I have recently had a lot of enquires regarding health insurance
and medical evacuation. To most people health insurance policies
are a maze of paper work full of semi-medical jargon that
is, to say the least, very confusing. The prices vary vastly
from one policy to the next, and even the various levels within
one policy can be very confusing. Here are a few of the questions
that I am most commonly asked.
Q. My policy states that it does not cover pre-existing conditions
for a period of one year after the commencement of the policy.
What does “pre-existing condition” mean and why
is it not covered?
A. A pre-existing condition is any condition that existed,
or is likely to have existed at the incitement of the policy.
There is a huge gray area in this clause as of course we may
not be aware that the condition existed when the application
was signed. Take for example a gentleman that claims treatment
for prostate cancer two weeks into the policy. Cancer of the
prostate is a slow growing tumor, and the company can argue
that his condition is likely to have been present even though
he may not have been aware of it at the time. Pregnancy is
also considered a pre-existing condition and no company will
cover this in the first 12 months of the policy.
Q. Why do all the companies here seem to medivac you to Singapore?
I am from Australia and it make’s more sense to me,
that should I need to be sent anywhere that I should go to
Perth or Darwin?
A. There are several reasons for this. From a medical point
of view, Singapore is close and the medical facilities there
are extremely good. There are commercial flights every day
to Singapore, and for the best part of the journey you are
flying over land with several airports that can be utilized
for landing should the patients condition deteriorate in flight.
If you are flying to Perth or Darwin, you are over ocean or
desert for the best part of the journey. Many of the assistance
companies have agreements with hospitals in Singapore, and
will therefore prefer to send you to those facilities. While
medical facilities in Singapore are second to none, I would
steer clear of policies that have “Singapore only”
agreements. Take for example the current SARS situation. Should
hospitals in Singapore become overwhelmed by this disease
out break, or any other similar event, where does your health
insurance leave you?
Q. I was under the impression that all medical evacuations
were done on an air ambulance, and yet when my husband broke
his back, he was put on a stretcher in the back of a commercial
flight Jumbo. Is this just a money saving option for the company?
A. Trust me, as the medical escort on over seventy medical
evacuations you are better off on a commercial carrier than
on a charter jet. It is a myth that “jets” are
super fast luxury planes that carry you off at the speed of
light. A jumbo will take approximately two and a half hours
to get to Singapore, where as a small plane will take at least
four hours. As for comfort, you can give me the big birds
any day. Some patients of course cannot be taken on a commercial
carrier. Those conditions such as infectious disease, intensive
care cases, conditions that may be offensive to other passengers,
or conditions that require flying at low altitude (decompression
illness, low hemoglobin count etc). Indeed some cases may
not be flown at all (i.e. conditions that are unstable or
require urgent surgery). For this reason you should ensure
that the policy that you choose covers you for treatment before
you leave Indonesia, as well as after you have been flown
out.
Q. I have a friend that has just bought a policy that is
less than a quarter of the cost of mine! We are the same age
and same risk bracket, and I realize that his cover is a “no
frills” deal, but the price is almost worth cutting
out all the frills that I pay for! What do you think about
this and do you think that “no frills evacuation only
policies” are a safe option?
A. Definitely not. It seems to me that “no frills”
policies are only for those that have enough financial reserve
to make cash payment for the treatments that a basic “evacuation
only” policy will not cover you for. Those treatments
not covered would be most of the bills that you get before
you leave the island (i.e. any emergency surgery, x-rays,
medication, doctors / surgeons fees etc, etc). When you consider
that accommodation charges alone can be 2 – 7 million
rupiah a day, and surgery can be upwards of 10 – 20
million rupiah then a policy that only covers you once you
leave the Island becomes worthless. You could argue that with
such a policy you will never need to be treated in Denpasar.
Wrong. If you require urgent surgical intervention or life
saving procedures, then waiting for the next plane will cost
you your life. Oh, and if any one tells you that their company
has an air ambulance on stand by at Ngurah Rai airport 24
hours a day, ask them to show it to you. Once you get to your
destination, whether it be Singapore, Perth or wherever, you
will have to provide evidence that you can pay for your treatment
(just what you feel like doing as you drift in and out of
consciousness, and the pain in your leg is excruciating!).
Bear in mind that if you have been air lifted out of Bali
there is a good chance that you are in pretty bad shape and
will need either urgent surgical intervention or intensive
care. Bear in mind also that orthopedic (bone) surgery can
come to tens of thousands of dollars, and that intensive care
beds / treatment can cost between USD $1,000 to $2,000 a day.
How far will your policy get you? My advice would be to stick
to your “frilly” policy. In health insurance as
with most things, you get what you pay for.
Q. My partner is Indonesian. If I buy an international policy
for her, can she still be evacuated if she is ill or injured?
A. Absolutely. I do not know of any polices that discriminate
against Indonesians. The only pre-requisite would be a valid
passport and travel documents. Of course it would be better
to have these ready rather than trying to process something
in a hurry should medical evacuation ever be needed.
Q. If I buy a medical evacuation / health cover policy, who
makes the decision whether I am flown out or treated here?
With the price of policies being so expensive, would I not
be better off to bank the money and just buy myself a ticket
to Singapore or Perth?
The decision to evacuate is a team decision, with input from
the treating doctor, the emergency assistance company (e.g.
Intl. SOS, BIMC) as well as overseas medical advisors that
are in telephone contact with the emergency team. As to boarding
a flight your self, this can be a risky business. Airlines
have rules as to what medical conditions are acceptable unassisted.
You might get away with a simple broken arm, or a simple uncomplicated
leg fracture at a push, but any thing more serious would be
knocked back without medical assistance.
Medical assistance is not exclusively available to those
insured by international health policies that are designed
to cover this kind of facility. You can request assistance
from any emergency assistance company at any time, however
you will be required to pay for this service in full before
any thing moves. (Take into account here that accidents tend
to happen outside of banking hours, and typically on long
weekends). If you are game to go down this road, let me give
you some idea of costs. Just for the flight alone, should
you require a stretcher on a commercial carrier, it will cost
upwards of USD $6,000; should you need a charter flight than
you are looking at USD $30,000 just for the aircraft.
Well I hope that helps you understand a little more about
the maze that is health insurance. Once again, as with most
things, you get what you pay for, nothing more and nothing
less. Until next edition stay happy, stay healthy, and stay
young!
Kim Patra is a qualified Registered Nurse / Midwife, and
mother of three, who has been living and working in Bali for
past 15 years. She has assisted many traveller (... and others)
either as a flying medical escort or just a voice on the end
of the phone! Kim is happy to discuss any health concerns
that your may have. Her e-mail contact is info@chcbali.com
