The Nightmare Called American Healthcare

On the road, the topic of American healthcare comes up about as often as my favorite country (in other words, a lot). Citizens of the world are fascinated by the twists and turns of the American healthcare debate, a subject which is pretty much incomprehensible to anyone born outside of the United States.

What many non-Americans do not realize is that the subject is as relevant to foreign visitors to the country as it is to U.S. citizens. Anyone who needs to visit a doctor or emergency room while traveling in the U.S. will be plunged into the complexities of a highly bureaucratic, highly bloated nightmare that has the potential to confuse and confound even the greatest mind.

Although I am American, I am insured through a German travel insurance company. This rather unusual status as well as some recent experiences with the healthcare system here in the U.S. have given me some insight into the difficulties that visitors might encounter. Here are a few bits of advice for foreign travelers to my home country:

1. Get really good travel health insurance while visiting the U.S.

The American healthcare system is RIDICULOUSLY expensive – far more expensive than in other countries. I would love to claim that you get something extra for all that money, but after visiting hospitals in many other parts of the world, I can’t really say that’s true. So how expensive is expensive?

One Norwegian exchange student recently found out the hard way just how high those bills can be. After being treated for a rattlesnake bite, he received a whopping $143,989 bill. Yikes, just how many gallons of anti-venom did they pump into that poor kid? The bill was so absurd, it even made headlines in the States. Make sure you have great travel health insurance to cover those high costs.

2. Inform your travel health insurance provider that you will be visiting the U.S.

Because of the high cost of treatment in the U.S., many travel health insurance policies require higher premiums for visitors to the States. Don’t assume that the same policy that has covered you on your trip around the world will cover you here. Call your insurance company to verify that you are covered in the States as well as to confirm any limits on your coverage.

3. Emergency rooms must legally treat you even if you are uninsured… but you’ll get one hell of a bill afterwards.

Many Americans who are normally insured have no concept of just how high medical costs can be. Many also recommend visiting an ER (emergency room) for convenience purposes, a practice which tends to fill up the ERs. Despite horror stories, American emergency rooms are required to treat you whether you are insured or not.

But be aware that emergency room costs are even more astronomical than standard healthcare costs. After a recent five minute consultation with an emergency room doctor, a blood test and an EKG, I was presented with a $3,500 bill. Ouch!

4. If you feel your bill is too high, bargain, bargain, bargain.

As surprising as it may seem, you can bargain on healthcare costs. Although staff will feign outrage at the thought, this is common practice between healthcare providers and insurance companies.

When the ER presented me with the $3,500 bill, I screamed, “Go back to your $%@$%$ boss and tell him to give me an offer that does not have me subsidizing every single person who walks in here.” Three minutes later, he returned with an offer of $1,400. I screamed my head off for an additional 20 minutes and then gave up. That’s still high, but it was a sum I thought would be acceptable to my insurance company.

(Note to healthcare providers: If you don’t want such bad behavior, don’t charge such stupid prices and don’t lie about what tests you have done. See #7 below.)

5. The U.S. IS NOT well set up to handle foreign travelers

Many American healthcare institutions are not set up to deal with foreign patients. Moreover, billing systems are often not able to process immediate payments. In my ER visit described above, the hospital (a very large and well known institution in San Diego) did not accept foreign insurance and was unable to provide any form of itemized bill for the services I received.

When I argued with the billing counter, it was revealed that the costs I was being charged had basically been made up because the hospital had no system in place for calculating treatment costs on the same day as the visit. Billing is a process that can take up to five weeks. By that time, you just might be out of the country, which might be a good thing.

6. Fight for your right to documentation including an itemized receipt

On my ER visit, my receipt basically said, “$1,400.” The bill showed no itemization of the tests or treatments I had received. I was told that non-itemized bills were standard practice in American ERs. This became quite an issue with my insurance company which, of course, wanted to see documentation of my symptoms and diagnosis as well as an itemized list of tests and treatments.

If you take the time to read about the Norweigian snake bite victim, you’ll see his ER experience was similarly odd with a bill which did not add up to the cost he was being charged.

Through much effort, dozens of calls, and work with the medical records department, I was able to accumulate the documentation I needed to satisfy my insurer. In total, it took around two weeks of work. The lesson I learned the hard way was DO NOT PAY if you do not receive adequate documentation to satisfy your insurer.

7. Check those receipts, ask questions, and then check them again

So why was the ER initially so reluctant/unable to provide me with an itemized bill? Once I finally received an itemized list of “treatments” from the medical records department, I understood why. The entire bill had been padded with charges for tests that the doctor had never done.

Am I an unlucky victim here? No, unfortunately, I am not. One industry insider I talked to about the billing confirmed this is standard practice in the ongoing battle between healthcare providers and insurers. The padding is meant to compensate for insurers’ attempts to bargain down payments. As a foreign visitor, you are not part of that battle, so check those receipts to make sure you aren’t being charged for treatments or tests you did not receive.

8. For basic treatments look for walk-in clinics and urgent care facilities

Many foreign visitors end up in ERs due to the complexities involved in getting an appointment with a general practitioner. When I called around to various doctors, many refused to take an appointment because they required new patients to go through insurance-specific referral systems.

If you have American friends, have them call their doctors to see if they can get you an appointment. If that’s not possible, look for walk-in clinics or urgent care facilities, which should generally be less outrageously priced and more streamlined than emergency rooms.

On a personal note, I had not been to a doctor in the United States for almost nine years, and I had certainly never experienced it as an “outsider.” My visits to an urgent care facility and an emergency room in San Diego went a long way to illuminating me on just how broken and bloated things have become. It certainly helps explain the enormous wave of American medical tourists we encountered in Asia. To put things in perspective, for the initial $3,500 price tag of my short visit to the ER, I could have bought a round-trip ticket to Thailand, stayed in a luxury hotel for a week, and had a complete physical at a world-class facility.