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Difficulty with French hospital bill/travel ins, Manosque FR

Kim G

Seattle, Washington

2 posts

Hello,

In April I was in Provence and needed emergency care for appendicitis. I was treated in Manosque, FR (the nearest hospital) with surgery and needed to stay for 9 days for treatment of infection. I took out travel insurance beforehand and I submitted a claim shortly after returning to the US. I have received a bill for ~11k euros from the hospital and gave this to the insurance company. Several months passed with no word from either the hospital or insurance company, so I called insurance yesterday who stated that they do not deal specifically with the hospital and only provide reimbursement after payment. Some issues that I have with this are 1) I am unable to pay that full amount, 2) I have a lot of difficulty communicating with the hospital due to language barrier, 3) I am not sure how the hospitals there accept payment (check, wire, credit cards). Credit card would be most ideal given the high expense, and 4) who can help facilitate this since the insurance company will not.

Does anyone have insight into how these small French hospitals work with billing and the payment methods they accept? Should I be going to my French embassy here for guidance? What happens if a person cannot pay that large sum?

Thank you!

Posted by
20316 posts

If your travel insurance is reimbursing you, then it is only a matter of a short term loan. You pay the bill, then you submit your expense to the insurance company, and they send you a check. Now I do think I would like some assurance from the insurance company that they will reimburse you.

Normally, European hospitals like to be payed with a wire transfer, since checks are largely a thing of the past in Europe. They don't like credit cards because they will incur a few percent cost of the transaction. Look at https://transferwise.com/us to make the payment. They are low cost, reliable, and can transfer the amount in EUR.

Posted by
3770 posts

I note that you say that you are unable to pay the full amount. If you do not have access to the equivalent of ~11k€ and then obtain reimbursement, I suggest writing to the hospital (use Google translate if you think you want to send it in French but I think English will work) and sending a letter via certified mail with a partial payment and suggesting a payment schedule and informing them that you submitted the invoice to the insurance company and explaining the insurance company's rules. Speaking of the insurance company, do let us know which company it is that does not respond to an insured's claim for months and also does not pay the hospital directly but makes the insured come out of pocket first. If I were you, I would make 100% sure that the insurance company does not have a time limit on when you can file claims after incurring the expense. I'd hate for the months you spent waiting for an answer to now mean that you will be too late when you send in claim for reimbursement. Also, if you have to pay in an installment plan, you want to be sure that the insurance company will reimburse you for your periodic payments.
As to not paying, my guess is that it will depend on the hospital in question. I'm sure they could pursue you if they want to go to the trouble and expense of suing you in France or whatever it is that they would have to do and then obtaining a judgment or maybe they can sell the debt to an enterprising US-based collection agency. Your state has adopted something called the Uniform Foreign Money Judgments Recognition Act and so a judgment from France could be enforced in Washington subject to some conditions but it really will be a question of how much time and energy the hospital wants to spend to collect this money. From what I know about French hospitals and this could have changed since I last had to look into this topic about 8 years ago, they are not known for chasing down non-paying patients.

Posted by
10297 posts

Every travel insurance policy we’ve ever had reimbursed us, but first we had to pay the bill ourselves.
With travel insurance you, 1. Pay the bill. 2. Submit it to your regular insurance which may or may not pay a portion, but proof of denial is necessary. 3. The whole bundle is then submitted to travel insurance.

As JHK said, I’d be concerned about a time limit. Also, I wouldn’t wait months before calling anyone, but days.

You should find a French speaker to help you talk with the hospital. You said small hospital, so was this a private hospital, or was it part of the large French medical system, Assistance Publique?

Posted by
8525 posts

First, i’m sorry you had this ordeal on your vacation and hope you are well now.
Paying this bill may involve taking a short term loan out which you repay when reimbursed by the insurance company. I don’t think an installment plan is a good idea. It would simply add layers of red tape and processing difficulties.

You will need to be a bit more proactive in following up with both the hospital and the insurance company. Also, have you checked whether you might also have coverage through your regular health insurance?

For general FYI, my health insurance works overseas, but it also clearly states that I am responsible to pay the institution and it will then pay me. I think this is a fairly regular practice.

Posted by
8169 posts

A travel insurance company this terrible (letting this go for months without contacting you? failure to pay the hospital?) probably has a time limit for reimbursements -- you need to look at your contract immediately and deal with this aggressively. 'not hearing for months' when thousands are at stake is a strategy that may leave you in collections. and never use this insurance company again when you travel. We used Allianz and they paid the hospital in France directly when I had emergency surgery there. We had worked this out with the hospital finance department and the insurance company before I was discharged from the hospital. Insurance companies are notorious for denying care or reimbursement; your company thinks they can wait you out and then pay nothing.

Posted by
5837 posts

First of all, glad you recovered and made it safely back home. Sorry to hear about the Catch-22 of having to pay before reimbursement.

While its too late for you, others should know that some MedEvac policies, like AIG's have an advance payment clause. Our last MedEvac policy said:

Advance Payment: If an Insured requires admission to a Hospital,
Travel Guard will arrange advance payment, if required. Hospital
confinement must be certified as Medically Necessary by the onsite
attending Physician.

Posted by
7496 posts

Immediately send a Certified letter to the insurance company describing late billing from the hospital and that you insist that they suspend any time-limit for the submission of a claim. Include another copy of the bill. Do not assume that the Insurance Company will "connect" your two contacts with them. This is a train-wreck waiting to happen.

As others have noted, it is NORMAL for travel insurance companies to reimburse only, not pay direct. If you have any kind of insurance at home, ASSUME that the Travel Insurance company is going to demand a paper DENIAL from your regular company. (You and I both know that your home insurance won't pay overseas. That "fact" is not relevant to the demand for a DENIAL. You have to produce it.) If you don't have any sort of health insurance, think about how you can "prove" that you don't.

Do not wait for something good to happen. There are clocks ticking.

Posted by
2858 posts

It will be helpful to everyone to know which insurance company you used so we can avoid the same problem.
I am so sorry the insurance company is giving you the run around. It’s bad enough you required surgery during your trip. Now you are getting the run around to pay your bills.

Posted by
7061 posts

Travel Guard will arrange advance payment, if required.

This means if the hospital requires advance payment, not if the insured wants it. Many hospitals, in emergency situations, don't require advance payment, so this statement is often moot and the insurance company is not going to automatically pay the hospital in advance.

Posted by
7496 posts

I had another thought: You have let this go long enough that you need professional assistance. The growth of Obamacare and other new health insurances has stimulated the growth of Health Insurance advisory charities. I wonder if you can find one with a general enough plan to give you after-the fact advice?

Alternatively, since Seattle is a big Metro area, there are plenty of social service not-for-profits that would give you help faster than state or county Social Services agencies could. Because my favorite aunt was a Licensed Social Worker for Catholic Charities her entire professional life, and it's a massive agency, it's a possible route for you. You don't have to belong to a Catholic Church to get help from them. Protestant church organizations have social service charity arms too. There are many Jewish social service agencies, as well.

My industry has its own charity, which I once consulted, even though I may have a little more money on hand than you do.

Posted by
5 posts

Thank you all for your help. I'm working on it as hard as I can. I was fooled because the website for the insurance company states that they usually work directly with the hospital, so I took it at face value. I had dealt with this company before for plane reimbursement for trip interruption for a family death, and while it took 8 months to get payment, they did it so I went with them again. I am using IMGlobal. I found out when I called the other day that the reason there was a stall in everything was also that they couldn't read the bill that I faxed tp them in June/July when I received it, yet they didn't ever let me know I needed to resubmit. Obviously very upsetting. With my prior claim for the plane, they said to allow 90 days for processing, so I didn't push it this time with calls until now.

And to answer Bets question, the bill seems like it would be paid to Tresorerie Principale, or at least that is where the billing is coming from. I'm not sure if that means it is a public institution or not.

I will likely go to or call the embassy in the next day to see if they can help with translation/communication. My friend in FR is not readily available.

Posted by
5 posts

Also, when I was at the hospital, I offered to give them my insurance information but they would not take it. I'm not sure why or if there was a language barrier there. They also wrote down my address completely wrong despite seeing my identification card which meant that the bill got to me late.

Posted by
8169 posts

We literally worked it out with the insurance company to pay the hospital before we left the hospital; the insurance company then reimbursed us for other smaller expenses e.g. my follow up doctor's appointment in Paris, my physical therapy in Paris etc which I just paid and submitted bills for. They paid the hospital directly about 4k Euro before I checked out. But YOU have to make it happen and not just wait for it magically to happen. Always assume the worst about insurance companies and you will not be far off.

Posted by
3770 posts

The consulate is not going to help you (the embassy is in Washington DC). You can get the documents translated using any of a number or online service. I use One Hour Translators but there are others. You just upload the documents and they tell how much a translation will cost and you go from there.

Posted by
20316 posts

Tresorie Principale is simply Main Treasury, or Billing Department. Is this the Hospital?
http://www.ch-manosque.fr/

I would say that most French hospitals, unlike American hospitals, will give care without getting multiple guarantees that they will get paid. They are not set up to deal with a maze of insurance companies and programs. 95% of their clientele are people on National insurance in France or other EU countries with which they have have reciprocity agreements. They don't want your first born held as ransom to insure payment. "We'll just send you a bill" is good enough.

And 11,000 EUR for 9 days in hospital for emergency surgery and fighting infection? I dare say the bill at a US hospital would be at least 10 times that amount, and probably more like 20 for that level of care. Of course, 75% of that is phony-baloney inflated fees they have to charge in order to play the insurance game and finally get reimbursed for their actual costs.

Posted by
5 posts

Thanks again for your guidance and insight everyone!
I am definitely not sitting back and waiting for anything to magically happen, nor was that my thought process back then. I honestly did not know how to navigate the system, I don't speak the language, I was not in a big city, I was traveling alone without any connections in the country during the time, and was very ill. I think there would be many people in my situation who would be in shock and not have the wherewithal/ability to be on the phone with insurance, especially when the hospital would not discuss cost or discuss insurance prior to discharge.

Posted by
5 posts

And to Sam, yes! That is the hospital! I had tried previously calling them directly for more information but basically once they create the bill and outsource is to Tresorerie, that is who I deal with. But they also did not have English speaking workers when I called. And of note, the hospital also did not have interpreter services when I was a patient. Google translate for everything :)

Posted by
3770 posts

"Immediately send a Certified letter to the insurance company describing late billing from the hospital and that you insist that they suspend any time-limit for the submission of a claim."
What late billing from the hospital? The OP said that "shortly after returning to the US. I have received a bill for ~11k euros from the hospital and gave this to the insurance company." Does not sound like late billing to me. The months delay is a result of the OP waiting to hear from the insurance company.

@kimgoal83, I totally get not taking care of the billing issues during the emergency. You had an emergency so what happened at the hospital is totally understandable. I also understand your delay in contacting the insurance company to follow up on your submission of the bill, especially based on your prior experience with them. That being said, I think that what people are, or at least I am, trying to say is that now is the time that you have to push this forward. What happened up to today is water under the bridge but now you have to aggressively move this forward and it looks like you are on the right track by seeking advice on this forum.

Posted by
10297 posts

Clicking on the link, it is the government hospital and not a private, for-profit hospital. You need to find a French speaker who can help you on the phone and then follow up with letters.

As for a travel insurance that can’t interpret bills from overseas—abominable! That’s what they are supposed to do, or let you know to submit a translation. JHK has provided a wonderful translation link.

Posted by
5837 posts

Is your only medical insurance your trip insurance? My Medicare Supplemental has a limited ($50,000) foreign travel coverage and when I was in the working class, my company paid medical insutrance had some kind of foreign travel coverage.

The reason I asked about primary medical insurance is that InsureMyTrip indicates that the MedEvac policies I looked at indicate that medical coverge limits are "secondary". InsureMyTrip defines "secondary" as:

Secondary Coverage means that this coverage will be paid after any
other Primary collectible insurance has paid the claim and the Primary
policy limits have been exhausted.

Posted by
32244 posts

kim,

This is a good reminder to always read the fine print on medical insurance policies. Requiring the insured party to pay upfront and then get reimbursement would be a huge red flag for me, and I'd be looking for another insurance company.

When I was hospitalized in Italy a few years ago, the hospital did want the details of my medical insurance, which I provided, and I never received any bills. I'm assuming the insurance company took care of all the paperwork.

Posted by
20316 posts

Hmm. How much did having Canadian health insurance effect that experience?

Posted by
7496 posts

JHK: “they couldn't read the bill that I faxed tp them in June/July when I received it”

Posted by
8293 posts

Sam, Canadian Medicare does not cover us when out of the country.

Posted by
3770 posts

JHK: “they couldn't read the bill that I faxed tp them in June/July when I received it”

@ Tim, Got it, but there is nothing in the OP's initial statement or in the quoted language that means that there was an unreasonable delay in the time between when she received treatment and when she received the bill. In fact the OP says she submitted a claim shortly after returning to the US. If she did not have a bill, what did she submit a claim for? The several months that the OP refers to in the initial post is the several months that passed with no word from the insurance company or from the hospital about the unpaid bill.

Posted by
32244 posts

Sam,

"Hmm. How much did having Canadian health insurance effect that experience?"

The travel medical policy that I was using was from a private insurance company based out of Sherbrooke (Quebec). A few points of interest.....

  • Canadian health care is administered separately by each province, and the amounts paid for different procedures varies between provinces. For that reason, it's also a really good idea to take out extra health insurance even when travelling outside one's home province. With any travel out-of-province, my provincial health coverage will only pay the same amount for a given procedure that they would pay at home. The health insurance policy has to cover any amounts above that.
  • in my case, the health insurance company was the "lead agency" in dealing with the foreign hospital, and would have initially paid all bills. However, I'm darn sure they got as much reimbursement as possible from my provincial health plan. They also asked about any coverage I might have through credit cards or other sources.
  • the travel insurance company conducted a detailed interview by phone prior to issuing the policy to get complete information on any "pre-existing conditions". As that's often the main reason they deny claims, I was extremely careful about giving completely accurate answers during the interview. They followed up on that with a document in the mail to confirm the answers I had given, along with a written document detailing all the terms of coverage.