High medical costs

[Firsttimecruiser1111122]

Hello, I am a first time cruiser. I didn't buy travel insurance as I am based in Europe and the cruise is of the baltic sea in Europe, and I thought my European health card would keep me safe.   I was feeling unwell yesterday and went to the medical centre. It turns out I had a high temperature and was dehydrated, but they checked me out, with a blood test and some things. They also put me on an IV. In general the care was great. 

 

However today I got an invoice for 3000 USD.. My health insurer will cover it, but at local rates. I live in the Netherlands, so at equivalent rates there.  I have to pay it up front. 

 

It is hard to compare, as maybe European governments subsidise health care, but the cost seems very high. And I need to pay it before Ieave the ship. I had been thinking if I could pay later my insurer could use their knowledge to challenge any excessive fees. 

 

Do I just have to pay this? Who sets the prices so they are fair, or is healyhcare just another way to make money, like the 16USD alcohol shots? Could they just charge double the price, for arguments sake? I feel that as a European based person I could never have expected this bill? 

 

Any advice is appreciated! 

[billslowsky]

9 minutes ago, Firsttimecruiser1111122 said:

Hello, I am a first time cruiser. I didn't buy travel insurance as I am based in Europe and the cruise is of the baltic sea in Europe, and I thought my European health card would keep me safe.   I was feeling unwell yesterday and went to the medical centre. It turns out I had a high temperature and was dehydrated, but they checked me out, with a blood test and some things. They also put me on an IV. In general the care was great. 

 

However today I got an invoice for 3000 USD.. My health insurer will cover it, but at local rates. I live in the Netherlands, so at equivalent rates there.  I have to pay it up front. 

 

It is hard to compare, as maybe European governments subsidise health care, but the cost seems very high. And I need to pay it before Ieave the ship. I had been thinking if I could pay later my insurer could use their knowledge to challenge any excessive fees. 

 

Do I just have to pay this? Who sets the prices so they are fair, or is healyhcare just another way to make money, like the 16USD alcohol shots? Could they just charge double the price, for arguments sake? I feel that as a European based person I could never have expected this bill? 

 

Any advice is appreciated! 

Yes you will have to pay it.  The ship is not part of your country's health care system.  Check your credit card to see if it provides any coverage.

 

The same would happen if you required care in the US.

[ColeThornton]

If the bill isn't paid you aren't getting off the ship.  🙂

[phillygwm]

12 minutes ago, Firsttimecruiser1111122 said:

However today I got an invoice for 3000 USD.. My health insurer will cover it, but at local rates. I live in the Netherlands, so at equivalent rates there.  I have to pay it up front. 

 

It is hard to compare, as maybe European governments subsidise health care, but the cost seems very high. And I need to pay it before Ieave the ship. I had been thinking if I could pay later my insurer could use their knowledge to challenge any excessive fees. 

I usually buy a (relatively) inexpensive health-based travel policy.  Being in my 50's, it cost about $50 for a week; it's higher if you're older.  But it covers the catastrophic stuff, like if I needed to be medevaced out. I just build it in to my overall budget, like extra specialty dining and the Premium Plus package.

 

A $3K charge is not at all surprising; if you went to a US hospital without insurance you'd probably pay at least that much.  You raise an excellent point: In the US, many of us have "in network" versus "out of network" providers and I'm virtually 100% sure NCL is not gonna be in my network! 🙂   All the more reason to get a supplemental policy.

[mjkacmom]

I believe the health center is a 3rd party vendor. You gambled and lost. I’ve cruised with my family of 7 without purchasing insurance, out of ignorance, once I realized that we could rack up a sizable bill if someone needed medical care I always purchased insurance. Here in the US our health insurance will try to negotiate with providers, sometimes that means they pay less and we have to pay what is left. That bill sounds normal for an ER visit without insurance.

[mjkacmom]

2 minutes ago, phillygwm said:

I usually buy a (relatively) inexpensive health-based travel policy.  Being in my 50's, it cost about $50 for a week; it's higher if you're older.  But it covers the catastrophic stuff, like if I needed to be medevaced out. I just build it in to my overall budget, like extra specialty dining and the Premium Plus package.

 

A $3K charge is not at all surprising; if you went to a US hospital without insurance you'd probably pay at least that much.  You raise an excellent point: In the US, many of us have "in network" versus "out of network" providers and I'm virtually 100% sure NCL is not gonna be in my network! 🙂   All the more reason to get a supplemental policy.

I was just thinking that it would be out of network, right now we’ve reached both in network and out of network deductibles for the year ($7000 each) so our insurance might pay for care on a ship, just not on land.

[Babr]

The health services onboard are provided by contractors. They determine appropriate fees to cover cost of operation and , yes, profit, not negotiated rates we may be used to seeing from health care providers at home. No one can assume their usual coverage at home will protect them on a cruise ship.

 

You’ll have to pay the bill out of pocket before leaving the ship and then file with your insurance for reimbursement. Be sure to get all relevant records because they will be required to document your claim.  You’ll have to absorb any excess not reimbursed by your insurer. 

[argyll1881]

I think I would have to have a sucking chest wound before using the medical facilities on an NCL ship.

[Firsttimecruiser1111122]

Thanks everyone. I guess it is a lack of knowledge on my part about potential costs as a European. I guess if costs are broadly similar to US prices, then tough luck for me, but just pay and move on from it. There must be lots of Europeans who get caught by this, especially in a Europe based cruise (Baltic sea) and Europe based Norwegian company. We would never expect such up front costs 

[TrumpyNor]

45 minutes ago, Firsttimecruiser1111122 said:

Hello, I am a first time cruiser. I didn't buy travel insurance as I am based in Europe and the cruise is of the baltic sea in Europe, and I thought my European health card would keep me safe.   I was feeling unwell yesterday and went to the medical centre. It turns out I had a high temperature and was dehydrated, but they checked me out, with a blood test and some things. They also put me on an IV. In general the care was great. 

 

However today I got an invoice for 3000 USD.. My health insurer will cover it, but at local rates. I live in the Netherlands, so at equivalent rates there.  I have to pay it up front. 

 

It is hard to compare, as maybe European governments subsidise health care, but the cost seems very high. And I need to pay it before Ieave the ship. I had been thinking if I could pay later my insurer could use their knowledge to challenge any excessive fees. 

 

Do I just have to pay this? Who sets the prices so they are fair, or is healyhcare just another way to make money, like the 16USD alcohol shots? Could they just charge double the price, for arguments sake? I feel that as a European based person I could never have expected this bill? 

 

Any advice is appreciated! 

Unfortunately you learned the hard way why you should always purchase a travel insurance, as it would cover ANY UNEXPECTED medical costs for you. Even when travelling in Europe.

 

I am European myself, but in addition to the European health card I ALWAYS have an additional travel insurance when cruising (in fact I always have a travel insurance for all travel I do, also when not on a cruise - as long as the travel is outside of my home country. The European health card only guarantees you the same help as a local citizent in the country you are in, it does not cover private clinics or private hospitals.

 

In the past I have needed it twice when cruising, once the bill was "only" about $200 and another time it was actually $2200. The European health card guarantees you medical help when onland in Western Europe, but it does not cover you when in "international waters" - on board a cruise ship the prices are similar to American standards and has to be paid before you leave the ship. For that reason I always bring with me an additional credit card that is only for "medical emergency". 

Edited June 4, 2022 by TrumpyNor

[TrumpyNor]

11 minutes ago, Firsttimecruiser1111122 said:

Thanks everyone. I guess it is a lack of knowledge on my part about potential costs as a European. I guess if costs are broadly similar to US prices, then tough luck for me, but just pay and move on from it. There must be lots of Europeans who get caught by this, especially in a Europe based cruise (Baltic sea) and Europe based Norwegian company. We would never expect such up front costs 

NCL is NOT Norwegian based/Norwegian owned anymore - it is only in the name.... In fact it is not even European owned - I believe it is mainly owned by Asian investors and it is run from the US with head office in Miami.

Edited June 4, 2022 by TrumpyNor

[GeezerCouple]

14 minutes ago, Firsttimecruiser1111122 said:

Thanks everyone. I guess it is a lack of knowledge on my part about potential costs as a European. I guess if costs are broadly similar to US prices, then tough luck for me, but just pay and move on from it. There must be lots of Europeans who get caught by this, especially in a Europe based cruise (Baltic sea) and Europe based Norwegian company. We would never expect such up front costs 

 

Alas, there are plenty of people who reside in the USA who don't think about medical care "elsewhere"... until they are forced to do so.

There are lots of complaints about care in other countries, where USA-based insurance also may not be valid.  And in almost all of these cases (including on ships), the costs must be paid first, with a claim filed with the insurer (if there is coverage) later.

 

In some countries, they will not begin medical treatment until one has made payment arrangements.

 

As for costs on ship:  Keep in mind they have to have staffing, and quite a variety of equipment and supplies, for what may be very infrequent need.  That's expensive.  The same thing happens in an Emergency Room, but at least in most of those, there are patients coming in frequently.  (And still those costs are high, at least in part for a similar reason:  they need to allow for a surge-capacity... it's not one patient arrives after another leaves, etc.)

 

Just be grateful the care was available!  And that it wasn't an incredibly expensive heart attack or some surgical emergency...

 

DH needed emergency care on board an NCL ship a few years ago.  We were docked overnight, fortunately.  At about the time that I was going to speak with the NCL physician about "could we please call an ambulance", he approached me to announce that they had just called an ambulance!  At the local ER, where they observed DH for much of the rest of the day, they said that the ship's physician "did exactly what we would have done."  And later, when we got home and met with some specialists at our major teaching hospital, one of the specialists said the same thing:  "If you had arrived in our ER in that situation/condition, we'd have done the same thing."  We never forgot that.

 

OTOH, on a ship at sea, they can't have ALL of the equipment or specialists that a big land hospital has, so this does give us pause sometimes, as we get older...

 

I'm glad you are okay!  That is the important part of this. 🙂 

 

GC

[billslowsky]

36 minutes ago, GeezerCouple said:

There are lots of complaints about care in other countries, where USA-based insurance also may not be valid.  And in almost all of these cases (including on ships), the costs must be paid first, with a claim filed with the insurer (if there is coverage) later.

 

In some countries, they will not begin medical treatment until one has made payment arrangements.

 

The insurance is valid, but it's an out of network claim in almost all cases.

 

It's the providers who don't coordinate with the insurance, and why should they?  Chances are the insurance will pay little or none of the costs due to deductibles and reasonable charge levels - and lengthy delays - and once the patient is out the door, why would they risk not getting paid from someone who has left the country and is not returning?  A collection agency would probably pay them pennies on the dollar for the debt.

 

And travel insurance will work the same way.  In most cases, you still have to pay the charge up front and file with the insurance to be reimbursed.

[Sthrngary]

1 hour ago, Firsttimecruiser1111122 said:

Hello, I am a first time cruiser. I didn't buy travel insurance as I am based in Europe and the cruise is of the baltic sea in Europe, and I thought my European health card would keep me safe.   I was feeling unwell yesterday and went to the medical centre. It turns out I had a high temperature and was dehydrated, but they checked me out, with a blood test and some things. They also put me on an IV. In general the care was great. 

 

However today I got an invoice for 3000 USD.. My health insurer will cover it, but at local rates. I live in the Netherlands, so at equivalent rates there.  I have to pay it up front. 

 

It is hard to compare, as maybe European governments subsidise health care, but the cost seems very high. And I need to pay it before Ieave the ship. I had been thinking if I could pay later my insurer could use their knowledge to challenge any excessive fees. 

 

Do I just have to pay this? Who sets the prices so they are fair, or is healyhcare just another way to make money, like the 16USD alcohol shots? Could they just charge double the price, for arguments sake? I feel that as a European based person I could never have expected this bill? 

 

Any advice is appreciated! 

@Firsttimecruiser1111122 The topic of having insurance on a cruise is a common topic on CruiseCritic.com.  To say it is both debated and complicated is an understatement.  I live in the United States and lets say, our health cares can often times be interesting.  Let me answer your questions first, then give you two stories.  I can make this situation go away but your story and all the comments provided might help others regardless of country of origin. 

 

You will both have to pay the bill upfront and live with the cost that your insurance company did not pay.  That is the unfortunate truth.  That is a harsh pill to take but you are not the only one whom had this type of situation.

 

I personally over 42 years cruising never took any insurance.  Then I started to have Medicare as my Coverage which in the united states is the Government Insurance.  Medicare does not cover me out of the United States so I had to get insurance.  Good thing.  Prior to my 40th anniversary cruise, like eight days before, my wife got Covid-19.  The insurance company paid all of my loss and did it in 12 business days.  It was a very expensive cruise and I was made whole.

 

Our very next cruise was a family cruise.  Again I had insurance for all in my party.  My adult son went on a snorkeling excursion with the family and was short of breath.  He went to the ship hospital and was seen by a doctor and given a Covid-19 test.  He was fine and the rest of the cruise went well.  The cost to me for this 45 visit when the majority of the time was sitting and waiting was $650.00 American. Again, the insurance company paid the entire amount within 12 business days.

 

Until this happened to me personally, I would be hesitant to buy this insurance.  Even if I read op-eds like yours.  When it happens to you, and you were effected; it changes the way you think.  I hope everyone feels better and I am truly sorry this happened.

 

Cruise well.

[1025cruise]

Even if you have insurance, you still need to pay before getting off the ship. Then you file a claim to get reimbursed.

[billslowsky]

17 minutes ago, Sthrngary said:

 To say it is both debated and complicated is an understatement. 

 

It's not complicated.  The cruise line and a provider outside of your home country does not accept your insurance for payment.  You pay up front and file for reimbursement.

[Sthrngary]

18 minutes ago, billslowsky said:

It's not complicated.  The cruise line and a provider outside of your home country does not accept your insurance for payment.  You pay up front and file for reimbursement.

@billslowskyThank you for your comment.  Allow me to clarify.  The Health Insurance coverage in the United States can be complicated.  Knowing it is pretty important to have this travel insurance was not intuitive.  I got lucky and got some really good advice because I had Medicare at the time.  

 

The actual process for filing a claim for the Third Part Insurance Company was easy.  It paid to my checking account in 12 business days which emphasized the ease. I hope that clarifies the sentence you quoted of mine and puts some meat on the bones.

 

Cruise well.

[GeezerCouple]

2 hours ago, Firsttimecruiser1111122 said:

Hello, I am a first time cruiser. I didn't buy travel insurance as I am based in Europe and the cruise is of the baltic sea in Europe, and I thought my European health card would keep me safe.   I was feeling unwell yesterday and went to the medical centre. It turns out I had a high temperature and was dehydrated, but they checked me out, with a blood test and some things. They also put me on an IV. In general the care was great. 

 

 

 

I should have added a suggestion that you browse, now or prior to paying anything for another trip, the Travel Insurance section of CC:

 

https://boards.cruisecritic.com/forum/499-cruisetravel-insurance/

 

Note that most of the discussion is USA-oriented, and the insurance issues here are not likely to apply elsewhere.  However, the *costs* that travel insurance might cover could apply anywhere.

 

I wrote "prior to paying anything..." above because at least in the USA, some of the policies with the best coverage (which is a personal decision, obviously) MUST be purchased within ~10-20 days of the very first payment, refundable or not.  (At least one only needs to insure that first payment at that time.). Insurance here is regulated by each state, which is why there is a range of deadlines.  And some of the preferred-by-many-but-not-all coverages aren't available in every state anyway.

 

My point is to get some background before starting the planning of your next trip.

IF they have "travel insurance brokers" in your country, that would be a good place to start when you are next looking for a policy.  They can answer questions about what types of coverages might be useful for which types of trips, etc.

 

GC

[njhorseman]

2 hours ago, TrumpyNor said:

NCL is NOT Norwegian based/Norwegian owned anymore - it is only in the name.... In fact it is not even European owned - I believe it is mainly owned by Asian investors and it is run from the US with head office in Miami.

NCL hasn't been owned by Asian investors (Star Cruises-Genting) for many years. Apollo Management bought 50% of the company from Genting in 2007 and received majority control of the board of directors as part of purchase. NCL's corporate parent, NCLH, was taken public by Apollo in January 2013. Apollo Management and Genting sold their remaining shares of NCLH in late 2018. NCLH stock is traded on the NY Stock Exchange and is largely owned by many investment management companies and mutual funds, as well as individuals. The current largest shareholder is The Vanguard Group, Inc. which owns 10.51% of NCLH .

NCLH is incorporated in Bermuda and headquartered in Miami.

Edited June 4, 2022 by njhorseman

[Firsttimecruiser1111122]

Thanks for all the feedback. I had to sign a consent form, that I would pay the bill.  But the price was so much more than I could have expected, how could that be consent? Anyway, live and learn 

[TrumpyNor]

3 minutes ago, njhorseman said:

NCL hasn't been owned by Asian investors (Star Cruises-Genting) for many years. Apollo Management bought 50% of the company from Genting in 2007 and received majority control of the board of directors as part of purchase. NCL's corporate parent, NCLH, was taken public by Apollo in January 2013. Apollo Management and Genting sold their remaining shares of NCLH in late 2018. NCLH stock is traded on the NY Stock Exchange and is largely owned by many investment management companies and mutual funds, as well as individuals. The current largest shareholder is The Vanguard Group, Inc. which owns 10.51% of NCLH .

NCLH is incorporated in Bermuda and headquartered in Miami.

Thank you for correcting me - then I learned something new today as well. 😊

Anyway - my main point was that NCL is not Norwegian or European owned anymore... 

Edited June 4, 2022 by TrumpyNor

[ontheweb]

13 minutes ago, Firsttimecruiser1111122 said:

Thanks for all the feedback. I had to sign a consent form, that I would pay the bill.  But the price was so much more than I could have expected, how could that be consent? Anyway, live and learn 

I wonder what they would have done if you said "this is too much, I refuse to sign the consent form". It's not like they can make you return the medical services they performed.

 

I guess they could sue you for the money, but what else could they do. Maybe bar you from ever cruising on their line, but what else. It's not like they could make you work off your debt as a galley slave.

[GeezerCouple]

And that is precisely why in some locations overseas (from the USA), they will not treat you until you have paid, such as presenting a charge card with a charge that is approved.

 

Many places do not have the requirement that is common here in the USA which to "treat emergencies NOW; worry about payment later..."

 

I just remembered that when DH was taken to the ER in the incident described above, while he was being transferred from the ambulance to the ER, I was being escorted to the ER billing office, which was covered with notices, mostly about how they do NOT take USA-based health insurance.  There were also a few notices with the names of some travel insurance companies that they do work with, but they'd need to verify the coverage first.

I handed over a charge card, thanked them, and was brought to DH's bedside.

GC

[Babr]

4 minutes ago, ontheweb said:

I wonder what they would have done if you said "this is too much, I refuse to sign the consent form". It's not like they can make you return the medical services they performed.

 

I guess they could sue you for the money, but what else could they do. Maybe bar you from ever cruising on their line, but what else. It's not like they could make you work off your debt as a galley slave.

I expect the consent to treatment form was presented before the OP saw the doctor or received the bill. Refusal to sign would probably mean he would have been denied service. 

[billslowsky]

40 minutes ago, GeezerCouple said:

My point is to get some background before starting the planning of your next trip.

IF they have "travel insurance brokers" in your country, that would be a good place to start when you are next looking for a policy.  They can answer questions about what types of coverages might be useful for which types of trips, etc.

 

GC

The first thing a person should do is understand the coverage(s) they already have.  Whether it's private insurance, public health insurance, an annual travel policy, whatever.

 

Then you can look into supplementing it with something you actually need.  

 

Go to a broker first and you may wind up with something excessive that duplicates what you've already paid for.  Most people would want additional coverage for evacuation and/or trip interruption, and coverage for out of network/country.  Travel maybe once a year?  Consider coverage for the duration of the trip.  Travel numerous times?  Consider an annual coverage (keeping in mind that it may have a yearly max, so if you use it once, you won't have full coverage for the remainder of the year).