Many folks still have a summer vacation trip in the works. The pre-trip checklist often includes a new wardrobe, notice to stop the newspaper delivery, and even a trip to the dog kennel. However, a recent story about a premature baby born in Mexico to an Indiana couple highlighted what many people so often overlook when planning and packing for a trip out of the United States – medical insurance.
An Indiana family is claiming a hospital in Cancún, Mexico, refused to release their premature baby until a $37,000.00 medical bill was paid in full. (https://www.gofundme.com/bringbeckhamhomeindiana)
Larry Ralph and expectant mother, Michaela Smith, were vacationing in Cancún when Ms. Smith went into labor prematurely, giving birth to a son 12 weeks early on July 18. For the first day of their son’s care, the couple paid the hospital more than $9,000 with another $4,000 in “fees”, according to Fox 59 in Indiana. The hospital bill had climbed to $37,000 by July 20.
The Mexican hospital would not release the baby to an air ambulance back to the U.S. until the outstanding balance owed by the family was met. Family members pulled financial resources and paid an air ambulance $30,000.00 to transport the baby and his parents to a Florida hospital for medical care. However, a snag happened when the contacted Florida hospitals would not accept the mother’s Indiana Medicaid plan, said the family on its GoFundMe page.
The lesson here is to know the ABC’s of your health insurance when traveling outside of the U.S. If your only source of health coverage is through Medicare or Medicaid, you effectively have no health insurance when leaving the U.S. borders. Medicaid pays only for services in the 50 states, Washington, D.C., and U.S. territories such as Puerto Rico. Medicare is nearly as strict, though it provides coverage in Canada and Mexico when an emergency occurs in the U.S., but the closest hospital is just across the border. You are also covered if you were to be injured or fall ill in Canada while on a direct route to Alaska. But in any other country, neither government program pays for health services, whether it’s an emergency or not.
The Indiana couple’s family eventually arranged for AirMed to transport the newborn and his parents to Indianapolis-based Riley Children’s Hospital. On July 20, Michaela Smith’s newborn son was released from the Cancun hospital and the family flew to Pensacola, Florida, in order to clear customs, before flying home to Indiana for continued care.
Most of the well-known commercial health insurance plans provide their subscribers and members some coverage in other countries. However, the only way to know exactly what is and isn’t covered is to check with your health plan prior to traveling. But since it is nearly impossible to anticipate every medical scenario in advance, a basic understanding of your health insurance should suffice.
If you have any of the major commercial health plans, you can breathe a bit easier. The standard commercial policies of the Anthems, Aetna, Cigna and Humana, will cover emergencies outside of the United States. So what exactly constitutes a medical emergency? United States commercial insurance companies employ the “prudent layperson” standard. This standard is that of a reasonable person and would the medical condition be one that could lead to death or loss of limb or serious bodily function. If a reasonable person deems this criteria is met, the medical situation is considered an emergency and will therefore be covered by the health plan.
Severe chest pains, altitude sickness, broken bones, dog bites, heat stroke and cuts requiring stitches are also just a small sample of examples of what would most likely would be covered under the standard.
Pink eye, poison ivy, mild cases of the flu and other bodily discomforts most likely would fall outside of the prudent layperson test.
A traveler should still remember that even if an initial symptom does qualify as an emergency, there is a strong likelihood they will have to pay for any follow-up care overseas. It is also good to make sure there are enough funds in the bank account. At many non-U.S. hospitals, the health insurance identification card will just be as useful as your plastic library card. Seeing a doctor or visiting a hospital outside of the U.S. means you will likely need to pay for the medical services upfront or before discharge.
In order to be financially reimbursed by your health plan, remember you will need to file a claim with your plan that will include an itemized bill from the foreign hospital. The claim review process by your health plan may take anywhere from weeks to months to complete. The expenses covered by your plan will be similar to how your policy works when receiving care in the United States. If you have a $50 co-pay for emergency-room visits, then your health plan will deduct $50 from its reimbursement check to you.
One way to alleviate stress and worries is to supplement your health plan with travel health insurance. There are dozens of U.S. travel insurance policies and even more offered in the country you are planning to visit. It is prudent to weigh the pros and cons of the competing national and international travel insurance companies so that you may make the best possible decision. Also, such travel policies are usually very narrow in score and limited in benefits. Care should be taken in relying on Travel Insurance as primary health coverage, as it is best to serve as a supplemental plan.