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.