Broken leg, need 2 surgeries without travelers insurance, should we get her home asap

[sailorcherry]

Hi experienced cruisers, I need your help - please!

We are actually not aboard cruising at the moment but instead on a family vacation halfway round the world. My mom had a bad fall (not the first time, she has brittle bones, poor balance etc) and they did not buy travelers insurance. Now they are looking at a $40k+ (usd) bill for surgery (in two phases). She fell and snapped her leg bones (open) above her ankle. First surgery is done (sewed the bottom end back on, idk enough details yet). And in about 3 days they want to do the more comprehensive (and expensive one).

There is a chance the doctors here would be okay with her travelling home (business class) and doing the main, second surgery back in California where they live and have Medicare part A and B and feel more comfortable with the setting, screws/plates being done there versus the hospital they are at.

Does anyone here know if this is possible? Will Medicare cover a surgery (this 2nd part) for a medical emergency that's happened outside the US?

Thanks a lot!

[s/v Moondancer]

I have a Medicare supplemental policy that I chose because it provides $50,000 of medical care outside the US but generally Medicare will not pay for care outside the US.

My policy is $300/month more than a standard supplemental.

[Suijin]

Originally Posted by sailorcherry

Does anyone here know if this is possible? Will Medicare cover a surgery (this 2nd part) for a medical emergency that's happened outside the US?

Insurance companies don't care where something happened, they care where you get treatment. I suspect that it will be covered. The only complication I can see is if a problem is found with the first surgery, but I'm guessing.

But I suggest you call them, talk to them personally and describe the specifics, and get a definitive answer instead of getting medical insurance advice on a sailing forum. I'm not being snarky, just want to make sure you get the best information possible for your mother's circumstances. Call Medicare in California.

[leboyd]

This is a somewhat unique situation. As stated Medicare will not pay for services OUTSIDE the US. However, what you are asking is whether they will pay when the service is INSIDE the US, but the injury was OUTSIDE. AFAIK, and my experience with my clients, is that the only stipulation is with where the services are done, not where the injury occurred.

For example, let's say you have both surgeries overseas and return home. However, after a couple of weeks you find out that one or both of the surgeries were unsuccessful. Medicare would cover her. Therefore, it's highly likely that she would be covered in the US.

I would recommend having someone in the US call Medicare for you and specifically ask. But I would lean towards the answering being that she would be covered.

[sailorcherry]

Thanks to all, cruising community fast at work, to help as usual!

Yes they have a medigap policy and it isn't cheap either, I wanna say 250/300 each/month?

Moondancer, they have Plan F. Per the pdf I downloaded it offers it.

I am here at the hotel with just wifi while they are at hospital. I have my sister in the states making the calls to their Cali provider. So far she is receiving recordings saying they are closed for the weekend. Alrighty?! Anyway, the foot was about severed, it's not a heart attack type emergency but surely this is a major enough emergency for coverage (80% foreign travelers coverage within 60 days travel is what I read).

I really don't want her and my dad doing the flight home, I fear risks while traveling and the care should be just as good as at home in our experience thus far (she has had back and hip surgery here already). The transfer time and flights from the Med back to Cali is a long haul, couldn't even imagine that just a few days after what she went through.

Really appreciate the quick responses guys and gals.

[s/v Moondancer]

I am glad they have F, which is what I have.

The danger of flying with such an injury is a Deep Venous Thrombosis which can cause Pulmonary Embolus.

If financially possible the surgery and recuperation should be completed before flying.

[Paul L]

. Medigap coverage outside the U.S.
If you have Medigap Plan C, D, E, F, G, H, I, J, M or N, your plan:
Covers foreign travel emergency care if it begins during the first 60 days of your trip, and if Medicare doesn't otherwise cover the care.
Pays 80% of the billed charges for certain medically necessary emergency care outside the U.S. after you meet a $250 deductible for the year.
Foreign travel emergency coverage with Medigap policies has a lifetime limit of $50,000.

.,.....

[roverhi]

Don't know where you are at or how complicated making connections for a flight back to USA but for $40,000 would buy two first class tickets and fly her and your dad back to the States. She can be immobile in a nice first class lounge chair just as well as she can in a hotel or wherever they are staying now. If the leg needs to be elevated or supported with a lift, see if you can buy a suitable support and use it on board. There are few complications associated with such an injury beyond the surgery. If it was a compound fracture, infection could be a problem but that should have made itself known by now. Sounds like she'll be in a cast for a long time while here porous bones knit back together. If they are going back home, they are going to have fly at some time with her still incapacitated.

[boden36]

You should also check whether the airline will fly her in that condition. I come from an isolated island and the airline has refused to fly injured persons in the past.


Regards,
Richard.

[KWISPEL]

We had a similar injurie in Vietnam. De States was very expensive for here and after contact whit doctors in Europe and the states did we the operation in the FV Hospital in Saigon. (Vietnam) The price was great, service amazing and on the end was the operation compleet wat we where hoping.
The Doctors where great, spoke all good English, where well educated and where before all working in Europe, ... .
They had 2 different prices for with and one without insurance.

The French islands have mostly also good hospitals but I am not sure that they are willing to help you by medical tourism !

Big question, where are you and are you abel to fly?

Send me for more info a personal message with your phone number.

[Dave22q]

Those prices ($40,000) sound very American. Your not talking heart transplants. If they are the local prices I think you need to do some research. There are many countries that offer quality care at a fraction of US prices. Where are your parents now?

[BandB]

Plan F will pay up to $50,000 emergency care but there are very defined requirements so talk to her insurer about what the rules are. Note that the $50,000 is a lifetime limit. Also, how long had she been on this vacation travel? If over 60 days, Plan F doesn't pay. It also only pays 80%. If the doctors say it's safe to travel, I'd get her home. If not, then work with your insurer to be sure her care is covered.

[belizesailor]

Originally Posted by Dave22q

Those prices ($40,000) sound very American. Your not talking heart transplants. If they are the local prices I think you need to do some research. There are many countries that offer quality care at a fraction of US prices. Where are your parents now?

That was my thought, sounds like USA prices.

OP: where are you?

[Christopherlour]

I live in Mexico and prices here for many medical procedures are often equal to the co-payment for Medicare plan B. The main problem with pricing: seems to be with price gouging of foreigners in the resort areas. Staying well hydrated on a long flight is always the best suggestion.

[buzzstar]

Originally Posted by sailorcherry

Hi experienced cruisers, I need your help - please!
....

Does anyone here know if this is possible? Will Medicare cover a surgery (this 2nd part) for a medical emergency that's happened outside the US?

Thanks a lot!

Assuming her Medicare A and B payments are current, it is my understand thet it will pay for procedures done here. BTW, if you have the opportunity, ell us where you are. Most, or at least many places, have medical costs far, far, lower than here in the USA, and there are the do pays to consider with Medicare.

What ever is decided, bet wishes for a speedy and full recovery for your mom.