Michigan Family Faces 42K in Ecuador Bills After Grandpa Has a Stroke

cccmedia wrote:

...$13,000 for diagnosis and care at a GYE hospital and other expenses during six weeks

As sad and frustrating as I'm sure this is for the family, I can assure you that the amount they owe is nothing compared to what they'd be charged in the US. I work in healthcare, and I can tell you that $13K for six weeks in a hospital is a bargain!. Again, sorry for what he/they experienced, but had the same happened here, they'd be much worse off.

With all that said, it does bring up the excellent point that those travelling to Ecuador should consider all the possibilities. If elderly or suffering from poor health, the risk of this happening can't be ignored. Thanks for posting.

languagetraveler wrote:

With all that said, it does bring up the excellent point that those travelling to Ecuador should consider all the possibilities. If elderly or suffering from poor health, the risk of this happening can't be ignored. Thanks for posting.

A daunting scenario is a single Expat carrying only an ID and a small amount of cash being rushed to an EC hospital due to the unexpected, and needing to prove ability to pay in order to access proper treatment and release.

Another scenario:  such an Expat arrives at the hospital expecting his IESS insurance coverage to take care of his emergency needs.  He presents his cedula, or national ID.  However, the bureaucracy informs him that they aren't finding his name in the system  (even though he's been paying $70 a month through his bank account for supposed IESS coverage).

cccmedia in Quito

languagetraveler wrote:

cccmedia wrote:

...$13,000 for diagnosis and care at a GYE hospital and other expenses during six weeks

As sad and frustrating as I'm sure this is for the family, I can assure you that the amount they owe is nothing compared to what they'd be charged in the US. I work in healthcare, and I can tell you that $13K for six weeks in a hospital is a bargain!. Again, sorry for what he/they experienced, but had the same happened here, they'd be much worse off.

To your point, check out this ongoing story of over-billing by Texas General Hospital in Grand Prairie, Texas (DFW area):

http://www.fox4news.com/story/27382240/ … al-billing

cccmedia wrote:

A daunting scenario is a single Expat carrying only an ID and a small amount of cash being rushed to an EC hospital due to the unexpected, and needing to prove ability to pay in order to access proper treatment and release.

A horror story from my stay in Cebu City, Philippines -- an expat was hospitalized in an emergency and presented his credit card (with adequate limit): "Sorry, sir, our credit machine is out of order, we need cash."

A friend who had accompanied him went to an ATM and used the person's card, plus his own, and was still short a few hundred. He posted on a local expat forum and several people responded to fill in the gap. Could have been ugly, since the Philippine policy on no-pays is to wheel you out to the parking lot and say, "Come back in when you have the money."

As the Boy Scouts say, "Be prepared."

BobH wrote:

A horror story from my stay in Cebu City, Philippines -- "Sorry, sir, our credit machine is out of order, we need cash."....
"Come back in when you have the money."

One more reason I won't be re-locating to the Philippines.

I brought the prior scenario up in informal conversation at tonight's gathering of the South American Explorers in Quito, and got two opinions:

From the director of the Explorers clubhouse:   No hospital here is going to send away a presentable Gringo.

From a local Ecuadorian:   Under the law, a hospital must provide emergency treatment to all comers.   Due to failure to show funds, once stabilised, one might be sent to the lowest of the three rungs of the Ecuador hospital system, a public hospital.

(The higher rungs are the government's IESS system and private hospitals.)

cccmedia in Quito

cccmedia wrote:

From a local Ecuadorian:   Under the law, a hospital must provide emergency treatment to all comers.   Due to failure to show funds, once stabilised, one might be sent to the lowest of the three rungs of the Ecuador hospital system, a public hospital.

From the Get Quito website, there is this advisory about hospitals in the capital:

"Be advised that in all hospitals OTHER than Quito's public hospitals, you will be refused treatment if you fail to present a valid credit card, proof of travelers insurance...or sufficient funds in cash or checks.  This applies even in emergency cases."
(getquitoecuador.com)

From donaldmurrayecuador.com:

"The private care system (in Ecuador) requires payment at time of service.  Hospitals and clinics must secure your ability to pay before admission."

The Murrays left Ecuador due to their perception that emergency care on EC's Pacific Coast was not up to their standards.  This does not necessarily invalidate the above quote.  Donald Murray is an author and a blogger on his own website(s).

cccmedia in Quito

SawMan wrote:

To your point, check out this ongoing story of over-billing by Texas General Hospital in Grand Prairie, Texas (DFW area):

http://www.fox4news.com/story/27382240/ … al-billing

Thanks SawMan, not that I needed another reason to avoid Texas.

Oh my, that's expensive.

We racked up about 5k in hospital bills in Quito when my wife need an emergency c-section and our baby spend a week in ICU.  We had insurance that covered us at the government hospitals, but the baby would not have survived if we kept waiting for them to get their act together (it was an overly busy day). I was in the US at the time. The baby came 6 weeks early. My wife gave up on the government hospital after waiting 6 hours. She took a cab to another hospital that turned her away because she didn't have the cash. The 3rd hospital took her in and billed us. We got very lucky.

jessekimmerling wrote:

My wife gave up on the government hospital after waiting 6 hours. She took a cab to another hospital that turned her away because she didn't have the cash. The 3rd hospital took her in and billed us. We got very lucky.

Really good information, Jesse.

Now, if you or your wife can remember the names of the second and-or third hospitals in Quito, that would certainly be beneficial to your readers.
Including yours truly.

cccmedia in Quito

Clinica de San Francisco is the place that took her in and allowed us to pay a week later when I arrived in Quito. It's in the Condado/Pomasqui area. I'm not sure exactly what the neighborhood name is. Possibly just south of Condado.

She says the name of the place that turned her away is Clinica de Muskos, but that name sounds improbable to me. I think her negative experience might be coloring her memory. She also recommends Clinica de Mujers for women's issues.

cccmedia wrote:

A daunting scenario is a single Expat carrying only an ID and a small amount of cash being rushed to an EC hospital due to the unexpected, and needing to prove ability to pay in order to access proper treatment and release.

Another scenario:  such an Expat arrives at the hospital expecting his IESS insurance coverage to take care of his emergency needs.  He presents his cedula, or national ID.  However, the bureaucracy informs him that they aren't finding his name in the system  (even though he's been paying $70 a month through his bank account for supposed IESS coverage).

This IESS scenario was on my mind because I recently called the government's IESS health number to set up a dental appointment, only to be told that there was no account in my name.  A check of my bank account, however, showed they'd been debiting  $70 monthly all along.

I have decided there are two steps I should always take (and maybe so should Expat IESS member-payers):

1. Always carry a copy of my cedula (the EC identification card that is required for IESS enrollment).

2. Commit to memory the cellphone number of my attorney, which he told me he answers afterhours.  If IESS lost my membership information, I figure it's likely he could straighten it out...or at least get me attention at the hospital.

cccmedia in Quito

So now we know what kind of healthcare $70/month buys.

I had a stent inserted in Calif in 2005.  I spent 2 nights in the hospital and one hour on the "procedure table" (they do not call that surgery).  The hospital bill was $135,000 -- for 2 nights. The size of the EC bill sounds quite reasonable.

Anyone traveling who has a history of illness like that should definitely get travel medical insurance.  It is cheap, costing a couple hundred a week, and would have handled all this, including the airlift.

mindstorm wrote:

I had a stent inserted in Calif in 2005...The hospital bill was $135,000 -- for 2 nights. The size of the EC bill sounds quite reasonable.

That figure alone could scare some 50-somethings right out of the U.S. (at least for a while) if they have trouble getting reasonably-priced insurance and are yet to receive Medicare.  When a single 'non-surgical' procedure can financially ruin someone, it's all the easier to decide (along with other factors) to make the move.

cccmedia in Quito

jessekimmerling wrote:

(She) gave up on the government hospital after waiting 6 hours....The 3rd hospital took her in.

Here's something to consider if joining the EC government's IESS program or already subscribing to it.

In an emergency, an IESS participant is to be treated at any hospital in Ecuador with no deductible.  Upon being brought to a stable condition, they are then to be transported to an IESS hospital if non-emergency hospital care is indicated.

For this reason, if it was an emergency, I might go to the best hospital I knew of and could get to, rather than an IESS hospital (although I do participate in IESS) to get maximal ER care in the crucial early moments.

Part of the thinking is that a top hospital may be better-staffed and would be less likely to keep an emergency patient waiting for an extended period.

Here in Quito, that would be Hospital Metropolitano...or Hospital Eugenio Espejo.

cccmedia in Quito

Greetings from Puerto Lopez. We have bern here about 3 years. We had talked about getting into the state insurance program as we have spoke to a friend who pays$70.00 a month. We recently were told of the new law that requires Health care coverage.  We checked on the IESS website and it is showing that we need to pay $300.00 (20%) smonth for my wife and I. 
Any guidance on this as 20% is a little shocking.

The immigration law's new health-insurance requirements are a complicated subject.  Fortunately, there has been an Expat.com thread discussing this topic at length since May (2017).

https://www.expat.com/forum/viewtopic.php?id=671624

Here is a distillation of how some Expats have been planning to deal with the increased insurance taxes....

1.  Analyze whether switching from IESS coverage to a less expensive private-insurance plan is an option.  This is a decision colored by pre-existing conditions and their effect on the private plan's rate.  Persons under age 60 and without serious conditions might do better in a private plan, given the IESS increase.

2.  Declaring as little income as possible to be taxed at the 20 percent couples rate or the 17.6 percent single-person rate.  For instance, if a couple has two pensions and only one was needed to qualify for a residency visa, not declaring additional income beyond the previously-declared pension.

3.  Waiting.  See how the government enforces the new rules.

4.  Consider living in Colombia or other countries where folks are not being health-taxed at 20 percent.

Note: these are the considerations expressed by Expats and I am not endorsing them.  Each individual may need to decide, for instance, whether not declaring all pension income is ethically correct when a government increases a major tax to a perceived unconscionable level.

cccmedia near the Ecuador-Colombia "Rumichaca" border crossing.