Out cruising-may need surgery

[Canibul]

You should check and see how many Canadians come to Central America for medical procedures. Rather than wait for a slot in Canada, I guess. I ran into a number of 'medical tourism' sites run by and primarily for Canadians. India, Mexico, and Costa Rica, for example.

Medicare sucks for people who don't choose to hunker down and restrict their lives to the USA. So basically it's useless to me. As are just about all of the other US "benefits" I paid into over my working career.

It's not a "mess", it's a chosen lifestyle. And NJ is the last place in the USA I lived. No thanks.

[hellosailor]

In my limited understanding:
"If your Canadian and get sick in Guatemala does your national Health insurance cover you?"
If you are Canadian and you are out of country for 6 months plus one day, you have no coverage anywhere. You need to come home and stay home to restart the coverage period. A number of Canadians have all told me this exact same thing. And their coverage apparently is like US Medicare coverage: It applies only to in-country plan participants. You want coverage? You go home to get it.


"Should medical emergency repatriation insurance be considered a part of a reasonable cruising budget?" DAN's medevac coverage was a great deal, and they've started advertising a similar "Boater's plan" because of the interest from boaters. Some fraternals like Hadassah claim to have similar plans, i.e. ~$200/year will get you and a caregiver medevac'd either home or to a suitable care location.


Considering that the closest "Class 1" trauma center in Columbia and Venezuala is Miami's Jackson-Ryder Trauma Center...I'd worry less about medevac in England or Switzerland, and a bit more in those cruising grounds where the government says "We don't have that standard of care available, anywhere."


But in the US we are all taught that we are invulnerable. We are not taught how to deal with death (beyond ensuring the IRS gets paid in any case) or mourning, or mundane matters like insurance, finance, retirement or savings in general. So why should cruisers be any different?


This would be a very good time for the OP to prepare some paperwork, in case they don't have it, and before it may be immediately needed. A Living Will, Health Care Directive, Financial/General/Medical Powers of Attorney, and to ensure the boat ownership is in BOTH names or other provisions are made in writing, just in case the boat has to be moved or anything else done that officials might get picky about.


Blank forms for all of those, conforming to your "home" state, are available on the web. In a US hospital, you will be asked for all of them these days, along with HIPAA releases. Things go a lot faster and smoother if you have them already on hand and filled out, notarized or certified as needed. (I even had one idiot tell me I needed to fill out a HIPAA release to get my own records. He swore that their legal department said "everyone", even though the patient themselves is entitled to all records, all the time, without further obstruction these days.)


And one hopes you never need them. Resist panic, get the paperwork out of the way, and good luck!

[JPA Cate]

Originally Posted by zeehag

lithotripsy. busts up the stones so they pass thru the ductus.
has been tried in cedars sinai med center in late 80s, when i worked there. -- research and see if this noninvasive proccedure is do able for you. it should open a whole new door ... best of luck and research the hellout of this before you go under knife.

meanwhile--No FAT diet. NO fat. none.

svdestiny,

Maybe zeehag and donradcliffe have just given you a plan D & E, which could really help. Would it not be wonderful to avoid surgery entirely?![By the way, donradcliffe's admiral is also a nurse, and she tried the least invasive treatment /most conservative one.]

I know no fat means one gives up a lot one enjoys, but it seems a worthwhile experiment if it will make your husband's gall bladder healthy again.

Good luck, guys.

Ann

[Capt Phil]

Originally Posted by Time2Go

First off I wish the folks on Destiny the best of luck in a difficult situation.
However I have to disagree with Phil here.
To some degree the mess was of their making.
These folks would be covered by Medicare if they were in the states
and this would be a non issue.
But they left their home country without a plan for just the situation that arose.
Are they alone? chime in here sailors not from the US.
If your Canadian and get sick in Guatemala does your national
Health insurance cover you?
Should medical emergency repatriation insurance be considered a part
of a reasonable cruising budget?
When I crew abroad I always have it and sometimes I have to prove
it or I can't step on the boat.
Once again I hope it all works out for the folks on Destiny,

Barcelona

I can only relate what I know from Canadian surgeons who are personal friends.
It is their experience that wait times for elective, non-immediate, life threatening surgeries in Canada can be lengthly. It is not uncommon for these patients to travel out of country for procedures and the Canadian/provincial health plans pay the going rate in the country in which the surgery is preformed.
For example, someone with a heart condition who would benefit from say a valve replacement but isn't going to die tomorrow could get treatment paid for out side the country. I personally know of 2 folks who went from Toronto, Canada to American surgeons for non-life threatening but needed surgery and their OPH (Ontario Provincial Health Services) paid off like a cash register for the US medical procedures.
My heart goes out to the folks aboard S/V Destiny. But they should not lose hope... There are many fine surgeons all over Central America, many of whom are trained in the US, Canada or Great Britain and are far less expensive than US doctors who have very high costs associated with their practice. Phil

[Capt Phil]

Well Said, Hellosailor! Cheers, Phil

[hellosailor]

The lack of Medicare's "global" coverage may suck, but that's not entirely Congress's fault. Medicare is a negotiated participant plan, like any other insurance or "franchise" arrangement. Medicare participants agree to accept certain patients, and certain fixed payments, in exchange for being bound by a sheaf of regulations (like the secret Medicaid billing numbers, which must be purchased and applied correctly or else claims are denied and sanctions may be levied) as well as some benefits.


To a foreign practitioner, all that paperwork and overhead in exchange for the chance to accept what is essentially "insurance" for some rare foreigners? Couldn't be worth it. Even ignoring the fact that it might raise complications with their liability under US laws rather than their own.


So I can't say the situation isn't actually quite fair and logical from both sides.


Now, if Congress said "We're going to be generous to recipients, and just pay whatever costs they incur, globally, for all sorts of stuff...." that would be nice, but then the bulk of the voters would say "WTF? They're rich enough to go traveling, their rich enough to pay for their own global expenses!"


That dog ain't gonna hunt. Yes, if you can afford to go vagabond and OWN something like a boat instead of living in an SRO...many people consider that to be rich, far richer than they are. Either way, it is a well-publicized lifestyle choice. Medicare makes no secret that coverage stops at the border, you can always come home to get it. More generous than Canada with their "six months and you're off the list" policy.


Some countries with "universal" medical care used to provide equal free medical care to any tourists under many circumstances. But, again, voters have usually said "Ah, no, if they're rich enough to travel, they're rich enough to pay their own fare."


I expect that as medevac insurance becomes more widely known, the price is going to skyrocket because of the way some folks have taken advantage of it--and the generosity of the better providers.


Now, if only hospitals (even here in the US) would aim at higher standards. Most of them still don't understand basic hygiene, much less the past hundred years of labor studies, all of which indicate that 12-hour shifts raise error rates by 50%. And they all cling to 12-hour shifts.

[zeehag]

dear destiny.. a few years on back i was eating some smoked oysters right out the can during my lovely snack i developed horrible hot burning pain along my diaphragm, and stopped eating. this pain lasted a hellova long time---1hour--
and as i am a self treater rn from hell, i ceased and desisted my snacking on smoked oily oysters. that helped. dammit.
and i gave up fat fro a year. omygods was that hard. i cried. i didnt wanna give upmy cherries garcia.. that sucked. so when my year penance was done, i ate ice cream and didnt die. someone had sed cider vinegar-- did some of that and just waited. if i was blocking a ductus, the blockage se fue. if i was trying to pass sludge, it went se fue.
no pain no mas. i hope yours fixes like that also. (mine only hurt with smoked oysters... gggrrr)
out of curiosity did they do a test of enzymes in blood?? they call it a cardiac enzyme panel. i was wondering if there was an elevation of one of the enzymes due to necrosis, if not, you may be ok without surgery.if so, may want to consult a local md and discuss this issue with that local md.

[Svdestiny]

Ok thanks to all who have posted. i do accept responsibility for our situation. I realize now that we will handle it as best we can, and on our own

[sv Winterlude]

There are excellent private hospitals in Guate City - a friend had 12" of his colon removed in an emergency and another friend had rotator cuff surgery. In both cases, their total $$ was less than they would have paid to fly back to the US, pay their deductibles etc. Both had nothing bad to say about their care or the facilities. If you want, I can find out the name of the hospital they used. Let me know.

[Canibul]

Originally Posted by craftconn

I'm disappointed that the OP has received so many unpleasant responses. Even people who don't directly insult her, feel comfortable giving their opinion as the only possible option (never mind that they are all different, they are all sure they are right).

S/v Destiny, are you a member of the FaceBook group Women Who Sail? If not, I highly recommend that you join, and ask your question there. You will find people who will genuinely try to help you, instead of grandstanding. You will need to have an account of your own, not a joint account, but it's free and simple to create one if you haven't already.

Destiny, this is actually very good advice for you. There have been many times when I wanted an honest, informed opinion about something that I have asked my wife to run it by the WWS. It's a different crowd entirely , and you're really going to appreciate it. Experienced seamanship without the testosterone.

I'd join it myself, if I could, but I'd have to do a Caitlin.

[achil]

Originally Posted by hellosailor

Pat-
If you just pick an ER, and you are not in crisis, you may not even be admitted. You may be told to go see a doctor at home. Even if you are admitted, there may be co-payments and other expenses (Medicare doesn't cover everything fully) that using the normal process would not incur.
Not to mention, if you go in through an ER and they say "OK, we're doing this tomorrow" you get whatever surgeon is on shift tomorrow--not a surgeon that you've chosen for their skill or manner. (And if it is a teaching hospital, no guarantee that the listed surgeon actually does the procedure, a student may.)
Something to think about.

True, they could turn you away, but if the situation is explained to them chances are they will not, or, see you in a clinic within the hospital. If Medicare is the only insurance, it goes without saying, there will be a co-pay. However, I thought the op said they were saving some money for the surgery? When it comes to doctors or surgeons I doubt there are many on this list that are qualified to rate either.

Many years ago I walked into a training hospital with severe pain. When the doctors and surgeons stopped arguing over what the problem was-not sure if they really did- but the surgeons won out, I got the best care I could have got anywhere in the Country. The people make the difference. I still remember how dedicated and caring they were, especially the nurses.

To the op. Good luck wherever you decide to go, it is not an easy decision, especially if money is a concern. You may want to look into natural remedies. At this juncture you have nothing to lose and everything to gain.

[svzafarse]

Guatemala has an excellent health care system do not be afraid to avail yourselves. Antigua has a English speaking rep who will steer you in right direction . Google it. Lots of older cruisers have hip replacements and other surgeries in Guatemala for a fraction of the cost in NA


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[nknowland]

Read the post more carefully. They are on Medicare. I think part of the issue is that they don't want to pay out of pocket. They want medicare to pay (aka US taxpayers). This has nothing to do with the Affordable Care Act.

[belizesailor]

Originally Posted by nknowland

Read the post more carefully. They are on Medicare. I think part of the issue is that they don't want to pay out of pocket. They want medicare to pay (aka US taxpayers). This has nothing to do with the Affordable Care Act.

Total cost in Guate is likely to be less than out-of-pocket under Medicare.

[model 10]

Originally Posted by belizesailor

Total cost in Guate is likely to be less than out-of-pocket under Medicare.

I just got on medicare and I am going to trust Guatemala's health care for the half year we live near there. It would cost another $150 per month to have a medicare policy add on that would cover foreign travel. It's not worth it, I can fly home for brain surgery.