Rolling the dice on your health


By Jim Carr, Reprinted with permission from Spa Canada Magazine

IF YOU’VE EVER suffered a serious illness or been injured in an accident while traveling abroad, you how just how unsettling the experience can be – even if you have medical travel insurance.

If you don’t, it can quickly turn into a nightmare that can haunt you financially for years.

Despite this, you’d be surprised at the number of people who take this chance, not just once but every year. Even if you’ve just had a check-up and received a clean bill of health from your doctor, that’s no guarantee. I know. I went for a medical check-up in order to qualify for an insurance policy, only to suffer from a heart attack a few days later.

It’s the unexpected, like a heart attack, a car accident or a nasty fall, that trips you up. When you’re traveling without insurance, you’re rolling the dice, not just on your health but with the unexpected.

“Canadians, Brits, Australians and New Zealanders are more casual about purchasing medical travel insurance,” says Dr. Michael Moreton, a Canadian doctor, international medical co-ordinator at the Bangkok Hospital, a five-star medical facility, in Bangkok.

“Their medical health plans – with all their faults – are always there for them and many people rarely think about private health insurance. This is in spite of the fact that your coverage is of no help when you’re out of the country.

Dr. Moreton 2“The phenomenon of being turned away from hospitals because they have no insurance or can’t document their provincial coverage is not part of their experience. If you are taken ill in a foreign country, and you don’t have medical travel insurance,” he added, “you are an uninsured patient and may have trouble getting care.”

What kind of problems? Accident injuries, for one. They’re big, especially motorcycle accident injuries in places like Phuket and Koh Samui, where I recall seeing one lady in her 60s whiz by my taxi on a motorcycle.

“They’re certainly the most dramatic,” he added. “But we also get vacationers who have been hurt in car accidents or who sustained injuries from a bad fall.”

He recalls the case of an older man who had not ridden a bicycle or a motorbike for some years. To make matters worse, this individual’s sense of balance was going and, combined with the erratic driver behavior on Thai roads, and the feeling of being on vacation and carefree, you have a perfect recipe for accidents.

Cardiac patients also often over exert themselves and end up in hospital.

Travel challenges for diabetics

And diabetics traveling across 10 or 12 time zones, may experience problems readjusting their insulin dosage to a 12-hour time split. “We see a significant number of diabetics get into trouble, particularly during their first few days here.”

It can be a problem but you can control the time changes, says Dr. Gerald Bernstein, a past president of the American Diabetes Association, an associate professor at the Albert Einstein College of Medicine in New York and author of a number of research studies on internal medicine and diabetes.

Dr BernsteinHe gets his diabetic patients to draw a time line that shows the actual number of hours they’re traveling and the equivalent times at home. Dr. Bernstein understands the problem on a personal level. He is a diabetic, himself, and travels to Japan from time to time to visit his son.

“On a trip like that, you’re traveling 14 hours and arrive in the evening of the next day and, because you’re crossing so many time zones, you don’t realize what the time it is at your home.”

In his own case, he helps his body adjust to the new time zone. He takes a dose of long-lasting insulin. This enables him to go for a long period without eating very much. “Then, when meal time comes, you do just what you always do.”

The key question is when you take the next dose. On the first day, he recommends taking two half-doses – the first at the time it is where you are and the other half, about 12 hours later.

“That will take you into the next day. At that time, you can resume taking your insulin the way you usually do.”

The biggest thing when you’re traveling is taking care of your medications. It’s important to remember, he says, that today’s insulins are stable at room temperature. Refrigerate or not? That’s up to you. Do what’s convenient.

“And always bring more medications than you need. If you’re taking a big trip, duplicate everything you need and carry the duplicates in a separate bag – and always make sure there are extras.”

That includes packing an extra meter. If you only have one, you could get stuck if you lose it. You can always buy a new one but even here, there could be a downside. The new one may not be in the units you’re used to looking at.

Going through airport security

He also recommends carrying a copy of the Rules of TSA, which outlines the correct approach when going through security, citing the case of a 16-year-old who was forced to go through a machine at the airport that destroyed her insulin pump. She felt intimidated and tried unsuccessfully to explain that the screening was not needed. She didn’t have a copy of the rules with her and wasn’t forceful enough to ask for a superviser. Simplest way to handle situations like this is to keep a copy of the rules with your passport. They’re available online.

Infectious diseases are also a big concern of many tourists, particularly malaria, says Dr. Moreton. “Actually, we see virtually no malaria among tourists, although some may possibly show signs of malaria when they return home because of the incubation period.

“We do, however, see a significant amount of Dengue Fever. One of the first symptoms is a great deal of joint pain and pain in the limbs. Dengue Fever has a significant death rate in Southeast Asia, particularly among children … but at Bangkok Hospital, we haven’t seen a tourist die from it for more than 20 years.”IMG_0749

Many tourists make a big mistake of not getting travel insurance with their medical insurance, he says. Travel insurance is usually ignored because most people don’t understand everything it covers. In addition to flight cancellation or help if your bag is missing, or you suddenly find yourself stranded, it also covers the expense of getting you home after treatment.

That can be a huge issue in some instances. Dr. Moreton cites the case of a British patient who needed to be transported back home after surgery and intensive care treatment for a collapsed lung, which happened “quite spontaneously and without warning.”

To get back home, the patient needed a nurse and doctor to travel with him because he was taking anti-coagulants and might need extra oxygen on the flight. He was flown business class from Bangkok to London with his two attendants.

Be sure your travel insurance covers evacuation costs

“This is often overlooked by many tourists. But if you have to be returned home this way, the cost can be incredibly expensive – as much as $50,000 or $60,000 in some cases.”

Why? Transportation in these cases often requires two rows of seats to accommodate your bed, plus space for a doctor and/or nurse, plus special transportation to the airport and again from the airport once you reach your destination.

“Despite all this, it’s surprising how many Canadians think they can send their medical bills to their provincial health care plans and recoup their costs. They can’t. In the case of evacuation, it’s usually part of your travel insurance but, even here”, he cautions, “you should look at the limits.”

Ideally, you should buy your travel insurance in your own country. One patient, he noted, purchased travel insurance in Thailand, which provided coverage for travel “back home” – only to discover “back home” meant Thailand.

Dr. Moreton cited the cases of two other travelers without medical coverage who became ill or were injured in Thailand. The first was a man who rented a motorbike to discover the back roads in Northern Thailand. He had not ridden a motorbike in more than 10 years and was thrown into the air when the truck he was following suddenly braked. He landed on his face.

His family was contacted for consent to perform an operation. They were not aware if he had any private health insurance and were reluctant to guarantee payment.

“Despite this, he received excellent medical care and is now on his way to full recovery after multiple surgeries for facial fractures and skin grafting.” He had to take out a considerable bank loan to cover the cost of his care.

A young Canadian woman, who was working as a volunteer in a children’s care home in Cambodia started to have abdominal pain after eating a spicy dinner. She had not obtained any insurance when she left Canada, thinking that her province would cover her medical expenses while out of the country. She was able to get a flight to Bangkok, where she had her appendix removed. Her family came to Bangkok and was able to transfer funds to cover the cost of her care.

Most problems depend on your age

What types of medical problems do travelers encounter while traveling?

It depends on your age, according to Medipac Travel Insurance. In the case of younger travelers, they’re more likely to be treated for accident injuries. For older individuals, like snowbirds, it’s usually for a medical emergency such as a heart attack or urinary tract infection.

It’s the prime reason why most insurance programs ask individuals over age 55 to complete a questionnaire about the status of their health as well as to ensure that all your medical problems are under control.

If you’re over 55, it’s really important for you to understand what your insurance carrier defines as “stable” and “controlled” and the time frame for that stability.

If you have a heart problem, for example, your condition needs to be stable and under control for a year. As a rule, insurance carriers will not honor claims where the applicant misrepresented their condition as stable.

It also means that if your health condition changes between the date you take out the insurance and the time you leave for your trip, you must call your insurance carrier and make sure they know there has been a change in your condition, Medipac advises.

They also recommend going through your insurance policy carefully, particularly as to what it defines as a treatment. Different insurance programs have different definitions of treatment.

You need to be very honest about your health situation. Sometimes, people do honestly forget something in their medical history when applying for insurance. In those cases, says Medipac, you can usually tell if it were an honest error or an outright misrepresentation.

What will your provincial plan cover?

If you do decide to travel without medical insurance, what kind of financial help can you expect from your provincial plan. That depends on where you live. In Ontario, for example, the provincial plan will pay up to $400 a day for out-of-province care – but even that amount depends on the nature of your treatment. Usually it amounts to 3% of what your total medical bill would be. So check with your provincial plan if you decide to travel without insurance.

What other alternatives do you have if you find yourself ill, perhaps suffering from food poisoning? In Thailand, you can also seek care at one of the government hospitals.

They’re a good bet – and the cost is a fraction of what you might pay at a private hospital. But only, cautions Dr. Moreton, if you have someone who can speak Thai to explain the nature of your medical problem or injury.

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