Health insurance while you travel abroad

Back in 1998, I hurt myself pretty badly in Rome.  Twice.  Within about two weeks’ time.

It’s not exactly a story that makes me look awesome, but since it’s instructive, here goes.

The first time I got hurt, I was out loitering by the beach with some Italian friends.  Basically, we were doing a whole lot of nothing and drinking a few beers.

At some point, I found myself standing on a small concrete barrier on the side of the parking lot.  If memory serves, I was trying (ultimately unsuccessfully) to sweet-talk a female friend of a friend in a language I didn’t speak all that well.

The conversation stalled, in part due to my limited Italian seductive skills but also doubtless due to the fact that I was around 20 years old and kind of awkward, and I turned to go back to the rest of the group.

I jumped off of the barrier.  It wasn’t very high.  At most, it was maybe a three-foot drop.

But as I hopped off, I slipped a little bit.  Not enough to make me fall on my back.  But it was enough to have me land squarely on my heels.

Plus, I was barefoot.

That little fall was enough to bruise heel bones.   Although this was not a life-threatening injury by any metric, the swelling and the pain were pretty bad.  I could only walk very short distances, and even then it was very unpleasant.  There was also very little anyone could do about the bone bruises themselves.  I ended up having to use crutches for about six weeks.

Fortunately, about a week before that, I had rented a little scooter, from a slightly shady place near the Termini rail station, for most of the summer to get around.  So the injury wasn’t terribly limiting.

Unfortunately, a couple of weeks later, that scooter had a little problem as I was riding along at a good clip, on one of Rome’s major roads.  The front fork (where the front wheel is housed) came loose as I approached a curve in the road, and the scooter low-sided or slid out.

Fortunately, I was wearing a helmet, decent shoes, and jeans.  Unfortunately, I was wearing a short-sleeve shirt and no gloves.

The fall — and slide across the pavement — scraped off one side of my left forearm, from my elbow to the tip of my pinky finger.  And, of course, all that contact with the pavement ground a bunch of dirt and asphalt into the wound.

In other words:  some classic, nasty road rash.

Luckily for me, I was working for the U.S. government that summer, and had access to a doctor and nurse at the U.S. Embassy.  They had checked out my heels and given me the crutches two weeks prior, and now they laid me down on a table and examined the bloody mess my left forearm had become.

And, as gently as they could, they picked out the bits of pavement cleaned the wound, and bandaged it up.  Although I can’t remember their names so many years later, the way they took care of me still stays with me.

So why am I telling you this story?

First, because I like stories.

Second, because if I didn’t have easy, free access to a doctor, things could have been much more complicated.

I am a U.S. citizen.  Even today, as a non-European Union citizen, the Italian nationalized health service would not have necessarily covered my treatment.  My private insurer back then wouldn’t have covered the costs, either.  And as a student with almost no money to his name, I would have had to turn to family to pay my bills.

The Rude Reality of Dangers while Traveling Abroad

What do you think represents the biggest risk to your health while you travel overseas?



Plane crashes?

Not so much.

It’s car accidents.  Seriously.

We know this extrapolating from U.S. State Department statistics.  That agency tracks deaths of U.S. citizens from non-natural causes abroad (military excluded).  Looking at the data over five years, vehicle accidents are far and away the biggest threat to your life overseas.  It’s a pretty good guess that the same trends apply to citizens from other countries, as well.

That is to say, every time you get into a taxi, rent a moped, or call an Uber during your travels, on average you are running a far greater risk than anything related to terrorism or kidnapping.

(Data from the U.S. State Department)

Car accidents, unfortunately, are not only something primarily out of your own control, but can also injure you very badly.  My accident on the motor scooter in Rome was pretty mild, all things considered. It could have been a lot, lot worse — like if a car had been behind me when I fell, and run me over.

All you have to do is search the news for stories about tourists who became very ill overseas without supplemental travel insurance (like this one, this one, and this one), and you will see how serious the financial consequences can be.

Here’s why:

  • Few private or nationalized health insurance products provide coverage outside of your home country. (Public health care for EU citizens who are traveling in other EU countries is somewhat of an exception.)
  • Many countries with “socialized” or “nationalized” health care programs, even in the industrialized world, extend only limited coverage to tourists, usually for emergency care.
  • In many countries, at least in private hospitals, you have to pay for medical services up front.  No money, no care.  “Well, I’ll just go to a public hospital,” you say.  You may not have the option if you are seriously hurt or sick and the only nearby/decent option is a private facility.

Don’t believe me on this last one?  Not long ago, a guy from the United States got appendicitis while on a cruise in the Caribbean.  He needed emergency surgery to have the offending organ removed.

The cruise ship’s doctor got the Mexican Coast Guard to take him to a hospital in Cancún.  It was a private facility, and when the guy arrived, they told the family how much it would cost:  US$6,000 for admission, and another US$25,000 for the emergency surgery.

The family didn’t have US$31,000 lying around.  What happened next will surprise a lot of people:

“When we didn’t have the $25,000 they stopped all of Chase’s treatment. They unhooked his IV, they gave him no more medicine,” Janie Kehler, Chase’s mom, told Fox 16.

Writing on her Facebook page, the mother said they were then “forcibly sent” to a nearby general hospital “in a very dangerous area, with limited services and severe lack of staff” because at 2 a.m. they were unable to front the surgery money immediately as a “guarantee.”

“The Amerimed ambulance workers left Chase sitting in a wheelchair in a hallway filled with people and then just left us there. Every hospital in a third world country you’ve ever seen depicted in a movie was what we were dropped into,” she wrote.

After an hour of waiting “in a filthy hallway in a too-small gown” without being checked or triaged, Kehler decided to take action on behalf of her son, who was by now too ill to fly back to America and seek treatment at home.

She was able to stop a passing paramedic in the hospital corridor, who raced her son for free in an ambulance to Hospital Victoria, a private medical facility, where he had surgery within the hour. This hospital only asked for a $6,000 deposit.

The mother said she had not purchased travel insurance for the cruise.

(Check out the full article here. Another, similar story from Thailand is here.)

Moreover, like in this story of a New Zealand woman who became deathly ill in Bali, or this U.S. citizen who slipped and fell in Mexico, there can be serious physical consequences to not having proper insurance coverage should you find yourself in a less-industrialized area and need to be evacuated to a top-tier hospital for specialized treatment.

A lot of travelers looking for “adventure,” especially younger ones in good health, understandably don’t think about how something like a severe illness like appendicitis, getting into a crippling car crash, or having diving accident can be life-altering without a medical evacuation in more remote locations.

A case in point:  I lived for two years in Cape Verde, a small African island nation off the coast of Senegal.  There is a lot of good scuba diving there.  There are not, however, any hyperbaric chambers in the country to help divers who ascend too fast and get the “bends,” or decompression sickness.

That means if you get the bends — which can be agonizingly painful, permanently debilitating, or even fatal — your only option other than suffering is a medical evacuation on a special low-altitude flight to the Canary Islands.  (Normal, higher-altitude commercial flights make the bends much worse, so you can’t use them.)

Guess what?  That flight is EXPENSIVE.  People don’t realize exactly how much a medical evacuation flight can cost.  The price for what essentially amounts to a trip in a specialized flying ambulance starts at over ten thousand U.S. dollars, and can end up as high as around US$100,000 or even more.  (Yes, that’s a one with five zeros after it.)

So What’s Your Point?  Are You Trying to Sell Me Insurance?

No, I’m not trying to sell you insurance.  There are a lot of products out there, and a lot of different needs.  Plus, there are a lot of posts out there about how to choose the right product for you.

The point is — make sure to check what health coverage you will have overseas, and buy any additional coverage, before you travel.

Most of you will be surprised at how limited your existing health insurance coverage is when you are outside the United States.

And many of you going to more remote parts of the world, or participating in more risky activities abroad, have likely underestimated the problems you will create for yourself if you have an accident or get very sick without medical evacuation insurance.

At the end of the day, you will have to judge your own risk tolerance.  But never underestimate just how badly things can go if you find yourself far from home, very sick, and very uninsured.

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