of the stories in the media about this incident  if we can trust the stories is they had no travel insurance and they did not have passports. 

[Charles4515]

1 hour ago, gpgal said:

But she couldn't believe that anybody has that high a credit limit.  When my husband heard that he said "well, then maybe she shouldn't be going on a cruise...or any other (relatively) expensive travel."

Carnival cruises are not all that expensive and there are probably many who have a low credit.  Some people use debit cards and have no credit or had bankruptcy. I believe they should be going on a cruise but they should not go without travel insurance. Or a passport. Many don’t cruise as often as CC members so a cruise is a rare vacation. 
 

When I travel I don’t bring all my cards but bring about 50,000 combined credit plus my Amex Platinum which is a charge card so I don’t know how high a charge they would approve. It also has Premium Global Assist including Emergency medical transportation at no cost if they authorize it. So I think I am well covered but I hope never to test it. 

[ldubs]

On 11/22/2019 at 3:17 PM, Flatbush Flyer said:

 

 

 IMO, when traveling internationally, one should have a total of available credit and easily accessible liquid assets exceeding SIX figures. And how much of that should be credit card(s) limits should be closer to six figures than to four figures.

 

Exceeding six figures in CC limits and liquid assets.  That is kind of sobering.  Seems a little over much to me.  I think 6  figures would be sufficient.     

Edited November 25, 2019 by ldubs

[Flatbush Flyer]

23 minutes ago, ldubs said:

 

Exceeding six figures in CC limits and liquid assets.  That is kind of sobering.  Seems a little over much to me.  I think 6  figures would be sufficient.     

Sobering? Yes (for anyone who hasn't ever thought about it).

Over much? Not really. If your okay with $100k, at lest you're "in the ball park."

[ldubs]

17 minutes ago, Flatbush Flyer said:

Sobering? Yes (for anyone who hasn't ever thought about it).

Over much? Not really. If your okay with $100k, at lest you're "in the ball park."

 

Um, I'm sorry but perhaps you don't really mean more than 6 figures as the minimum.  That would be 7 figures which is  $1 million or more.   

[Flatbush Flyer]

53 minutes ago, ldubs said:

 

Um, I'm sorry but perhaps you don't really mean more than 6 figures as the minimum.  That would be 7 figures which is  $1 million or more.   

Oops! Sorry.

My intention was to suggest "more than $100k.