How my trip changed in a blink of the eye
 

Fully flat bed, 21” screen with 20+ channels of entertainment, amenity kit with cool stuff, slippers and pj’s plus robe, more than 30 items on the menu, 3 kinds of tea, etc. Sounds like CX or JL first class long haul flight. Not really. The above describes my 2 day, unscheduled stay at Raffles Hospital just after this year’s SIN FT DO.

As I was saying farewell to the last remaining FT’ers in Singapore on Monday morning, I noticed an oddity in my left eye. I am sensitive to eye health since I had a tiny tear in my retina nearly 10 years ago. While en route to the tourist kiosk for some info, more changes to the vision in my eye occurred. After some minutes of indecision, I finally went to the hospital emergency department at Raffles Hospital. Luckily Raffles Hospital has a special eye center, but I had to wait until 2:30 before I could go there and wait for an examination. Go eat lunch the staff said. Always an emphasis on eating in Singapore.:D The ophthalmologist diagnosed me with a detached retina and wanted to operate that night. Returning to the US was not an option since repair has to be done with 24 hours of detachment without a loss of vision. Within 12 hours of the first symptoms of vision problems, I was being wheeled into the operating room at 11 PM for a successful surgery to repair my detached retina.

After the initial shock of needing an immediate surgery, the next step was figuring out the financial arrangements. The hospital provided me an estimate of $17K SGD. Normally, a deposit of 25% is required for hospital admission, but this estimate was so high that payment in full was required before admission. I did not have any special travel medical insurance since my health insurance has international coverage. My first step was calling the Blue Cross Blue Shield worldwide number. That service indicated that a direct payment to the hospital might be possible if my benefits could be verified with my health insurance, but they needed at least 24 hours. I tried to calculate the amount of credit I had on my credit cards as a fall back option, but was a little short. The hospital was adamant about full payment before admission. I was running out of options.

I next remembered a benefit of my membership in a business group. I had access to the services of Assist America. I called them and explained the situation and my actions so far. With their help they were able to convince the hospital to accept a larger, but less than full payment before admission and the surgery. Assist America medical coordinators were going to get Blue Cross and Raffles hospital to arrange the necessary payments while I was in the hospital as well as coordinate with my family relatives. After 3 or so hours of frantic phone calls, I was admitted to the hospital for emergency eye surgery 2 hours later.

Later that morning after recovering from the surgery, the saga continues. Assist America was able to do a conference call between my brother and me regarding payment. Because of the MLK holiday in the US, Blue Cross needed another 24 hours for verification of benefits. The hospital expected payment of all outstanding balances upon discharge. They would not accept a payment from Blue Cross 12 to 24 hours after my discharge. Meanwhile, my doctor kept me in the hospital an extra day due to the circumstances of my situation. The end result was that a credit card authorization of my brother’s credit card would help pay for the final bill. A claim for expenses to Blue Cross would be made after the fact (and has been submitted just before the 2 east coast blizzards).

One positive note during my SIN trip was the front desk manager at the Conrad Centennial. I was on a 6 night award stay that ended 1 day before my flight departure with the Conrad ‘sold-out’ the last night of my stay. I planned to go elsewhere that last day, but that was before my hospital stay. I discussed my situation with the day manager (her name was Mai or May, not sure). She was able to allow me to stay in my original room at a reduced rate since no award inventory was available. Whether my gold status with Hilton made a difference is not known. Having a place to ‘go home to’ after my hospital discharge was a relief.

Being alone and in shock with a medical problem in a foreign country obviously affected my actions, but what should I have done differently? I’m still unsure what would have transpired if I had not been able to access the resources that I did use. I do know that I will buy special travel insurance if only for the 24/7 access and coverage.

Wow! Sorry to hear about your troubles, that is quite a story. Not the usual trip report by any means. I hope the payment issue works out with your health insurance company. Isn't dealing with them simply divine?

Hope BC/BS steps up and covers the claim quickly ... scary to be in a funds first situation without the availability on hand and your health at stake. I'm glad to hear it all worked out well for you and hope you're recovering well (and get over that headache) !!

Glad you're doing better. It can be weird being ill in a foreign country. I broke a leg in Cambogia and had to spend a little time in BKK General.

I'm actually a little surprised BCBS covered you with that pre-existing condition. You should be very careful about what claims you submit. They'll be looking for rescission to deny your claim and you may come out ahead by paying your bill directly and not seeking an insurance claim.

Don't be surprised for a legal fight. After all, they do need to take care of their shareholders before paying claims. They're a for profit company after all.

Hope that you are recovered.
 

You raise some excellent points in respect to foreign travel. As you know, your situation was one of two known serious medical issues during SINDo 2010. Additionally, while in Kuching, I was approached by two attendees to see if I would be willing to arrange medical evacuation for another individual who they suspected might need it. Fortunately, that person did not require my intervention.

It is absolutely imperative for a comparatively small amount of money that travelers have medical evacuation insurance. Since most of these policies also include at least some medical insurance, what you encountered probably could have been eliminated. These travel insurance policies have contact numbers (and presumably skilled personnel) to deal with the issues you encountered.

Having now taken groups across international borders between Singapore and Indonesia (2X)/Malaysia, I've come to the realization that despite feeling confident that dealing with the logistics involved could be accomplished, I (as a non-paid unofficial volunteer) have no desire to assume responsibility for people who do not have insurance. Should I do future cross border trips, I shall insist that people provide proof of evacuation insurance as well as abiding by a few very simple rules.

1. Absolutely no photography in any security zone.
2. Respect the culture and mores of the country visited in respect to dress, simple business relationships and potentially offensive actions.
3. Realize that being a foreigner does not exempt one from the laws of the country visited. Those statements on entry cards concerning the death penalty for contraband are intended for all. The signs in arrival halls signify the same consequences. When in a group one's actions may impact the other innocent members of the group.

Hopefully, you will get prompt repayment of the amounts expended.

Like magicsampras said - WOW! I'm sorry to hear about your ordeal. At least you were in Singapore, and you were able to get the problem fixed before it caused permanent damage. Kudos to the Conrad for helping you out with accommodations.

Given how rarely events like this happen, I don't know that you could have done anything differently except for the obvious -- have a line of credit available in case of emergencies, and have backup source of insurance or advocacy to help you out.

Are you feeling okay now?

Im glad your ok. Good to know about the Blue Cross delay, as it's one of my concerns when I travel. I guess I need to look at other insurances when I travel for immediate payout if nec.

Glad you are doing well and back stateside Sid!

Whoof ... at least mine was sort of plann-able. Glad you can, like, see.

Glad hear you're ok and got your eye problem straightened out. Also, I would have thought BCBS would have been able to help right away since I've always considered the PPO I have to be the universal coverage in any developed country. Since I have one of their policies I'll have to look into making sure I'm covered with them for international travel in the future since I don't want to rely on my backup travel insurance.

I love your opening paragraph :D. Glad to hear things worked out okay and I hope that your eye will be trouble free from here on.

I am always amazed how many people I meet abroad that don't have some form of travel insurance. And, the farther you are off the beaten track into Third World nations, the more highly recommended medical evacuation coverage becomes.

headinclouds - Thank you for your "trip report". I'm glad to hear you had 3 types of tea to chose from on the menu. :) Is it just me, or do others think $17K SGD is a lot to pay for retinal detachment surgery in Singapore?

Wow, that must of been scary. Being in a foreign country and stuff, although the fact you were singapore was good :)

It makes me wonder. I live in Canada and have free health care and out-of-province coverage, as well as private health care though my employer. This all sounds good and well, but what happens when I need to use it? How easy is it to use? 24 hours seems like a lot to wait in an emergancy!

glad all worked out

Oh wow, glad to know that you're doing just fine now!

That brings up a questions, what kind of travel insurance do FTers usually get when traveling abroad? This trip report definitely urges me to get it every time I'm going out of country now.

Just shows you the value of arranging travel insurance, so that you're covered in the event of an emergency.:)

It is never pleasant to hear about a fellow member of the online community being down with a serious medical condition and should be applauded for even taking the time to type out a detailed report. And to make it a bit funny too.

There was a question about prices of medical treatment in singapore. There is no doubt, it is expensive. At least when you compare it to other asian countries like bangkok and Malaysia or south america. You are essentially paying for the brand name.

I suspect the op must have done his/her homework before checking into Raffles hospital. I'm not sure about present time but it is the medical provider for singapore airlines at one time, to my understanding.

Its considered expensive for locals and those whose HMO/insurance doesn't have an agreement with.

Prices for common surgeries at public hospitals are listed online but not private hospitals like Mouth Elizabeth or Raffles Hospital. The former is known to have rich clientele and "businessmen" doctors that charge an arm and a leg.

Most people normally depend on their credit cards for travel insurance but if you are based on long term assignments and you need extra cover, there are lots from Bupa,Blue cross etc...

Bummer of a story. I hope you are feeling better. :)

I use IHI
 

Many years ago I had a burst appendix in Yemen, of all places. The Swissair (SR not LX) representative in country arranged an evacuation via ATH to both ZRH and LHR, so my spouse could make the destination decision in ATH. I ended up in LHR with the best hotel, oops, hospital I had ever seen The Wellington, which had concierge service and a mini-suite so my wife could stay with me.

That made me very loyal to SR and determined to always have good international health/evacuation insurance. I have not had a claim on IHI but I have had occasion to seek their advice, which is excellent, and a close friend was evacuated from the Sudan by them with superb service. I cannot recommend them highly enough.


http://www.ihi.com/

geesh, sid, thanks for the detailed 'trip' report. hope you're feeling better and glad you're home!

No time to read all the comments, so this might be a duplicate.

I pay the rather exorbitant fee for an AMEX Platinum card. (I usually don't pay for colored plastic). Two essential features (plus one nice-to-have)

Essential: Worldwide access to a medical emergency number. I've used it twice, once in LA and once in Krakow. I talked to a paramedic both times, tho the second time he put me on hold and relayed info to a specialist. First one (LA) ordered a prescription from a nearby pharmacy. Second got me to hospital with English-speaking staff where they were able to take care of me (steroid shot for tendinitis in my foot, painful but not life threatening).

Essential #2. No credit limit. That SIN problem would have gone onto the card and we could have sorted it out at home. Imagine if access had been denied for a few days. The result would have been permanent vision impairment, all because of a paperwork problem. Not acceptable.

Nice to have: Access to CO/DL/AA clubs as part of membership.

Worth $350 or so, just for peace of mind (for both me and my wife.)

FYI - no preset credit limit cards do have spending limits. The spending limit changes from day to day, month to month, based on your credit profile and how much Amex likes/believes in your ability to pay.

In my case, my spending limits have fluctuated between 1X and 3X my revolving line limit.

You were very lucky that you were still able to fly after treatment. I had a detached retina in one eye several years ago and the other retina has experienced a number of tears. In the first instance, a variety of techniques were used to seal the retina back against the wall of the eye, including laser treatment, a scleral buckle, a vitrectomy and pneumatic retinopexy.

The latter technique involves the injection of an inert gas into the vitreous, which pushes the retina against the back of the eye and helps it heal. After this type of treatment, one needs to lie face down for an extended period, often up to two weeks or until the gas has dissipated on its own. This would have deleteriously impacted your ability to fly. According to Boyles law, the volume of a gas expands appreciably as the altitude increases (and pressure decreases), which could have left you grounded for quite some time.

By the way, all types of gases respond to pressure in this manner. In fact, some have hypothesized that this is the reason that many travelers often experience increased flatulence with increased altitude. :eek:

Would the Amex Platinum card have been of any help in this? They promise evacuation for medical, but I know time was of the essence. Were there any restrictions on flying after the surgery? Glad to know that you are doing ok.

JudyJFLA

I don't think they cover evacuation any longer (at least the US Plat card).

Greg

I thought it was extremely expensive too!

wow thanks for the trip report...
Raffles Hospital is generally viewed as one of the best hospitals in Southeast Asia, if not the world. However, being adamant on payment before admission is, in my opinion, a big ole negative. Retinal detachment, while not life threatening, is an emergency because of the risk of vision loss. Delaying surgery for a couple hours is ok, but the situation needs to be addressed. I wonder what the laws of Singapore would require Raffles to do if you had been unable to come up with the payment. In the USA, EMTLA requires stabilizing of the medical condition....

FDW

Glad to hear that you are okay. That was quick recognition of you and a good idea to stay and go to surgery.

Howd the rest of the trip go after the surgery?

Wow! Quite a story. I'm glad you were able to get the surgery quickly and hope all works out well with the insurance. Cleverly written intro, btw.

Geesh, Not only have I endured a once in a century blizzard, but the rebooked flight to visit my brother in Ohio has me stranded during their current snow storm. 2 flight cancellations with Southwest in 1 week tests one’s patience since Southwest waits until the very last minute to cancel. I hate winter.

Regarding a couple of items mention in prior posts, I wish to expand and extend my remarks (as they say in the Capitol).

Not having special travel medical insurance was an oversight since I normally purchase it. I determined that the circumstances of this trip did not warrant a priority. I was staying the entire time in Singapore and my current health insurance had international coverage. Any problems could be easily coordinated with the blue world wide insurance office considering there was a specific note on my insurance card titled ‘overseas medical assistance’. That was a bad assumption. Even though the office is staffed 24/7, they cannot always act that quickly while I assume that the specialized insurance carriers can act quickly.

I agree that the costs appear to be nearly as expensive as the US even though the doctor in Singapore kept telling me that it would be more in the US compared to Singapore. Depends upon the contracted rate for the preferred providers in my network whether that is correct. I did have an extra day in the hospital and there is the 7% GST which is added to the bill. Not to mention the 3% credit forex rate. I’ll be happy if the amount billed is covered less co-pays and deductibles.

My treatment options were limited to one due to the circumstances. One option precludes flying for 2 months though there is only 1 procedure. I need a follow up procedure in about 2 months’ time. At least I’m only using 2 eye drop medications 2 times per day compared to the 4 different drops 4 times a day.

Lastly, I wrote this report to educate the many travelers on this site of the risks that may befall one while roaming the globe. I need to follow my own advice.

Wow. A detached retina is the scariest condition I could think of, emergency operation or you're blind on that eye :O Extremely glad you could get everything financed in time and hope the eye won't give you any more problems of this magnitude in the future!