Adventures in the ER

It sounds so glamorous, living the life of digital nomads. Traveling the world without cares or encumbrances.

Then reality hits… you right in the face.

Or at least a door does. On a holiday.



Fireworks ringing in 2017 over the San Francisco Bay

Planning Medical Insurance Coverage

Getting medical care on the road is not always easy. We are set up to protect ourselves in case of major problems knowing that we will have to cover most of our care out of pocket.

Up until a year ago we kept our legal residency in Texas and that was our base for insurance purposes as well. We were back home in Austin often enough to manage all of our routine care visits with only minor scheduling issues. For a number of years we had Blue Cross Blue Shield PPO insurance with national coverage which would at least get us a negotiated rate with some out-of-state providers.

In the fall of 2015, we spent almost 3 months on various trips in Central America and Mexico so I bought an annual membership for a Medjet Assist medical evacuation plan. It wouldn’t cover any actual medical care but we could get back home to the States in an emergency. Generally, we haven’t bought regular trip insurance since we aren’t paying large deposits far in advance. The evacuation plan is a product that I will buy again when we start traveling abroad.

This past year we moved our residency to Minnesota which required a switch in our insurance. We’ve actually been thrilled with the upgrade to HealthPartners since we have a network of clinics and coordinated care that wasn’t available to us back in Texas. We have a high deductible plan with HSA accounts so we can save pre-tax dollars for medical expenses with any unused amount staying in the account year after year.


Ouch – That Hurt

I’ve posted about the fun stuff with our free stay in the Mission District and being tourists in San Francisco.

Curious as to what got left out of those posts? Then read on.

The morning of New Year’s Eve we had dropped bags at our hotel and were heading to the Jewish Contemporary Museum in San Francisco. Lunch at the in-house deli and a visit to the galleries would leave plenty of time for a nap before meeting friends for dinner and a Paula Poundstone show followed by fireworks along the waterfront. Still the glamorous life then…


I exited the revolving door a little too quickly and slammed my face nose first into the glass panel.

And broke it.

My nose, that is. The glass was just fine.

I managed to stop the bleeding pretty quickly and I seemed to be breathing fine so off we went on our adventures. My initial internet checks reassured me that things would be fine. Back home on Monday (the observed holiday), I could see that my nose was still a bit swollen and out of joint.

With the interwebs warning that noses needed to be reset quickly or re-broken months in the future I phoned the clinic on-call nurse for advice. Headaches that couldn’t be attributed to drinking in the New Year were the deciding factor so the doctor on call said I should probably take a trip to the ER to be looked at.

The exam and a CT scan confirmed that my nose was indeed broken and I probably was concussed but there wasn’t really anything to do but let it heal. On the edge of the scan is something the doctor advises me to have my dentist examine – he didn’t have enough scan area of my jaw to tell me more information.


Now It Really Hurts

I just got my insurance explanation of benefits – OMG!

I was expecting to pay somewhere between $1-2,000 out of pocket. The CT Scan ‘listed’ at $6,000 and was reduced via insurance to around $4,000. This is still over 200X for what Medi-Cal base rates are set at.

At this point, I am awaiting the actual bill before I decide how to proceed once I have the actual service codes.

I feel like the doctor should have given me more info when he said he’d like to do a CT scan and asked if I would approve. If I had asked more questions then I might have skipped it – What info would it provide? Would the course of treatment be any different based on the results? Could it wait and be done somewhere else off-site?

The confluence of holiday closures and being away from “home” are adding up to our most expensive night on the town – ever.

If we had been back at our home base in Minneapolis, I would have been seen within our local clinic network. I realize it’s not the ER doctor’s fault that the system is so out of whack. All the care givers involved were making sure nothing more serious had happened but at this point I’m perversely hoping something comes of the mysterious spot on my jaw.

I will have invested so much in the CT scan that I want a return on it down the road. If it saves a tooth from cracking or prevents a root canal, then maybe it’ll seem worth it.


A little more glamour of the holidays in San Francisco cuz no one really wants to see my broken nose

Wisely using insurance protection is important for travelers, especially as we get older and can expect to need more medical care. The money we saved by dog-sitting during the holidays and the fact that we are out of town for Joel’s current work contract will help to financially balance this out in the long run.

Hopefully, this behind-the-scenes look at life on the road doesn’t discourage you from traveling but helps you plan for the unexpected.


Any advice on how to negotiate a lower ER bill?