An expat’s dilemma: Would getting sick break my bank?


Injured construction worker is to be transported to hospital.  Source: Phnom Penh Post

Part 1: Decisions, decisions, decisions

It began with my absent-mindedly stepping on a wet tile floor and falling down hard on my right side.  It ended with important lessons not only for me but for many others, especially older individuals, who also choose the expat life.

In addition, the incident could prove illuminating to anyone who seeks some insight into the complexities of obtaining first-rate medical care overseas, whether tourists or expats.

One of the lessons that I learned reinforced the importance of my paying undivided attention to where I walk, especially if I am outside in Phnom Penh.  I walk for miles everywhere, in large part for my health, despite the dangers that pedestrians face here. We cannot navigate cluttered sidewalks and must always be on guard in a city where the multitude of cars and two-wheeled vehicles pays virtually no respect to the right of way of pedestrians in seemingly chaotic traffic.

Equally important, the whole experience of my fall taught me that I had made the correct decision about medical insurance when I retired to Cambodia from Manhattan at the end of 2013.

Having done my research before my arrival, I learned that Medicare doesn’t cover expats like me when I am overseas and that much healthcare where I now make my home is substandard.  (However, if you are in Mexico or Canada and need hospital care, Medicare will reimburse the facility provided that it is closer than one in the U.S.)

At least Medicare and supplementary coverage do offer benefits when I am in the United States, not that often.  I’m glad to have it: Who knows what the future will bring?

So it was that soon after I arrived in the capital city, nearly five years go, I met with a highly regarded insurance broker.

Although I watch my budget, the best evidence being my monthly rent of only $1,050 for a roomy one-bedroom nicely furnished apartment in a new building, no one would mistake me for a Bezos or a Zuckerberg.

Despite my admittedly inconsistent thrift, I decided after meeting the broker to self-insure.

I calculated that the cost of a major illness absent additional insurance would dent my savings significantly but without, as it were, crippling me.  Should I be so sick as to require repatriation all the way “home,” I resolved not to begrudge the expense, which would not be inconsiderable.

Until my fall, expenses have been relatively minor — for example, blood tests, a couple of doctor visits (one of which resulted in a pneumonia diagnosis quickly cured with antibiotics) and daily medications that haven’t strained my budget.

Why I rejected health insurance came down to three key reasons:

  • I recall that the cost for a nearly 70-year old expat amounted to something close to $8,000 annually for a decent policy in addition to what I spend on Medicare and supplementary insurance;
  • The expense that most worried me has been the astronomical cost of a medical evacuation (medevac) to the U.S. in a worst case or perhaps Bangkok or Singapore in a slightly better event. Those Southeast Asian cities boast excellent medical care, as opposed to Cambodia, from which the prime minister heads to Singapore for treatment and the king, to China.  Since we all know that insurance companies don’t love paying out money, I focused on a clause that gifts the companies what I took to be a gaping loophole.  It permits the companies to decide whether a condition is critical enough to require evacuation.  How broken does a bone have to be for the company to conclude it is critical?
  • The insurance company or companies that were available to me in Cambodia, only before I reached 70 as I understand it, are based in other foreign countries.  I could envision a raft of complications related to a claim, though perhaps I was more skeptical than necessary.  If I waited until I turned 70, there would be no acceptable options available to me; should I find one, the premiums would be sky-high.

When I fell on a Sunday evening, momentarily blacking out and being helped up in excruciating pain, I tried to deny how badly hurt I was.  While I barely could walk, I managed after a time to hobble home in perhaps 20-30 minutes unable as I was to lift my leg high enough to get into any conveyance or find a stick for support on the way.  (Walking normally would take way less than half the time.)

Looking back, I am dumbfounded that I made it home without further injury or additional harm, meaning that no one took advantage of my condition to mug or run into me on dark side streets.

I also don’t know why I didn’t think to call, or have called, an ambulance, perhaps because I was in shock and perhaps because I wasn’t ready to admit that my excruciatingly painful injury was so serious.  However, as the evening wore on at home, I reluctantly realized at least an x-ray ($18) was mandatory.

Using a cane that my partner purchased, hastily taking a low-slung tuk-tuk with his help and using his shoulder getting in and out, I presented myself at a reputable clinic at 7:30 a.m. in order to be first in line.  Reputable or not, there was no digital image; the film, we were informed, would not be ready for pickup until 5 p.m.

The technician said I had “cracked” the neck of my femur.  In other words, I subsequently discovered, I had broken my hip.

Next: Now what, now where?


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