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Medical emergency during foreign travel can mean insurance claim frustration

Karen Grunenfelder spent part of her dream European vacation in an Italian hospital getting emergency surgery{ }{ }{ }Loren Grunenfelder photo

The last thing we want to think about when planning a big vacation is having a medical emergency in the middle of our trip. But medical emergencies can create a financial nightmare, especially if you're traveling outside the country.

Karen and Loren Grunenfelder they thought they'd done everything right when they planned their overseas cruise for mid-May. They even purchased travel insurance.

But just days into the trip Karen got sick.

"We had one night in Venice and then we were on the ship, and we were at 3 ports. " said Karen. "I woke up with a stomach ache at 4 o'clock in the morning."

It was acute appendicitis- on a ship in the middle of the ocean. Karen was moved to the ship's infirmary.

"They hooked me up to an I-V, gave me antibiotics and morphine and Tylenol as needed."

While still at sea, Karen's husband, Loren, notified the couple's health insurance team at Kaiser Permanente.

"So he told them up front, right away," Karen explained. "And they said, 'Okay'. To me it meant, do what you need to do."

Once on shore, Karen was rushed to an emergency room in Naples, Italy, then transferred to a Naples hospital where the staff spoke English- for an emergency appendectomy.

Before the surgeons would operate, the Grunenfelders were informed they would have put money down and agree to pay the balance out-of-pocket, before they left the hospital. They felt lucky to have 2 credit cards between them that would cover the charge of 20,000 Euros which is roughly 25,000 U-S dollars.

"I'm thinking that when we get back to the United States, we'll get the paperwork, whatever we need to do, with our insurance, and they will take care of that and pay us back." Karen said.

Remember, this was back in mid-May. When Karen contacted me in mid-August, Kaiser Permanente had denied their reimbursement claim. But Karen says no one could explain exactly why the claim was denied.

"I wrote down the names of different people that I talked to trying to understand what they needed from us." Karen said.

"Eventually we talked to somene who told us that we were denied because not all the documentation had been translated from Italian to English."

As part of the claims process, the Grunenfelder's not only had to provide records and receipts when they filed for reimbursement, they were also responsible for translating all the Italian from the hospital records.

"My husband worked really hard on that, on the paperwork that he had, and translated everything that he could read."

But the Grunenfelders say some notations were indecipherable.

"I'm sorry." Karen exclaimed "But it was doctor writing and it was hard to read. I'm pretty sure it was in Italian. So we didn't know how to interpret that."

I agreed to contact Kaiser Permanente on Karen's behalf to get answers. But despite receiving Karne's written authorization to discuss her case, Kaiser Permanente would not discuss her claim with KOMO News, citing federal privacy laws.

The company did offer these tips for you when you travel to a foreign country:

*Always check with your health plan before you leave to learn your benefits and responsibilities.

*Take your insurance card and a claim form on your trip, just in case.

*Plan to pay out of pocket for any medical services you need.

*Save all your medical receipts

*Be aware that translation services may be your responsibility.

Karen kept me posted, and says in the weeks since our interview someone at Kaiser Permanente resubmitted her claim.

She and her husband finally received a check on August 22nd for the nearly $25,000 they were owed.

While Karen and her husband missed most of their cruise they were able to salvage enough of their Eruopean trip to still share some pleasant memories.

Now, they're sharing their story in hopes that their medical emergency in Italy will help you avoid insurance surprises, if you get sick or injured while traveling overseas.

I contacted several other health plans about their claims policies for foreign emergency care. Of those that responded, 2 said they never require patients to be responsible for foreign language translation.

But one said it also makes translation the patient's responsibility, including foreign exchange rates, and the translated documents must be notarized.

I also learned that some plans are set up so American patients have little or no out of pocket costs.

So again, be sure to check with your health plan before you travel abroad.

And it's a good idea to have a financial back-up plan in the event that, as with the Grunenfelders, you're required to pay out-of-pocket for emergency medical expenses incurred in a foreign country.

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