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IMPROMPTU MEDICAL TOURISM:
TIPS ON COPING WITH AN ILLNESS OR INJURY ABROAD
by Cynthia Pearson

We were just popping over for five days to visit family in the French-speaking area of Switzerland. It never occurred to me to take out medical insurance, or to take any of the other precautions that this article recommends. Nor had I done so on many other short trips to Europe or Latin America. I had to rethink these lapses when I landed in a Swiss hospital with a heart attack.

Know Your Insurance Coverage
Most U.S. medical insurance policies operate on a reimbursement basis for expenses incurred outside of the country. That is, you pay the bills yourself, submit a claim, and wait and wait and wait. This is true for both primary and secondary coverage. Medicare does not reimburse such expenses at all; if you don't have a Medicare supplemental policy you will be out of luck. I knew that, of course. When I traveled frequently on business, I carried an annual international medical policy. After leaving that job, I have taken out trip insurance with medical coverage for long trips, prepaid trips or those to exotic locations. I cannot explain why, other than blind optimism, I didn't think anything serious could happen in more familiar places.

Keep Sufficient Funds Accessible
While my husband refused to believe that our supplemental policy would not pick up the tab (and was telephoning people in the U.S. for a contact name and number), I was busy calling my bank. I needed to have someone there get in touch with VISA and have the "fraud alert" function cancelled. From past experience I knew that a major charge outside of our usual spending pattern could trigger a denial. I also wanted the bank to move funds to pay off any outstanding VISA charges so that we had a maximum line of credit available for the hospital. At that point the actual amount we might need was completely unknown. Fortunately, the Swiss hospital does accept VISA so that the initial payments were easily made. The final bill was paid from the U.S. by wire transfer. Without the ability to pay about half of the total bill while there, which came to about US $12,000, I merely would have been stabilized and sent on my way. Instead I had complete treatment, including the insertion of a stent, and left confident of a full recovery after a week's stay.

Take All Relevant Data with You
So why was my husband phoning around for insurance company numbers and why was I asking my bank, the issuer, to contact VISA? Because either we did not have the numbers with us or because they were 800-series numbers. It is not generally known that toll-free numbers are not accessible from outside North America, so an actual number with area code is a must in those circumstances. It is sometimes hard to get such "real" numbers, but the effort is worth it. Put them in your traveling phone book.

My most ridiculous error was to leave my Blackberry at home. Until a little over a year ago, my cell phone and PDA were separate devices. I never took the cell phone out of the country because it didn't have international capability, but the PDA went everywhere. While packing for this trip I looked at the Blackberry, saw just a phone and jettisoned it. (Traveling light is an obsession of mine.) I knew I could telephone and access email at my family's house but totally forgot that all of my addresses, telephone numbers and passwords were also stored on it. Do not overestimate your ability to remember such data in a crisis. At one point I could not even think of my own daughter's telephone number. Passwords were even more difficult to come up with. Because my home computer remembers them, I seldom key them in and, believe me, they are eminently forgettable. In whatever format you keep such information, always take it with you when you leave town, no matter what it weighs.

Take a Phrase Book
Even if you don't plan to have any interaction with the locals, you should be prepared for anything if you are going to a country where a language other than your own is spoken. While doctors in many other countries have reasonably good English, the nursing, cleaning and food service people usually do not. Most foreign language phrase books have a section on medical issues as well as the basics, such as "I need a ..." Some of the entries are pretty comical, but they will give you an idea of how to pose your questions or requests. It will make your life easier if you can communicate the basics and you will earn good will and entertain the staff with your feeble attempts.

Acquire All Hospital Records, with Translations if Applicable
One of the more valuable documents you can acquire is a hospital discharge report or a physician's medical summary. It not only relates what transpired for your doctors back home, but it just could be your pass out of the country. In my case, the discharge report said I was cleared to leave for the U.S. The hospital did not know that I had developed pneumonia after I left, undoubtedly contracted while I was there, and was in pretty poor condition to travel. Nevertheless, I desperately wanted to go home so I clutched my discharge report in my fevered hand and waved it at all the airline people. Actually, they were very cooperative and arranged for a wheelchair run through the bowels of the terminal to avoid the long lines at certain checkpoints. Ask to use airline services when you really need help. They are prepared for almost anything.

I had a translation made of the discharge report while still in Switzerland so that I could easily brief my primary care physician and newly acquired cardiologist as soon as I returned home. I also carried a CD of the angiogram and angioplasty procedures so my cardiologist could see how things were done and what the current condition of my arteries was. Be sure to get copies of any imaging that may be done, such as X-rays, MRIs and CTs so that your home medical team has all available information and does not need to re-perform those expensive procedures.

You also may need translations of certain portions of the bills to fully understand what they cover and, importantly, where to send the money. Those translations need not be "professional" but should be clear enough for those purposes. You will need to explain everything to your insurers and bankers, more than once.

Take Your Prescription Drug List with You
We usually travel with the amount of prescription drugs we will need for the estimated duration of the trip, plus a few extra days' worth just in case. We had never anticipated an extra two weeks. My husband takes a few drugs that are critical to his survival, so he was especially eager to solve that problem. We learned that a local pharmacy in the city where we were staying would fill a temporary prescription based on a fax from our pharmacy at home. In other places, you may be able to get certain drugs without a prescription as long as you know the precise names and dosages. Be aware that the brand names may be different in other countries, so the scientific name of the drug may be necessary. In any event, when you travel carry your drug list with your pharmacy's telephone number written on it.

Don't Let Anything Short of Death or Severe Disability Keep You from Traveling Again
So, I will take another trip just as soon as I can obtain international medical insurance and get the go-ahead from my various doctors. Life is too short to stay at home, right?

Bon Voyage!
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PAPERLESS BOARDING PASSES - Where May Travelers Use Them?
If you fly in and out of any of 43 U.S. airports (and Frankfurt, Germany), you may be able to use an electronic boarding pass. An electronic boarding pass allows passengers to download their passes on to a cell phone or smartphone. Before traveling, check to see if your airline, or arrival/departure cities, are set up for paperless boarding passes. If so, you just may be able to leave one more piece of paper behind. For more information, and a list of participating cities and airlines, visit the TSA website.