Titanic-sized medical bill surprises couple
Chest pains land cruiser in ship's infirmary — and with a bill for $1,200
By Anita Dunham-Potter
updated 2:51 p.m. ET, Mon., Aug 10, 2009
Susan and Larry Smith were looking forward to their first-ever Cunard cruise across the Atlantic onboard the fabulous Queen Mary 2. But the fun stopped for the New York City couple the moment Larry had chest pains along with gastrointestinal malaise.
The Smiths immediately sought treatment at the ship's infirmary, where the ship's doctor ran an EKG and some tests. Fortunately Larry's heart checked out okay, but he was dehydrated and was given intravenous fluids and was kept in the infirmary for an hour of observation.
Larry's tests ruled out any infection, but the doctor couldn't figure out why Larry had become so dehydrated. Therefore, no definitive diagnosis was reached. The next morning Larry felt much better and the cruise continued. A few days after the visit to the infirmary, the Smiths got another unpleasant surprise: a bill for medical services totaling $1,200. The amount was immediately charged to their shipboard account.
The Smiths were shocked. "It didn't seem like a lot of treatment for $1,200. It was as much as my cruise fare," said Susan Smith. Even worse the couple foolishly believed that their health insurance would be accepted onboard the ship. It wasn't. Fortunately they did have travel insurance (purchased through the cruise line) that covered medical issues.
Insurance doesn't travel well
What many people don't realize is that all cruise ships of foreign registry are considered to be entities operating outside the United States. And, as the Smiths discovered, domestic medical insurance coverage doesn't travel the same way aboard ship as it does within the United States. Sometimes, coverage doesn't extend to foreign travel at all; other times it just works differently. For example, co-payments may be higher than usual or your reimbursement may be limited.
Even with complete medical coverage, you can't just hand the cruise line your insurance card. You will usually have to pay your treatment costs up front and file for reimbursement after you return home. That's what the Smiths did. Their insurer accepted the claim but explained it could take up to three months to receive reimbursement. The Smiths were relieved to be covered at all.
Could the Smiths have avoided the $1,200 out-of-pocket expense? Maybe. If they had purchased third-party travel insurance, they could have received upfront financial assistance and they might have gotten their money back more quickly.
Third-party insurers usually provide primary coverage, i.e., the insurance company pays the traveler directly for any medical claim. Most cruise lines also sell insurance policies, but these usually provide secondary coverage, which means that you must file your claims through your regular medical insurance carrier, then seek reimbursement from the cruise line's insurance company.
Cover the gaps
Medicare beneficiaries should always purchase travel insurance when they cruise, because they do not have Medicare coverage outside the country. Another very big gap is medical evacuation and transportation services, which are seldom covered by medical insurance policies.
According to Medjet Assist, an Alabama-based evacuation operation, domestic air medical evacuation services average $10,000 to $20,000, while international transports can exceed $75,000. If you travel more than once a year, consider buying an annual policy; both MedjetAssist and Travel Guard offer this kind of policy, which can be purchased for as little as $185 a year.
Cruising is exciting, but it can turn into more of an adventure than you planned if you discover that you aren't covered for the unexpected. So check your insurance policies and fill in the gaps with supplemental coverage.
James H. Allen