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.
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…
Bam!
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.
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?
Sorry this happened to you. One time I was able to drastically reduce my hospital bill (was a scheduled surgery, not ER) by providing proof of my low income and by saying I would pay the lowered amount immediately.
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Did you research local prices and make an offer to pay immediately?
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No, it was through Northwestern University Hospital in Chicago. I just called the billing department and had a polite conversation with a rep. I asked if they had any wiggle room for financial hardship and they sent me a lot of paperwork (I think I needed to show my W2’s.)
Good luck!
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Thanks for the advice!
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Oh and it also helps to write down the name of everyone you talk to and repeat it a few times. Then if you’re talking to a different person you can be like “Oh I was just talking to a really nice lady named Eileen yesterday and she mentioned that you might have reduced rates for paying cash and for low incomes. Is that something you can help me with Bob? ” Also, throw some compliments around about the service you received at the hospital. I work in customer service and I’ll always bend the rules to someone who is super nice, compliments my organization and is persistent but does not bully. And if they do end up cutting you a deal write them a nice review or a thank you email.
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That’s good advice – I got exceptional service from every person I encountered that day starting with the nurse on the phone and each contact in the ER.
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I hope your nose heals and is OK. While travelling I ended up in the ER in Jefferson, Missouri after a dog knocked me off my bike on the Katy Trail. I felt such a lack of control, but luckily I only needed stitches, no broken bones. Make sure you get a break down of exactly what you are paying for, but I have never had luck getting a price reduction. Good luck.
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Thanks – glad your trip was relatively minor as well.
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Guess you sang “auld lang syne” with a nasal brogue…
Even if I didn’t love my job as much as I do, I’d be hesitant to break ties with my employer because of the sweet health insurance that comes with my employment. Would “Medicare-for-All” be a solution?
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That would seem like an easy solution- it’s the inconsistency that is the problem with negotiated rates being confidential information. I’m glad that thru ACA we aren’t subject to the pre-existing conditions. Joel broke his arm 10 years ago so we couldn’t get his left arm covered before ACA.
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Nothing has the potential to ruin a perfectly exciting trip like incredibly high and not budged for medical expenses! I met an Australian who is now $30 000 in debt due to a snowboarding accident. He prematurely returned to Australia and the only thing he can think about a 3 month trip to America is his bill. Its sad really! I’m sorry for your experience, and not taking away from that I’m glad you wrote about it. Not enough people think about getting hurt while travelling, maybe now more will!
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It’s a ridiculous system that we have here. Our planning helped but I learned an expensive lesson. The Zero to Travel podcast just did an episode with a doctor from the CDC that was really interesting. She talked about vaccines, access to health care, insurance and making good choices while traveling.
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Cool, I’m interested to give it a listen. Where can I find it?
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Here’s a link to the episode on Jason’s site: http://zerototravel.com/podcast/travel-health-everything-you-need-to-know-before-you-go/
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