If you follow the journey of 4 Deep Around the World, you know I’m a huge advocate of international travel. I constantly promote taking advantage of every opportunity to see the world. World travel is the new “it” thing that’s taking the world by storm. This is evident by a simple peruse of the multitude of travel related Facebook groups and travel deal websites that have developed in recent years.
Often, when I booked a flight deal I’d irresponsibly forgo purchasing any travelers insurance for my children, or myself. I would shrug it off as an unnecessary purchase that would make the overall cost of the flight deal less favorable to my pocket book, and defeat the purpose of booking the deal. It wasn’t until this last October that I began to view my approach to travel differently.
After two years of living abroad, I was finally able to convince both my parents to visit us in Abu Dhabi using a flight deal as a financial incentive. My dad and stepmother visited in September without a hitch. My mother and stepfather followed suit in October after the departure of my dad and stepmother.
They were scheduled for an eight-day vacation in the UAE. Our itinerary was set and we were ready to show them how 4 Deep was living.
Everything was going smoothly until the fourth day. On the fourth day of their visit, my stepfather began to feel slightly ill. He said he was feeling somewhat fatigued, he chose to hang out on our couch instead of touring the city. We figured his minor fatigue was dehydration because his choice of daily beverage was coffee instead of water. He decided to tough it out, drink water, and rest.
By day six his condition had worsened. In addition to the earlier symptoms and some other added ones, he couldn’t balance himself. At this point, toughing it out was no longer an option. I arranged for him and my mother to visit a local clinic here in Abu Dhabi while I was at work. I also had Jane (our family nanny) escort them, since I was unable to take time off of work without facing a financial penalty so harsh that I am contractually obligated not to discuss the actual amount. I knew they were in good hands because Jane is familiar with the city and with the chosen clinic.
As I headed out to work, they readied themselves to go to the clinic. By 10 am my mom called to update me on the situation. The general practitioner had diagnosed my stepdad with pneumonia and he was in critical condition. The staff at the clinic immediately directed him to the local hospital across the street to be admitted and treated.
This is where it got interesting.
I arrived at the hospital at 4pm. My parents had been sitting in the emergency room behind a curtain for almost five hours. My stepfather had not been admitted and I could see his condition had severely deteriorated since I had last seen him that morning. He could no longer walk, and his speech was so slurred I could barely understand what he was saying.
My mother was stressed that upon their arrival to the hospital they were told the hospital would not accept the worldwide insurance coverage they had through BlueCross/BlueShield. Needless to say I was upset and baffled by this news because the hospital was one of the facilities named on the insurance company’s website as a network provider.
She was told no services would be rendered unless she was able to pay for services upfront. Of course my mother had no choice but to hand over whatever cash and/or credit cards she had available.
After handing over every type of currency she had this is what happened:
In order to do the much needed blood work, they demanded she pay for the services. She paid them promptly. After she paid for the service, they returned his passport to her. This process was repeated for any and every service rendered, including seeing the doctor.
When I arrived I was livid to hear how my parents were being treated. I was even more appalled to see the condition of my stepfather as he laid in the Emergency Room for hours while in critical condition. Why was he being treated like this you might ask? Because they did not have insurance the hospital would accept.
After hearing and seeing how my stepfather was treated, I remained calm. After living in the UAE, I’ve learned the best way to handle any situation is to remain calm. I asked my mother to escort me to the receptionist desk so I could ask what was going on. The receptionist told me what I’ve been saying; the insurance they carried would not be accepted at this hospital. I immediately asked to speak with someone in the billing or insurance department. That poor soul must have called five different people and with each call I could see the frustration mounting on her face. No one could tell her whom we needed to speak with.
Eventually, a gentleman, Mr. X, arrived to speak with us regarding this issue. I explained to him that my stepfather had worldwide insurance that should cover him for the services rendered because the hospital was within the network of providers. He said to me, “If you could get a letter of guarantor for the hospital, we can admit him and continue services he needs.” This was ridiculous . In my past dealing with UAE hospitals, all that was needed was a valid and up to date insurance card.
Finally, in our sixth hour, we thought we could see a beacon of light at the end of the tunnel of ambiguity. We were advised to call the insurance company and have them fax the letter of guarantor to the hospital. Normally, one would think that piece of advice would be simple enough to carry out and make the rest of the hospital visit smooth. However, we weren’t working with a normal situation in the UAE.
My mom and I retreated to the hospital parking lot to contact the insurance provider. After telling our situation to the first representative we spoke with we were transferred to another department. (Note: My cell phone was unable to complete the collect call to the insurance company so we are using international mobile minutes on my prepaid phone). When the next representative answered, and we told her the situation, she assured us we were speaking with the right department and she could assist us.
I explained to her that we needed a letter of guarantor from the insurance company to be faxed to the hospital in order for them to admit my stepfather, their client. She asked us for his general information and his current status. After about thirty eight minutes into the conversation she assured us she had everything they needed. Before wrapping up the conversation she drops the bombshell on us: that it will take forty eight hours to process our request and have the letter of guarantor sent. *Ok…. Breathe Tanai. Breathe and count 10, 9, 8, 7…*
Please know that being a resident of the UAE I am well aware that I must articulate my words wisely to avoid arrest. According to Wahab, Article 373 of the Penal Code states“Detention for a period not exceeding one year or a fine not exceeding Dh10,000 shall be imposed upon anyone who, by any means of publicity, disgraces the honour or the modesty of another person without attributing any particular act to the defamed party. “
As my mother sat next to me, I strategically chose my next words carefully (translated, no cursing). I needed this representative to get on and remain on our side and make an exception and bypass their 48-hour policy. As an added bonus, the UAE was approaching a national holiday. What this meant was if we didn’t get the letter of guarantor that day we would be up the creek without a paddle until the proper department in the hospital reopened after the four-day weekend. After hearing the “I understand” and “I am sorry there is nothing more we can do” from the representative I realized one thing. That this particular representative was just a representative and her hands were tied by just as much red tape as ours. So I wished her a good day and ended the call, especially since she was costing me a minimum of two dirhams ($.54) a minute.
We left the parking lot and went back into the hospital to explain to Mr. X that the insurance company was processing the request for the letter of guarantor but it would take forty eight hours for the request to be completed. He didn’t offer us any other options except for cash payment; and that was required upfront. So we went back to the drawing board.
We were still behind the curtain of the ER holding room and the hospital still held my stepfathers passport as the eighth hour approached. At this point his Oxygen Saturation (SpO2) level was holding at a low 84%, and he remained unable to stand or walk. Normal SpO2 values vary between 95 and 100%. His speech was still slurred to the point that his words remained unrecognizable. We were at a complete stand still and he still wasn’t receiving any care.
When I requested to speak with the doctor on duty I asked why my stepfather wasn’t getting the medical attention he needed. I reminded the doctor that he had taken an oath to provide service to the sick. He informed me that the hospital was a private facility and they were not required to render aid if the patient could not pay. * Breathe Tanai. Breathe. 10, 9, 8, 7… *
I began dropping as much medical terminology and information I had acquired through my countless hours of Grey’s Anatomy and Private Practice viewings. Here I was, a High School Math teacher suggesting to a medical professional that a CT scan may be needed and that his symptoms are in line with swelling of the brain or some other neurological issues.
I’m not exactly sure what I said that touched a place in him, but he asked me if we had been offered to make a down payment to secure services. I asked him what he meant by a down payment? He explained to us that if we put down 1200 AED (326 USD) that we could have him admitted and treated.
My stepfather had been laying in the ER in critical condition for hours because we couldn’t provide proof of immediate payment and all we needed was $326?????
WOOSAH! *This is when I mentally begin to say the Lords Prayer and attempt to not allow the disgust to visibly show on my face. * I took my mothers credit card and headed to the billings department to make the payment. I signed a few documents, not really caring that I could possibly be signing away my soul, and handed over my residence ID to be copied.
By midnight, they had retrieved him from the emergency room, taken him for a CT scan and admitted him to a private room. I think both my mother and I breathed a sigh of relief. We had bought ourselves some time to allow BlueCross/ BlueShield to take care of business on their end and get us the letter of guarantor needed to cover his services while simultaneously ensuring he received proper care. Neither my mother nor I had realized the hospital never offered to return his passport to us and the business office would be closed for the extended holiday.
My stepfathers’ condition had worsened within nine hours of being admitted to a room, so he was sent to ICU. The doctors on duty remained baffled as to why his condition was worsening. This was no longer just a case of pneumonia. After a series of questions their final question was if he had acquired the viral respiratory illness MERs (Middle East Respiratory Syndrome). Days later he was finally diagnosed with having a stroke and a collapsed lung.
By the end of our UAE weekend, Friday and Saturday, BC/BS customer service had dropped the ball. The parties responsible for handling our case were off on the weekend, which was Saturday and Sunday for them. Emails were sitting in employee inboxes unread until we, the insured, followed up. It was becoming a total nightmare but we remained calm all while trying to effectively problem solve. It’s what we do best. Between my mother and I we’ve had our fair share of prior personal hands on crisis management.
By Monday the UAE holiday was over and I had to return to work. My stepfather remained in the ICU and the hospital was requesting payment for services. They were adamant about receiving payment despite our hold ups with the insurance company. My mother handed over her credit card once again to pay a small portion in hopes to buy more time for BC/BS to fulfill their end of the bargain. She called and updated me on the most recent payment requested. I asked her if they had given her a detailed invoice of services rendered and to itemize what the payments were covering. She said they had not so I told her to request one. A few hours later, she called to inform me that they have given her a receipt; but it was only an estimate of charges to date and it was handwritten. I WISH I could make this stuff up. Yes, her receipt was a hand written estimate of charges.
At this point, my frustration had mounted to an all time high. Our request for the return of his passport was falling on deaf ears and our intelligence was being insulted by handwritten estimates. To top it off, the hospital had received the letter of guarantor from BC/BS that itemized his international coverage as requested; however, due to their discretion, the UAE hospital decided they would not accept the letter. This is the point where I mentally inserted those colorful words and called on Jesus at the same time. I could not (and still can’t) fathom how people could travel halfway across the world WITH worldwide insurance coverage and still have to deal with this nonsense.
If this had been a simple cut acquired during a zip line tour in Brazil that needed six stitches then it would be no big deal. Lets pay, keep it moving and submit receipts to the insurance company later. Unfortunately, it wasn’t that simple. An extended stay in the ICU in a foreign country is probably the last thing anyone could imagine when booking the latest flight deal.
By now I had reached a dead end. I wanted, no needed, to ensure that my thousands of friends realized the consideration for travel should be more detailed then catching a cheap fair. I vented on my Facebook page to my family, friends and followers in hopes that some one could shed some insight on possible options.
Within minutes, a local friend of mine called me to let me know that she had a doctor friend who worked for the hospital and may be able to assist us. Okay, okay I see you GOD. We are making progress!
The doctor friend was able to arrange a meeting with the hospital administration for us to discuss our financial payment options. I am truly grateful for this doctor friend whom I have not met to this day. The meeting scheduled with the hospital administration was the most unprofessional experience I’ve had with someone in a business environment in a very long time. My mom and I sat before a male administrator along with his female colleague who possessed much more tact and compassion sitting behind us.
He explained that the hospital was not going to accept the guarantee of payment unless BCBS had an affiliate in the Gulf region with a representative they could work with directly. Otherwise, he said we had two options.
He could give us the hospital’s IBAN (bank account information) and we could request BlueCross/ BlueShield make an immediately transfer of funds to the hospital’s bank account
* This mad me chuckle internally* I had to explain to him that option 1 wasn’t even feasible because A) he had not been discharged yet so the total hospital charges would not be calculated and B) That’s not how insurance companies in the U.S. A does business. So I asked him what the second option was.
He looked at me and said that since I didn’t have the funds at the moment, I could write a postdated check for the estimate of total charges, (which at this point was over 62,000 AED or $17,000). THE DEVIL IS A LIE. A bounced check here is automatic jail time and no one will set me up for failure.
At this point, I could only imagine my facial expression. Below is our word exchange after he uttered such foolery.
Me: Why do I have to write the check? I’m not the patient.
Him: Well he is your family member and you are the resident here.
Me (with minor neck roll): Well technically he’s not my family by blood. Look, that is her husband and she is my mother.
Sidenote: I love my stepfather dearly but a sister can’t go to jail. My mom will not let me live that portion of the conversation down to this day. We can laugh about it now.
Since options one and two were both no go’s and he didn’t offer an option three, I asked the seemingly simple question – What if we can’t pay? I was appalled by his response. With a straight face and no compassion he said it would become an issue for the local police. Where I’m from that means you are going to jail, don’t pass go and don’t collect $200. This is the point where my mother, who was attempting to let me take care of the situation, went from zero to one hundred real quick. There was nothing I could do to calm her. I think he had insulted our intelligence one too many times. We walked out of that meeting with no resolution, no hope and a lack of respect for the hospital, administration and their policies.
Still filled with frustration I took to social media again. This time not only did I take to my personal account but also to a larger platform of a travel group I am in. Nomadness Travel Tribe has over eleven thousand world travelers as members and I knew hundreds of them would be converging on the UAE within the next few months. I wanted to ensure they remained informed and had a plan B in case of an medical emergency. So I posted this:
From this post an angel arose. Little did I know that a member of the group worked in an internal position at the hospital and that person had some pull or as the local here would say wasta (clout). My new angel’s private message led to us conversing about the situation. We spoke briefly and she followed up with a message assuring me that everything would be worked out. Within thirty minutes my mother contacted me and stated that two compassionate and caring hospital representative had just left after speaking with her to gather the details of our experience. Once again, they reassured her that the situation would be resolved. Within an hour, my mother called me again and said the billing department had just left the hospital room and the insurance would be accepted. Well Hallelujah!
My family will forever be indebted to this Facebook angel. I could only imagine the “what ifs” had she not stepped in.
The life lesson bundled in this situation has caused me to re-evaluate the approach I take when traveling on a budget abroad without medical insurance and /or enough cash on hand for medical emergencies.
Below are a few tips of items to consider before you travel internationally.
1.Check your health insurance coverage/policy
Before traveling abroad, check with your health insurance provider or travel insurance provider to see if you have coverage in the country you will be visiting. I would advise that you actually contact your provider to ensure they have an upstanding/active relationship with a hospital in the country/area where you would like to visit.
2. Have your insurance card or travelers’ insurance information available at all times
3.Purchase Supplemental Insurance
Before you visit abroad you might want to consider purchasing supplemental insurance from a provider based out of the country you plan to visit. Experience has shown me that sometimes hospitals prefer to work directly with a local insurance provider rather than work with a company in your home country. If you ever visit the United Arab Emirates, consider the Daman Visitors Plan.
4.Wear A Medical Bracelet If You Need One
If you have any life threatening health conditions, a medical bracelet could mean the difference between life and death, especially for solo travelers.
5.Register with your Embassy/ Consulate
Unfortunately, the Embassy or Consulate may not be able assist you financially when confronted with a medical emergency with a hefty price tag. However, they may be able to assist you with locating the best medical facility for international travelers.
Per the U.S. Department of State – Bureau of Consular Affairs website
“If you or a U.S. citizen loved one become seriously ill or injured abroad, a consular officer from the U.S. embassy or consulate can assist in locating appropriate medical services and informing your family or friends. If necessary, a consular officer can also assist in the transfer of funds from the United States. However, payment of hospital and other expenses is the patient’s responsibility. You can find local medical and emergency information at the website of the U.S. embassy or consulate near the ill or injured person.”
6.Have an international calling plan
Imagine being confronted with a medical emergency without a legitimate way to contact your family or your insurance company. Imagine racking up an immense mobile bill after spending hours on an international call with your insurance company as you get passed from department to department while trying to cut through the red tape.
7.Have a Plan B
Accepting your insurance is completely at the discretion of the hospital. I suggest that each traveler has a high limit credit card available with an excessive amount of cash available to you on demand. Coverage does not always mean you are immediately covered.
8.Be familiar with local emergency numbers
Believe it or not, 911 is NOT 911 everywhere. For instance, in the UAE, the emergency contact is number 999. Knowing this information could save your life in the event of an emergency abroad.
9.Be familiar with the International Association for Medical Assistance to Travelers
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