The ambulance hit every speed bump between the port and City Clinic.  Lying on my back I felt every jolt.  There was nothing to look at to distract my attention so with each jolt I wondered “how much is this going to cost me?” 

(Photo courtesy of Ken Yokouchi- Loading me off the ship into the ambulance.)

There was always the lurking fear that some illness would cause one of us to be dropped off the cruise in an unfamiliar port. I started internal bleeding on the long stretch of sea days crossing the Indian Ocean and ended up in the ship’s sick bay’s intensive care.  The staff captain called for blood donors to help a “critically ill” patient.  I heard the announcement and asked “Am I really critically ill?”

“Yes, you are.”  Thirty-seven people came forward and I had three transfusions before I got off in Port Louis, Mauritius.

The experience taught me several lessons.

Before this cruise there was discussion in forums about what type of travel insurance to get.  One cruiser said he never paid for insurance.  He “self-insured,” putting the money he would spend on insurance into an account and withdrawing anything he needed to cover emergency expenses.   That certainly saves a lot of hassle with insurance companies.  Had we done that we would have covered our out of pocket expenses but not compensation for trip interruption.

We took the HAL Platinum Protection Plan and signed up for an additional emergency assistance program.  The HAL policy had a $50,000 limit on sending us home.  I live in Alaska, have used emergency assistance, and know that an air ambulance from Sitka to Seattle can run upward of $75K.

We flew home on a commercial flight from Mauritius.  I did not need a flight nurse or air ambulance.  Suzi was my attendant.  Because I was on blood thickeners and needed to move my legs frequently, we were sent Business Class.  That easily fit within the $50K limit of the HAL PPP plan (see the earlier blog post).  We opted to have the HAL plan send us home rather than the emergency assistance program because it was less paperwork.  Carefree, which handles the HAL PPP, was proactive, calling us to ask what we needed.  We are happy with their service.  They paid for the airfare directly so there was no out of pocket.  I don’t regret having the emergency assistance plan that we didn’t use.  If we needed a helicopter, air ambulance, or attending physician we would have had the coverage.

Basic Medicare is our primary medical insurer.  With a few exceptions it does not cover care outside the U.S.  Medicare Part F (Medigap) covers 80% of overseas emergency care (with a $250 deductible) but only during the first 60 days you are abroad.  Part F has a $50K lifetime limit.  Part F is our secondary.  Our next line is the HAL PPP, covering up to $10 K.  We have additional coverage on our credit card of up to $250K.  The 40 hours I spent in the ship’s intensive care cost us more than $14K.  Since that was within the first 60 days, Plan F should cover 80% of that after the deductible.  But we had to front the money and wait for reimbursement.  Had I gotten sick a week later I would not have had Plan F coverage.

The two weeks in a Mauritius Hospital (5 days in the High Dependence Unit) was over $16K.  Medicare Plan F should cover the first two days of that. (After that we are more than 60 days from leaving the US.) We will make a claim to the PPP insurance for $10K after that.

We will apply for the remainder through our credit card, but we might not get any benefit because they may view my illness as a pre-existing condition.  It is likely that I will be out of pocket for several thousand dollars. 

I have learned several lessons from this experience.

1)  Have a good cash cushion.  We had to put both the on-board care and care in Mauritius on our credit cards.  (We had to use several cards because of credit limits.) Medicare will take up to 90 days to reject our coverage.  They will submit the claim to Premera Blue Cross (My Part F Carrier) and that could take another month.  I will need to submit the coverage Part F declines to the travel insurance company.  Travel insurance companies are backed up on claims because of problems with air travel over the holidays.  HAL’s underwriter told us it would take them 30 days just to enter the claim into their system.  If our credit card insurance pays out anything that will take an additional 6 weeks.  Adding it all together we could be carrying some of these medical expenses for more than 6 months.  Before traveling we opened a line of credit guaranteed by our retirement account at a favorable interest rate.  We will use that to avoid having to carry thousands of dollars at credit card interest rates.  We will repay the line of credit as we get reimbursed by the different insurances.

2) If you have the HAL PPP you need secondary coverage, especially if you have Medicare Plan F as a primary and your foreign trip is more than 60 days long.

3) Read the exclusions of pre-existing conditions carefully.  If I had had a stroke, I would have been covered on the credit card but internal bleeding from diverticular disease may be a problem because I’ve had diverticular problems in the past.  My insurance broker says most travel insurance companies have pre-existing condition exclusions.

4) You can file for trip interruption separately from medical on the HAL PPP, which means we may get Suzi’s expenses in Mauritius and compensation for unused travel before we get medical payments.  We can use that to pay off the line of credit while waiting for health insurance.

5) Have a mobile phone and a good data roaming package.  We spent a lot of time on the phone and online with HAL, the insurance companies, and local doctors.  Without a good roaming program, we would have had a difficult time.  You will want to have another communication program, like WhatsApp or Skype on your mobile as well.

6) Have a good advocate those first hours on shore.  If I had been sailing solo, I do not know how I would have handled the situation.  I started getting calls from HAL, Carefree and the insurance company the day I arrived in Mauritius when I was in the HDU with no access to insurance numbers or credit cards.  Suzi handled that.  If you are traveling solo arrange for a cruise mate to give up their shore day to handle those initial contacts while you are being treated.  That includes dealing with the hospital business office.  If you can’t get a friend, try to get a member of the ship’s staff to be with you in those first hours.  Have someone with power of attorney at home who your local advocate can contact to hand off negotiations with insurance and evacuation companies before your advocate gets back on the ship.

The port agent in Mauritius was helpful.  He handled our passports, customs issues and our baggage, but he also has other duties while the ship is in port.  He kept in contact with us after the ship had left. 

7) Try to get as much of your account settled before you leave the ship as you can.  Get an itemized medical bill and your ship account printouts.  This will save you time and frustration later as you file your insurance claims.  The ship’s doctor will provide medical records to you and the local shoreside hospital. 

8)  Be nice but be persistent when you call HAL for information after you get home.  The people who answer the phones may not be well trained.  Although I hate being “that guy,” ask for a supervisor.  I called the World Cruise Desk, they told me to call Guest Relations, who told me to call the World Cruise Desk who told me to call Guest Relations.  Sometimes I was on hold for almost an hour.  Be kind but be assertive.  When I got a supervisor, I found that guest relations guestrelations@hollandamerica.com was the proper place to call for some issues, but there are two other email addresses that are essential, mrecordsrequests@carnival.com for medical records and onboardbilling@hollandamerica.com for getting an updated folio.  Once I had these email addresses, and the name of an experienced person in guest relations who I could ask for when I called, I got rapid responses.

9) When you get your folio review it carefully.  I found that I had not gotten credit for port fees and taxes for ports we missed.  Guest Relations is working with me to fix this.

10) Be careful of the return addresses on the emails you get through the HAL PPP.  We got emails from “Carefree Assistance,” “Live Travel,” “AON,” “Holland America,” “Carnival Corporation,” and “Princess Cruises.” Keeping them straight was difficult.  Sometimes we sent information to the wrong email address.

We are nowhere near done with the process and I am sure there will be other lessons we will learn along the way.

Overall, the experience was not as bad as I expected.  HAL called frequently.  When we got home Carnival Corp called to make sure we were ok.  We got follow up emails.  The insurance claim forms, already partially filled, from the PPP carrier were waiting in our PO box in Sitka when we got home backed up by the forms in the email.  I was impressed with the service we got through the Holland America’s PPP and by the concern shown by HAL and Carnival Corporation.  The medical staff on Zuiderdam sent me a get-well card when I got home.

The care we got on the ship and in Mauritius was first rate. I have written earlier about our experience with the hospital in Mauritius.  They took a holistic approach to recovery, which included getting a taxi and taking me to see parts of the island during the afternoons.  I took short walks on beaches and to waterfalls that helped me build strength and quickened my recovery.  Because I am curious and open to changing plans, it turned out to be an interesting experience.  I learned a lot about my host country and took every advantage they offered me to see new things and taste new foods. (You can navigate back to earlier posts.)  The kitchen staff brought out cell phones to show me pictures of local vegetables they were about to feed me and explain how they were cooked. I also learned a little about traditional Chinese medicine. (There was a floor dedicated to it.)

The hardest part is not being able to return to the cruise.  We had hoped to rejoin, at the latest, in Amsterdam.  But the medical providers do not think I should be more than a couple of hours from hospital care.  With sea days and the possibility of missed ports they would not certify me “fit to sail.”   

But many of you are on Zuiderdam.  Please, enjoy the remainder of the cruise for Suzi and me.  Don’t let the small stuff (I am still reading Facebook and Cruise Critic) take away from the big picture.  Relax!  The joy is in the journey and the travel companions you meet along the way.