What You Don't Know Can Cost You Vacation Illnesses

June 27, 1995|By Patricia Meisol | Patricia Meisol,Sun Staff Writer

You're headed for a summer villa in the English Lake Country. You're packing the bags for a week at the beach. You're getting ready to introduce the children to Paris.

Seasoned travelers always remember to bring toilet paper to Asia, detailed road maps to Cancun and an extra water supply for California's Mojave Desert. But has anybody thought about packing a health insurance card?

In an era of managed care, when health maintenance organizations dictate who you see and when and what for, and refuse to pay up when you break the rules, now may be the time. Managed care is supposed to reduce the price of health care. But unless you pay attention to the rules, it could increase the price of your vacation.

The basic rule of managed care is familiar enough: Turn to your primary care doctor first or you'll pay extra, sometimes even the whole bill.

So what happens when you're on vacation and your doctor is thousands of miles away?

"My bottom-line advice is to call your HMO before you go," says Don White, spokesman for the Group Health Insurance Association of America, which represents HMOs.

"Tell them where you are going. Different HMOs handle it differently. Find out what the rules are -- that's the single most important thing," he says. "Some HMOs have agreements with other HMOs in areas where they don't have their own doctors."

Until the 1990s, when traditional health insurance held sway, a traveler who became ill abroad needed only to ask the U.S. Embassy for a list of doctors or hospitals. Once home, the traveler had the bill translated into English and presented it to his or her insurance company for reimbursement.

Today there are trans-Atlantic phone calls and medical conferences involved.

First, two bits of good news:

Serious illnesses while on vacation are rare. Blue Cross and Blue Shield of Maryland, for example, which insures 1.3 million people, handles a traveler emergency only once in two or three months.

Second, when emergencies do come up, they tend to be covered anywhere in the world, by HMOs or any other type of health insurance plan.

Now the caveats:

* Many plans won't pay the whole bill as they do in the United States and won't pay for immediate follow-up care, including required medications, unless the patient returns home.

* Medicare won't cover health emergencies outside the United States at all -- unless you happen to travel along the Alaska Highway through Canada on your way to to Alaska.

* Typically in emergencies, patients have to pay up at the time of service, even if the bill runs thousands of dollars. Hospitals in some countries won't discharge patients until they pay in cash -- "which means you stay an extra day waiting for money to be wired," says Guido Adelfio, whose family owns Bethesda Travel Center. "It can happen."

In such an instance, it pays to have easy access to money by wire -- some travelers deposit it with relatives ahead of time -- a travel insurance plan, or a credit card, such as the American Express Platinum Card, which carries extra health insurance and medical assistance as long as you also charge your trip. Here again, check the rules. Pre-existing medical conditions may be excluded, which makes credit-card insurance worthless for some people.

Once you are able to return home, fill out a claim form and send it to your HMO. This is the only time HMO members ever file a claim. Emergency medical care is similarly reimbursed by preferred provider networks and other forms of managed care as well as by traditional indemnity companies.

"People worry about it, but here's what they should remember: Take their health insurance card with them, bring back all their receipts, and if you are in a managed-care program, have somebody notify the insurance company within 24 hours," says Robert Gallen, chairman of GF Capital Insurance Services Inc., a San Francisco Bay Area broker that handles health insurance for the international adventure company Backroads of Berkeley and other large business clients.

Emergencies could include things like an ear ache, a severe stomach cramp, a diabetic who goes into shock, a concussion, or stitches required when a child steps on a piece of glass at the beach. Many companies also pay for transportation home to continue medical treatment.

"You could have had a bad pizza and you think you are having a heart attack," says Kevin O'Neill, senior vice president of Chesapeake Health Plan. When such a patient winds up in the

emergency room, he says, "we do pay for that."

The catch

OK, so you can enter an emergency room anywhere in the world complaining of chest pains and your care will be covered -- at least under the same rules as at home.

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