law offices of merwyn j. miller
191 calle Magdalena, suite 270 • encinitas, San Diego County, ca  92024 • 760-436-8832

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US Medical Insurance
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How to Pay for Everything


This is a continuing series of articles with a number of "parts."  See Table of Contents and search for "Don't Leave Home Without Them" and "Don't Leave Home Without It"

Dear Mr. Miller:

I read your article from last month in which you wrote about your wife’s and your five day adventure in an Argentine hospital. I am glad to hear that your wife has recovered from her bout with pneumonia. Your discussion of the travel insurance that people should purchase and the smart phone and apps people should have with them was very helpful. I look forward to reading about the money issues in such a situation.

Avid Reader

Dear Avid:

Introduction: I am glad to hear that last month’s column was so well received. Hopefully all of this information will make what can be a terrifying experience a little less so.

When a loved one becomes seriously ill on a trip, it can be worrisome at best. When it occurs in a foreign country with a different language, it can be far, far worse. Obviously, communication is made substantially more difficult and at a time when one is worried about his or her loved one this problem can reach crisis proportions. But there is another lurking issue—money! (back to top)

US Medical Insurance: Medical costs are a big part of that issue. But don’t think that your medical insurance (only some of which covers you outside the US) will pay up front. Even travel medical insurance rarely pays up front for anything more than a nominal amount. Although Blue Cross and Blue Shield (and maybe others) have agreements with foreign hospitals, my information is that these agreements do not apply to Medicare supplement policies. So having insurance pay up front is extremely rare; generally the policy will only reimburse you. (back to top)

Medical Costs: In our case, by the time my wife was admitted to the hospital (after the ER stay of about 9 hours), I had approximately $1000 out to the cruise ship for medical services, $1000 out to the ER, and $12,500 out to the hospital, a total of $14,500! The $12,500 was a deposit upon which they would draw as services were rendered. So, as far as I knew at the outset, the final hospital bill could be more or less in which case they would refund to my credit card–I hoped. (They actually did refund the unused portion to my credit card so that fear proved to be unfounded. That being said, I did lose about $300 in currency conversion, between when I paid and one week later when I received my refund, due to the significant inflation that that country was experiencing.) (back to top)

As I sat in my wife’s hospital room with not much more to do than think (and worry), it occurred to me that she might need a “med jet” to get home. I asked the English speaking physician about this and he said that she was not that sick but might need a medical escort home.

In one of my many telephone conversations with the travel assistance service (they were the ones who made the arrangements for the medical evacuation) that comes with most travel insurance plans (I used to believe that this benefit was of little to no value—boy was I wrong) I brought up the subject of medical escorts and how much that might cost. I knew our departure was several days away but in running the numbers I wanted to know what I might be looking at from a money perspective. (back to top)

The service called me back several hours later and gave me a $21,000 US estimate. The escort would need to be flown (along with oxygen and other equipment from the US to Argentina and then my wife, the escort, and I (and the equipment) would need seats on a commercial airliner to get back. And the seats, for the return flight, would need to be business class to provide the extra room that was going to be required. By the way, the $21,000 number did not include the business class seats for my wife and I–that would be extra. Since I had no idea whether we could transfer our existing business class airfare to the new return flight, I figured that another $10,000 might be necessary for that.

So adding it all up we had $14,500 already outstanding on the credit card and another $31,000 ($21,000 + $10,000) possible for a $45,500 potential total. And this was just the medical end of things; obviously, we had spent some money on hotel and other amenities prior to my wife falling ill. Looking down the road, I was getting worried that if we did need that medical escort, something that I actually did not know until the night before her hospital discharge, I would exceed my credit card balance limit and have the charge refused. In my mind that was simply not an option. I wanted to get her home, safely and efficiently, and a problem with rejection of the credit card payment at the last minute was not acceptable. (back to top)

How to Pay for Everything: There are a limited number of options to pay for these things: credit card, of course; or take a loan from a credit line, deposit it into your bank account, and use your debit card; or some type of emergency loan from your bank. But doing anything other than the former requires a great deal of patience on your part and assistance from the bank to get done quickly and at a long distance.

Next month, we’ll discuss my suggestions and how to protect yourself. (back to top)


This is a continuing series of articles with a number of "parts."  See Table of Contents and search for "Don't Leave Home Without Them" and "Don't Leave Home Without It"

April 3, 2016