Bolivia severe injury lessons learned

Discussion in 'Americas' started by kkpsyop, Mar 8, 2016.

  1. kkpsyop

    kkpsyop Adventurer

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    I have learned a lot about overseas medical insurance lately and I thought I would share what I learned for the greater good of the group.

    My wife broke her arm severely while we were riding DR650s in the backroads of Bolivia late February. Multiple breaks and bone sticking out of the arm. We were between two smally cities about 50 miles from La Paz.

    I had a Delorme Earthmate GPS emergency satellite communication device which I activated. It does not lead to an ambulance heading your way el-pronto - I put it in the category of better than nothing, but nothing is pretty bad.

    Luckily I had purchased a local cell phone when we arrived in Bolivia. Luckier yet, when Lynn broke her arm we had cell service. Winning the lottery lucky the motorcycle rental company had a relationship with what I call a medical fixer. Like Saul on Breaking Bad, but named Oscar.

    Oscar got an ambulance headed our way el-pronto (el-pronto for Bolivia, it arrived 6 hours later). Due to the severeness of Lynn's injuries Oscar recommended we go to Cemes Clinic in La Paz. Turns out Cemes Clinic is one of two medical facilities the US Embassy lets its employees go to.

    Between her arm breaking and her being released from the hospital six days later I learned a lot.

    Americans are used to the American style of healthcare and billing. The concept of skipping your broken ass into the emergency room and getting patched up without paying first or demonstrating ability to pay is something that pretty much ends at the US border. Some western countries in Europe and Canada may patch you up and ask for money later, but 180 countries aren't that nice.

    The hospitals in some countries are more like a restaurant where you eat a bunch of food and if you don't pay, the police come and arrest you.

    More likely, before they treat you they guarantee you have means to pay. Oodles of money or proof of insurance from an insurance carrier they have experience with. Shocking, to me, the hospital I was at in Bolivia had never dealt with Blue Cross Blue Shield.

    Pros and cons. Medical care is cheaper because everyone that gets care pays for it. Sucks to not have any money though.

    Do some countries have government hospitals that will treat your emergency situation then seek money? Yes. But take Lynn's case. Bones broken and some dirt had gotten in the wound. A lessor hospital could have simply cleaned up the wound a little and kind of set the bone (no plate nor pins) and sent her on her way. Would the bone heal correctly? Probably not. Risk of infection - oh heck yes.

    Bolivia has hospitals and clinics all over it. There are a total of two hospitals the US embassy lets its staff go to.

    So, do do research before you go to the country as to what hospitals you should go to. The US embassy has a list.

    So now you know where to be taken, next is paying. Paying is harder than it sounds.

    I checked before we came to Bolivia and our Blue Cross Blue Shield covered overseas emergency room visits. So I figured we were golden. Not so fast skippy.

    The overseas hospital doesn't care if an employee of BC/BS says words over the phone. The hospital wants paid, or a very specific formal letter that they have agreed they will pay X $ to the hospital for treatment of specific person for injuries sustained on X date.

    BC/BS rep says "what's the hurry? Bring the bills and stuff back to the US and submit a claim when you are back in the US." The people manning the phones are not well trained, nor do they care.

    If your insurance hasn't paid (past tense) or issued the letter, you haven't paid. If you haven't paid you may be arrested and put in jail just like if you didn't pay at a restaurant in the US. Different countries treat it differently, but jail is definitely an option in many of them.

    This is where speed of processing payments or cutting letters is key. BC/BS was saying they would cut a promise letter after they receive all the paperwork from the hospital (thankfully by email) it will take 24-48 hours to process NOT COUNTING WEEKENDS. In our case it was a day or two after surgery that the surgeon felt confident enough to say Lynn will probably be fine - she can be released on Monday. This occurred Friday and there was a big fat weekend right in front of us.

    So, were we covered by BC/BS for the injury? Yes. Does that help us in any way in the short term? No.

    We paid the bill out of pocket and plan to get reimbursed by BC/BS later. This isn't really a valid plan for healthcare costs. Even in these far cheaper countries a serious injury could be low six figures.

    What is the main problem if you have US insurance? Speed of processing payments. Does anyone know of a medical insurance company that is fast at processing anything?

    These days, fewer and fewer health insurance plans are covering overseas emergency room visits. Oddly, when googling travel insurance I found a guy's story where he lived on the east coast and bought travel insurance for a trip to Arizona. He said his PPO was on the east coast and any treatment outside is PPO was $12,000 deductible and 40% copay.

    Enter travel insurance. A dodgy realm where companies profit by selling many policies and then declining to pay claims.

    Lynn had travel insurance for a trip to Ireland. She broke her leg in roller derby. The travel insurance refused to pay because she was injured in an amateur sport league.

    So research is key, but difficult to do because the vast majority of people buy the insurance and never use it.

    Enter Oscar the medical fixer I dealt with in Bolivia. His full time job includes dealing with insurance companies and getting money out of them fast.

    Oscar recommends two companies. HCC and Allianz. Oscar recommends Allianz over HCC because HCC is bigger and less responsive. I can understand his logic as BC/BS is huge and was pretty much non-responsive and the individuals on the phone each are knowledgable about 5% of the whole.

    Back to paying. Paying was hard. Partially self inflicted. We don't charge much so we keep our charge card limits low. That decision meant we had to use multiple cards to pay.

    I averaged 1.5 hours per card to pay. They would swipe the card and it would fail. They would call Visa in Bolivia who would say the transaction was rejected at source. I would call the source bak and they would say they saw no attempt to charge. After repeated calls and more people involved, it would go through.

    We notified the card banks we were traveling to Bolivia before we went.

    Side Note: I locked down my credit at the three credit bureaus years ago to prevent identity theft. This meant that attempts to temporarily increase my credit card limits were rejected because they couldn't check my credit.

    Side note: in Bolivia you must swipe the credit card to charge the credit card. This is to prevent fraud. So having a friend with lots of credit email you his card info is of no value. You can't charge it.

    Side note: if you max out a credit card, it hurts your credit rating.

    We ended up charging some on each of two credit cards then wire transferring the remainder. The wire transfer took about an hour on the phone. International wire transfers involve the federal reserve which is closed on weekends and holidays.

    The phones were dodgy in Bolivia. I mostly used Skype on my iPhone on hospital wifi. Insurance and bank customer reps would often hang up because they got annoyed with my "bad cell connection".

    Oscar had a wifi hotspot hanging off the cell provider. It worked better than the hospital wifi but I still had dropped calls.

    We got the bills paid and returned to the states. First doctor we saw said the Bolivian doctor did everything perfectly. He referred Lynn to a hand specialist for possible tendon repair since the Bolivian doctor chose not to fix everything at once due to risk of infection.

    Specialist doctor did not like the Bolivian doctors work and removed all Bolivian plate/screws and put in new plate/screws. Good news was there was no tendon damage, just some ligaments need repaired.

    Lynn's Bolivian hospital bill was just shy of $17,000. Allianz max medical travel coverage for medical is $50,000. I asked Allianz if the would sell me a policy with >$50,000 coverage. The answer was no.

    Which brings me to the medical repatriation portion of the travel insurance. Allianz covers $1,000,000.

    After Lynn having her Bolivian surgery redone coupled with a max benefit of $50,000 medical - I am left with the thought that just getting her carcass back to America ASAP would have been better than getting her patched up in Bolivia.

    So we are still pursuing getting reimbursement for the $17,000 from BC/BS.
    #1
  2. oldmanb777

    oldmanb777 Just say NO to socialism!

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    Thanks for sharing. I have had to deal with med issues with co-workers I was responsible for in foreign countries. Really bad experiences. We are told how bad our health care is. And yes its expensive. But it is also very good (compared to most) and you can count on it. Your story is a real eye opener. I think all of us could use some real world education on this subject.

    Mods should start a sticky about how to deal with health care in countries other than your own.
    #2
  3. Valker

    Valker Long timer

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    Makes something like Med-Jet sound like a bargain!!!
    #3
  4. stevo7706

    stevo7706 Been here awhile

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    Wow! $17k for a broken arm. That's probably 3 years wages for average Bolivianos. I broke my finger years ago in Brasil and I think it cost me less than $100. It's good to know NOT to use the embassy recommended hospitals in Bolivia. Sorry for your experience.
    #4
  5. kkpsyop

    kkpsyop Adventurer

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    A broken finger and both lower arm bones broken in multiple places and bones sticking through the flesh into open air are very different. If you have a serious injury, you may want to consider higher tech health care.
    #5
  6. Kiko

    Kiko Long timer

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    I haven´t checked my latest BCBS pólicy, but they have arrangements with some hospitals overseas. For example in Guadalajara near me, Hospital San Javier has administrative staff who deal with foreign insurance carriers. Under my PPO last year, there was a 500 deductible for emergency care, once they move you out of the emergency room, then you have no coverage and are liable up front for full payment. Allianz or Met Life is what most of the expats carry here in this area of Mexico. It is still a crap shoot however you look at it, since the insurance carriers are evasive when it comes to confirming coverage on the phone. I don´t know the current medjet rules, but I doubt if they would retrieve you with only fractures unless a local doctor authorized it. I would think it has to be life threatening. If the local hospital staff can grab 17k, then it is very unlikely that they would have authorized a medjet evacuation. Just my guess, it varies with each situation.
    #6
  7. kkpsyop

    kkpsyop Adventurer

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    Valid points. I guess that's why they call it an adventure.
    #7
  8. jonz

    jonz Miles are my mantra

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    If you are admitted to a hospital by a doctor, Medjet will pay to bring you back. Once you are discharged, you are on your own. They intervened one time when a rider or surfer (I forget the exact details) got hurt in Baja, hospitalized, and the hospital wanted payment before release. Somehow they brokered a settlement and flew the guy back to the states. I've read of similar circumstances in Mexico and carry that insurance because of the relationships they have demonstrated in the past and how those have relationships have been valuable. I don't know if they have those contacts in all countries but would bet they do in many instances.

    A source for medical treatment recommendations can be seen here:

    https://www.iamat.org/

    At least, it's a start and was recommended to me by the traveling nurse who did my travel vaccinations.
    #8
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  9. markinthailand

    markinthailand Been here awhile

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    You need to look into insurance SPECIFICALLY for ex-pats -- that is, people living outside of their passport country. I've had it for 20+ years and with several different carriers, and they are all generally very good. All they do is insurance for people outside of their passport country, so they know what to do, will have a network of vetted doctors and hospitals, and a 24/7 helpline where you can call when it all hits the fan. HTH Worldwide, Cigna Global Health, etc. US based insurance is pretty worthless, and "travel" insurance is really only meant for minor issues for short trips.

    We are partnered with a hospital here in Chiang Mai (Bangkok Hospital) which is world class (I know, as I've had the head of Wilderness Medical Associates and others check it out). They ALSO require payment up front OR the insurance to clear it. But they have a long list of insurance companies they work with all the time. Talking with them we found out that they have had patients try and skip out ALL THE TIME on paying. So they won't even admit unless they've got a guarantee. You roll into the emergency room they will take care of you, but as soon as you're able they are going to get a guarantee, or maybe require you to hand over you passport, etc. I don't blame them -- some of the hospitals here have had patients come in for very expensive procedures and then unhook themselves from the IVs, change clothes and walk out.

    Glad you guys got the help you needed! Good luck on a quick recovery! Now both of you go take a Wilderness First Responder course! :-)
    #9
  10. tricepilot

    tricepilot El Gran Payaso

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    Just a slight tweak about MedJet so there's no confusion:

    MedJet will only retrieve you from a medical facility, not the bush, and the kicker is you have to have a need for further in-patient care back home. In other words, they will talk to the attending physician in whatever country you're in and confirm that treatment is not complete and that you're not ready for discharge because you need further treatment but you are ready for transport back home to complete it.
    #10
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  11. Mastery

    Mastery Mr. Funny Man

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    That is correct. For anybody looking for "come to the bush and get you to a hospital insurance", that's the S-N-R insurance (search and rescue), like when you hit the SOS button on the inReach device. I think I paid like $18 extra for Rescue insurance for a year: http://www.geosalliance.com/geos-services/worldwide-search-and-rescue/

    This is a great thread, covering something not really talked about here. Thanks to the OP for starting this and sharing their particular information.
    #11
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  12. kkpsyop

    kkpsyop Adventurer

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    Lynn is recovering nicely from her second surgery - even went to a bar tonight.

    BC/BS has yet to acknowledge they received our bundle of email attachments with hospital receipts and the like. Looks like BC/BS is going to be a long slog.

    I am also wasting my time pursuing MASTERCARDs reimbursement for airline tickets. I'm trying to get reimbursed for the $1,200 I spent to change our return flight to be two days later to accommodate the doctor's desire to have Lynn on an antibiotic IV drip fro five days before returning to the states. MASTERCARD has referred me to an insurance carrier that handles the reimbursement. I suspect this insurance carrier's business model is to NOT pay out claims, but time will tell.
    #12
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  13. FakeName

    FakeName Wile E Coyote SuperGenius

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    Thank you for sharing this story. Very valuable information, and much appreciated.
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  14. eddyturn

    eddyturn Eternal Wannabe

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    Don't be too pissed at a credit card issuer for not getting you a refund on any change fees. The change fee represents a service (bullshit service BTW) and if the airline provided that change service and you got the benefit of the service, there is no dispute. 22 years working for the associations and that's just they way it is. Bad news and I always hated telling them that they did not have a chargeback right for change fees.

    Thanks for your posts on this subject!!
    #14
  15. FTL900

    FTL900 White and nerdy

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    Thanks for taking time to share this, it's a real eye-opener. Particularly with my first Baja trip planned for next month.
    #15
  16. MitchG

    MitchG Iron Collector

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    Good report!

    How I operate is travel insurance issued/sponsored by my bank(a national bank at which I know my manager personally and can use her to expedite coverage and or issue a credit/promissory letter to the medical facility), as well as Medjet, Medjet, Medjet.........Don't leave home without it!
    #16
  17. kkpsyop

    kkpsyop Adventurer

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    We ended up getting 100% reimbursed by BC/BS four months after the accident.

    I did eventually get my airline flight change reimbursed by the credit csrd company. The fees were $600 total. In the end, it worked out to about $10 an hour for my efforts.

    I ended up filing a complaint with the federal agency that oversees credit cards.



    Sent from my SAMSUNG-SM-G891A using Tapatalk
    #17
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  18. Tewster2

    Tewster2 Long timer

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    Thanks for the info everyone. Your post are what convince me I'll never travel outside the US and Canada. There's enough here to keep me busy until I croak.
    #18
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  19. oneway

    oneway Long timer

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    It's hard to find recent accurate info on the subject of travel insurance, medical treatment, evacuation etc. thanks for taking the time to post.
    #19
  20. Woody2627

    Woody2627 Grey Wobbler

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    Having a debit card is a good option. You don't have much loaded so risk is low, but if you need money fast you can get someone back home to load it up and you have the money available.
    #20