Where to Get Seriously Ill?
 

I have traveled all over the world, but have never encountered the following scenario. I am very aware of insurance options, evacuation back to the US, etc. I have excellent US insurance which covers problems in foreign countries.

But, what happens if I become seriously, even terminally, ill in a foreign country? I understand that this varies from county to country, but let's use France and Italy as examples. How do those countries handle such situations? Who pays for care? Supposing one's condition is terminal- do they throw you out to avoid the costs or do they let you remain and just accept insurance payment?

It is exceptionally unlikely you'd be turfed out if SERIOUSLY ill (ie brought in an ambulance) most western nations in the world, and especially those with public health care plans. The Hippocratic oath is what it is.

They will "bill" your insurance company if you have one and they accept it. In some cases it's too much hassle and they just don't bother. It depends on how much help you need. If it's serious and big money they can also bill your estate if you die.

For example, in Australia we had insurance and my wife saw a doctor but he said it was too much work to bill the foreign insurance companies and just to forget about it.

I had an ear infection in the UK and asked to see a doctor and the answer was the same; here's your prescription, appreciate the offer of insurance but not worth it.

Why would they deport you? If U.S. insurance is going to pay, they'd probably make money off the deal.

Say you're in intensive care, and U.S. insurance pays $5,000/day (that's a low estimate of cost - ICU can cost $10k+/day). Healthcare in most of the developed world costs half of what it does here in the U.S. ($2,500/day for the same services) so bingo -- 100% profit.

When I get sick here in Korea, I can see a doctor for pretty much anything, and I pay ~7$. I have insurance, I can send my Canadian insurance the receipt and I get about 75% of it back.

My friend recently had wrist surgery here, and he paid about 1,000$ out of pocket, and that included the an ambulance ride, surgery, an overnight in a hospital and a bunch of follow up visits.

That's not quite how most US insurance works. Many - if not most- US based insurance requires tons and tons of paperwork to be filled out for reimbursement. And most require American specific diagnosis codes and treatment codes before they will pay out ANY money. Foreign countries do not use this system or have access to the codes. If the foreign hospital DOES manage to file a claim that will be paid, then the insurance company will only pay actual costs, i.e. you can't inflate the cost just because they may pay more.

So foreign health care runs on a completely different system. The trouble of taking people hours and months and months to maybe collect monies is probably not worth the effort to try and file insurance. That is why most require you pay up front and then you file an insurance claim and try to collect.

I actually did get seriously ill in South Africa. I was pregnant and began to miscarry on the day I arrived in Joburg. I went to the ER, twice, then was seen by a gyn/ob who diagnosed the end of the pregnancy. I was admitted to the hospital overnight and had a D&C the next morning, then was released.

I paid everything up front with my Visa credit card, got receipts for everything, then submitted the receipts and currency conversion rates to my insurance company. My own insurance company paid promptly, probably because the total cost of care in South Africa was a fraction of what it would have been in the United States. ($839 vs $4-5k in the US)

The lady in the bed next to me told me she was a South African citizen, but living in Virginia, USA. She actually traveled back to South Africa for her hysterectomy because the cost of medical care was so much lower. She could stay with her parents during the recovery period, then return to Virginia.

Some years later, I came down with severe tonsillitis in Germany. I saw the doctor, paid with my Visa card, and again submitted the paperwork to my insurance company back home. I was reimbursed promptly.

In both countries, South Africa and Germany, I was impressed at how quickly I was seen and by the high standard of care I received. The German doctor was great, and all the doctors and nurses I saw in South Africa were wonderful.

ETA: I'll note that this wasn't some "friend of a friend". It happened to me, Yours Truly.

I got seriously ill (may have actually been terminal had I not sought treatment) with botulisim in Northern Ireland. Went to hospital, got treated, stayed 4 days. $20 administrative fees. But I hold an EU passport although I am American.

Fewer and fewer overseas health care providers will bill US insurance for you and most require you to pay and then submit for reimbursement. The reason is that US insurance companies require paperwork which all USA health care providers can at least understand and most can readily process (although a growing # won't).

The real issue arises when you need care which either cannot be provided locally or cannot be provided up to par locally and you need an airlift out. Depending on where you are and where you are headed, that can run over $100K.

If you travel a lot, it's worth having all of this figured out in advance: 1) what, if anything will my existing health insurance pay? 2) what other options are there through my employer (many policies designed to cover work-related travel only, actually extend to leisure travel as well under certain circumstances); 3) should I purchase individual trip insurance, an annual policy or something inbetween and what exactly do I want covered?

Excellent answers all. I am familiar with Australia, having lived there for three years, and my daughter just came back from South Africa where she, too, had a life-threatening allergic reaction to something she ate.

I was thinking more of a diagnosis of something longer lasting- e.g., a cancer or something similar. Suppose one just wanted to stay in place and get whatever treatment is available to locals rather than return to the massively expensive US. I have lived in Peru and know some people there. Other than visa issues (which can be handled in a variety of ways), is there something I am not thinking of that would prevent me from just deciding to "ride it out" in such a country?

Wouldnt the worst place in the world for a foreigner to get seriously ill be the USA?

If I were diagnosed with a terminal disease, I would think I would want to get back home to be with my family in my final days, and be around my doctors who know my medical history better. Might want to even get a second opinion - who knows what another doctor might say. My grandmother was diagnosed with terminal breast cancer in the early 1980s and lived until 2009. Talk about a crappy diagnosis.

Why do you think that? People come (illegally) from all over the world to receive our top-notch medical care.

An excellent point and one I have considered. I watched my father go through the entire course of Alzheimer's over about 7 years and there is no way I would want my family to go through a similar experience. I know from my conversations with him, that he would not have wanted it either. Yet, often things just follow a certain course when no advance preparations have been made.

I have contacts in several countries, speak a couple of useful languages, and would prefer to do the family bit when I could do so in a meaningful manner. The diagnostic issue is a real one, but for purposes of this discussion I would prefer to skip over it.

It appears that there is no one place where conditions are conducive to this option. I guess the best place is where one is comfortable and can participate in care.

PBQ: It's not that foreigners come here illegally for "free" medical care. Most of them are already here working for cheapskates who don't want to hire legal workers.

It's that our emergency rooms are required to treat all comers, which is a huge waste, since the uninsured come in for ailments that are not true emergencies (strep throat, etc.) However, if the hospital can find you, they will require you to pay at a higher rate than they charge an insured patient. Before the collapse of the housing bubble, most bankruptcies in the U.S. were due to exorbitant medical bills.

In addition, if you are uninsured and are diagnosed with cancer or another life-threatening ailment under this system, they will not admit you for surgery and/or chemo unless you can show an ability to pay or unless you can qualify for charity care, which is not easy.

The illegal immigrants get "free" care in effect because they use fake I.D.s. But they do not get high-quality care.

I am only familiar with the rules in my country. Here, all residents - also temporary residents like expats and exchange students receive free health care. Non-residents, i.e. tourists will receive free emergency heath care and released when their condition has no emergency status anymore. They will have to pay for repatriation themselves via insurance.