Ahem. Are we forgetting something?
The debate about health-care reform seems to be ignoring a significant group of Americans: international travelers.
People like Aphrodite Tsairis, who said she fell "violently ill" on a visit to Bermuda last month. After a CAT scan, a diagnosis of bowel obstruction, a night at King Edward VII Memorial Hospital and a medical evacuation by private jet back to the States, Tsairis got a bill for $23,785.
Traditional health insurance plans typically limit out-of-country coverage to emergency expenses, at most. They also have high deductibles and co-pays for treatment abroad and don't cover evacuations such as Tsairis'.
About one in five Americans buys travel insurance, according to the U.S. Travel Insurance Association, a trade group. But a new survey by the organization found that only a fraction of the policies bought — about 5 percent — are primarily medical in nature.
That means a lot of Americans might be traveling without adequate coverage. The Joint Commission International, which accredits hospitals, estimates that 6 million Americans will be treated in overseas hospitals next year. Some, of course, will be medical tourists, but others will just be tourists like Tsairis, who had the misfortune of getting sick while on vacation.
Tsairis, the director of a nonprofit foundation in Bloomingdale, N.J., wasn't covered under her American health insurance policy and would have been liable for the entire hospital bill and evacuation costs were it not for the coverage on her American Express card (about $216 a year) and by MedjetAssist, a medical evacuation service ($250 a year).
"It's a good thing we had that," she told me.
Amex paid the $9,885 hospital bill. MedjetAssist covered her $13,900 in evacuation-related expenses.
Not everyone is so fortunate. As a reader advocate, I often hear from travelers who forgot to take out travel insurance only to find themselves in a postoperative daze in a Mexican hospital, clutching a five-figure bill. One bad trip like that can clean out your bank account.
Shouldn't health insurance cover you no matter where you go?
I asked some of the folks who were working on health-care reform, and they agreed that it should — kind of. An aide to the Senate Finance Committee said that its version of the bill creates an insurance exchange that would increase competition and force insurance companies to offer the best plan at the best price. As they do today, health plans will have the flexibility to cover overseas health-care expenses, the aide said.
Actually, that sounds like a "maybe."
"I'm told there is nothing specific with regard to requiring overseas coverage," said Brendan Daly, a spokesman for House Speaker Nancy Pelosi. "But there could be an added benefit at premium-plus level."
A premium-plus level, in the context of international coverage, would be an option for policyholders, but not a mandate. In other words, insurance companies would be able to continue refusing to cover their customers when they leave the country.
Hey, I know health-care reform is hard work, but I don't understand why our coverage must end at the border. Considering that medical care is less expensive almost anywhere outside our country, shouldn't it be a no-brainer to cover American policyholders regardless of where they are?
Until that happens, says Michael Ambrose, president of the Travel Insurance Association, you might want to consider buying separate insurance for your international trip. He recommends a policy that includes trip interruption because of a medical emergency and that covers emergency services required in any country, including doctor expenses, ambulatory services and hospital fees, plus medical evacuation coverage.
"You would need to review some of the top health insurance plans in order to analyze what they would and would not cover," he says.
Under such a policy, if you get sick while you're on vacation, at least you'll be covered. Whether you'll actually file a claim is a different question.
Gwen McLean, an information designer for a financial software company in San Jose, Calif., says she'd be thrilled if health insurance covered more Americans who travel internationally. But after being treated for a painful urinary tract infection on her last vacation to Scotland, she decided not to bother with a claim on her American policy.
McLean was charged a total of 11.50 pounds (about $19 today) for prescription drugs and a doctor's visit, less than it would have cost under her American insurance plan. She was also, much to her surprise, allowed to see a doctor without the customary one-hour wait at the hospital back home.
"National Health," she says, "saved my vacation."
Christopher Elliott is the ombudsman for National Geographic Traveler magazine. You can read more travel tips on his blog, elliott.org or e-mail him at .