Health Insurance and those expected medical emergencies

[Putawaywet]

Greetings everyone,

I've searched on this one but all I keep getting back are threads on boat insurance.

How does a sailing couple handle the logistics and payment for medical issues that are beyond their capabilities onboard when they are outside of U.S. waters?

I understand this could vary from country to country, but anyone have experience getting medical treatment while cruising? Specifically experience with the Canadian medical system since the wife and I have our eye on Canadian and Alaskan cruising destinations. Back in the mid 90's a friend of mine was visiting Canada and needed treatment for a broken nose along with some stitches. At that time it was cash up front before a doctor would touch him since he was a non-canandian resident. He then spent 6 months fighting with his PPO to try and get reinbursed. I can only guess this would be the norm almost anywhere outside the U.S.

Obviously, a dozen stitches or so probably wouldn't hit the pocket book to deeply, but what if one of you came down with a hot appendix, gallbladder, kidney stone, etc, and you suddenly found yourself altering course for the nearest major foreign port. If you wound up needing surgery and a couple overnights in a hospital the tab could add up pretty quickly.

Is there is some kind of international health insurance that covers situations such as these? And if so how does that work? Or is this what Visa and Mastercard are for?

Brett

[Lancerbye]

Interglobal Insurance based out of the U.K. does International Medical coverage. Mine covers for anywhere except the U.S. This is primarily because health care costs in the US have gone way out of touch with the rest of the world.

[hellosailor]

"He then spent 6 months fighting with his PPO to try and get reinbursed. "
Maybe you missed the news, but it is widely confirmed that a large number of insurers routinely deny some claims without even looking at them, knowing that if they deny 100, perhaps 60 will simply pay it on their own and never bother them. Is this illegal? Yes. Is it documented behavior? Yes. The usual response from an attorney general or DA is "Well if we prosecuted them we'd wind up closing all the insurance companies in this state and that won't work either."

It doesn't matter which form of insurance you have, you need a plan that provides "out of network" coverage. HMOs and PPOs are designed to reimburse you for using THEIR networks. Go out of network, or heaven help you out of town, and you will pay a severe penalty for getting sick or injured--if you are covered out of network at all.

Check out the Seven Seas Cruising Association (Welcome to the Seven Seas Cruising Association) for discussions of international medical insurance. Health insurance, medevac insurance, etc.

And don't feel like you are alone in being screwed by insurance companies, I have several friends who are "providers" ("doctor" is passe) and the insurers screw and abuse them regularly as well. Finding a company that doesn't play games, usually means a lot of work, and a stiff premium.

[Dream Maker]

We have been cruising for 2 years so far and have purchased and had claims twice. In both cases, our insurance company had arrangements so that we didn't have to pay anything at the hospital and the bills went direct to the insurance company.

In both cases, the insurance companies paid the bills. Sometimes, we had to forward them a copy of the bill that eventually made it to us by snail mail. We are currently with etfsinc.com as we have provincial health coverage.

Now we are in the process of changing to a different plan that is for people without provincial health coverage.

[Hud3]

We've had a couple of incidents in the eastern Caribbean.

Lynne had stitches in a private emergency medicine clinic in St. Thomas, with additional work by a plastic surgeon on Tortola. Both required payment on the spot, and we used a credit card. Our health insurance company in the states reimbursed us according to the plan provisions, without any hassle.

Last November, I had an emergency appendectomy here on Nevis. Again, I paid on the spot, in cash. The total bill for surgeon, anesthetist, OR nurses, OR, and three days in a private hospital room came to $1,335 USD. I thought that was pretty reasonable. Aetna reimbursed me for most of it. Being out of network down here, they pay anywhere from 80% to 100%, depending on what it is. I've never been able to figure out the formula, but I'm not complaining. They've been more than fair with us.

[hellosailor]

"Our health insurance company in the states reimbursed us according to the plan provisions, without any hassle."

The good guys deserve credit, the bad ones deserve brickbats. Either way...if folks would name names, it would be a service to the good insurers and to fellow sailors.