Long-term readers will recall my medical event almost a year ago in Spain. Three posts addressed the event, here, here, and here. Medical insurance was mentioned, but a financial resolution was not. I paid twenty thousand dollars to a Spanish hospital; was I ever reimbursed? The answer was not to be found in this blog until now.
Disclaimer: If you follow this blog as a travelog, I will forgive you if you skip this post. There are no pictures. There’s no new territory to explore. On the other hand, some of you are interested in the practical elements of full-time travel: finance, transportation, preparation, and insurance. To paraphrase Anheuser-Busch, this post is for you. This is a log of my traveler’s medical-insurance events, from inception to resolution. May they rest in peace.
Another disclaimer: My insurance policy is a MediCare supplement. It is not an insurance rider of some sort, nor is it travelers’ medical insurance. Long ago, when I applied for travelers’ medical insurance and listed all of my pre-existing conditions (three heart attacks, numerous strokes, chronic hypertension), I could almost hear them snicker at the other end of the email. My application was politely declined.
April 22, 2013: In Spain, a sudden severe headache sends me in search of medical care. I am hospitalized and require brain surgery (hat’s me in the Spanish hospital pictured above). Medications from the brain surgery provoke a heart attack a week later. There is more surgery, but I’m cleared for release in early May. The hospital bill is $20,000 US, which I pay personally.
June 4, 2013: I submit a $20,000 claim to my insurance carrier using their online claim form, requesting a wire transfer of the cash to my bank account. The wire transfer option is the first option listed on the form.
June 18, 2013: I submit another claim form for $497.88, to cover four follow-up appointments at the hospital.
August 21, 2013: I email my insurance carrier asking if there has been any progress on my two claims. They respond by saying that yes, they did receive the claim, but “due to the fact that the direction of pay was a wire transfer, the claim was stalled.” (You’ll recall that a wire transfer was the first payment option available on the claim form.) They also say that, “A further review of our records indicate that we have received returned mail. On June 18, 2013, we attempted to call you at [my discontinued US phone number], which is no longer in service.” This delay, to my mind, was reasonable. The only one.
My initial email was sent via my personal email account. All the rest of our communication transpired via a secure email network that was operated by the carrier.
August 22, 2013: I write back, explaining that we don’t have a permanent address or phone number, that we’re vagabonds, living a life on the road. This may have been an error.
August 22, 2013: The insurance carrier responds by saying, “At this time we are looking into the demographic changes given.”
August 27, 2013: Another note from the carrier: “Please note that your permanent address must be inside our service area in order for you to be a member of [my insurance plan]. You may request that we send mail to you at another address outside our service area. You may also temporarily reside for up to 12 months outside our service area and remain a member….” They also indicate that they had sent a “residence verification letter” to my daughter’s address in Portland, which is the address I have been using for paper mail. The residence verification letter must be hand-signed.
August 30, 2013: A $432.54 check to cover the June 18th claim arrives. My daughter deposits it into my account. No mention is made of the June 4th $20,000 claim.
September 11, 2013: Louise and I have returned to the US for the month of September. I collect the residence verification letter from my daughter, sign it, and send it back to the carrier.
September 13, 2013: An email from the carrier says, “The international claim…has [been] processed and payment has been sent to you….” Hallelujah! The check is in the mail!
September 25, 2013: No check has been received. I inquire politely.
September 30, 2013: The carrier emails to remind me that a check was mailed August 30th, 2013 and cashed. Well, that’s true. See above. A check. Not the check.
October 1, 2013: I respond to the email above by saying, “I submitted a much larger claim (in the neighborhood of $20,000). That’s the one I am inquiring about. Any news on that one?”
October 2, 2013: Their reply, “Our records do not indicate a second claim…. We are researching this issue….”
October 4, 2013: The carrier asks me to resubmit the June 4th claim. Miraculously, although I am now living in Mexico and three prior countries of residence have passed, I still have the original claim in my suitcase and am able to copy the form and comply with their request (see below).
October 7, 2013: I email an electronic copy of the original claim form and receive a thank-you note from the carrier a few hours later. The note also contained my favorite line from all of our correspondence: “It is possible they missed the facility bill….” (“They,” in this context, being another department of the carrier’s office.) In other words, the carrier is saying that they have been completely ignorant of my $20,000 claim since its inception, in spite of their statement August 21 saying that they had received it.
It’s interesting to note that this email was deleted from their system soon thereafter. None of the other emails were. Fortunately, I made a copy for my records before it disappeared.
January 9, 2014: Three months pass. I email the carrier again, asking if there has been any progress.
January 10, 2014: The carrier replies saying that they have sent mail to my Spanish hospital asking for copies of all my records and that the hospital hasn’t responded. Their email concludes by saying, “The claim has been denied at this time due to ‘requested information not received.'” DENIED! In Mexico, it was time for a margarita.
January 13, 2014: I email the hospital myself, requesting my records.
January 14, 2014: The hospital emails back within 24 hours, saying the records have been sent to my daughter’s address. Quite fortunately, my daughter was scheduled to visit us in Puerto Vallarta soon thereafter, and when she does she brings the records with her.
January 28, 2014: I scan nineteen pages of hospital records and email everything to the carrier.
February 25, 2014: An email from the carrier: “We have completed processing of claim [number redacted] for date of service April 22, 2013. A reimbursement check will be sent to you….” I email my daughter, telling her to be on the lookout for the money. In Mexico, it was time for another margarita.
March 5, 2014: An email from my daughter in Portland says: “The check has arrived.” She photographs the check and all the accompanying paperwork, attaches the photos to an email and sends it to me. The check is for $10,649, $9,750 short of the $20,399 I paid the hospital. Almost all of the unpaid claim is for hospital room charges.
Naturally, I’m perturbed. I ask a friend — he has been in the insurance business for almost fifty years — to look everything over. He explains that the overseas section of my policy promises to cover “emergency medical costs,” and that most of the room charges were not emergency in nature. To paraphrase my friend: “Nine thousand dollars to have people save your life — twice — seems like a bargain to me.” He’s right, as he usually is. That’s why I called on him to help.
March 21, 2014: I ask my daughter to deposit the check and the matter is closed. Total time required from my original claim submission until payment: nine months.
Regardless of the nature of one’s coverage — Medicare supplement, travelers’ rider, or travelers’ medical — anyone embarking on an expat adventure such as ours had best have either a ready line of credit or plenty of money in the bank. Hospitals in far-away countries do not like to collect from American insurance companies (I can’t imagine why), and some hospitals, like mine, will not release you until you’ve paid in full.
To be specific: Have money in the bank, be monastically patient, and be prepared to ask how high when they tell you to jump.
In this post, I listed some of the things we miss the most by not having a permanent home. I omitted one important item: a nearby in-network medical facility. Having brain surgery and a heart attack was bad enough; the added insult of pursuing a lengthy and expensive insurance claim was simply tyrannical.
Adventure is a wondrous thing. Most of it.
Rick Pullen said:
Unfortunately, what you went through is the norm. That’s why people hate the insurance industry. I can’t speak for your individual insurer, but the industry makes a habit of paying very slowly when it can get away with it. As long as the carrier doesn’t pay you what it has promised, it can invest your money.
You are right about one thing. If you travel overseas, have a good line of credit or plenty of access to cash. Who would want to deal with what you went through?
Thanks, Rick. I truly have no idea what would’ve happened if I couldn’t have paid the $20k bill on the spot. Hospital food forever? Put the hematoma back? Regardless, it’s best to have the money (or the credit) at hand.
Brian Gruss said:
Thanks Rick for your post. The expat life has been intriguing me for the last couple years, and have started reading more about it. I like your friend am an insurance agent. I would like to impress upon your readers is yes I believe if you give a insurance carrier a chance to wiggle, they will wiggle (delay paying claims). Asking your agent an abundant amount of questions when buying the policy, as well as reading the wording of the policy when it arrives and maintaining a working relationship with your agent, would have changed not only the outcome of your claim but the time line as well.
In insurance you are passing on your risk to an insurance carrier, carriers write the language of what risks they will accept and what they will take a pass on. Kind of like going to a foreign city, and choosing not to go to “that part of town” due to crime or another factor.
I’m glad you got this all wrapped up, and can know enjoy your future excursions.
Brian, Funny thing: I have always used an independent agent in all my insurance dealings. Always. But this time around, although I tried to use my agent, the carrier employed their own agents, and they were the only supplement carrier with out-of-country coverage. As it was, it was my friend the agent who helped me understand the situation and helped me with that sage perspective about money and life. I am the independent agent’s staunchest advocate.
Tom, you have experienced and lived through the nightmare that every long-term traveler hopes and prays will never happen. This experience would be difficult enough in the US, but in a foreign country with language problems and uncertain processes and procedures, it’s hard for me to imagine. It must have been excruciatingly difficult for both you and Louise. I sometimes wonder about solo travelers, and if they realize the implications of being truly own their own. I contracted dengue hemorrhagic fever in Central America, and literally crawled back home to Terri in the US on my own. It was one of those “I didn’t see that going that way” moments. The Nietzsche quote comes to mind, but I’m sure that you wouldn’t have minded missing this experience and being a bit weaker. Welcome back and good luck on the next phase. ~James
“That which does not kill us makes us stronger.” My Spanish experience overwhelms me with ambivalence. I made so many good friends; I came to appreciate — honor — so many people; I saw a caring hospital staff that has revised my view of hospital staffs forever. On the other hand, I had a visit, however brief, with Death, and that wasn’t particularly pleasant. So it didn’t kill me, and I *am* stronger. But would I do it again? Let’s have another beer and talk about it.