Insufficient travel insurance to cover the massive medical expenses for a visitor to US?

Question

What happens if a tourist to US needs a medical surgery in U.S and the tourist's travel insurance does not cover the massive expenses?

Answer 1

If you're in a life threatening situation, unconscious and dying - the US hospitals are obligated to treat you whether you can pay them or not. But once you're no longer in a life-threatening condition, if you cannot provide financial guarantees (whether your own money or insurance), you'll be discharged. Whether you're in a state that allows you to travel back home at that point is not their problem.

If you provided guarantees and don't pay - they may end up suing you. Since the amounts may be significant, it may be worth the collectors' while to chase you to your home country with that lawsuit.

If you have an insurance that's anywhere near decent, they'll either cover your costs in the US or will do med-evac back home (depending on what's cheaper for them).

Answer 2

Depends how they enter the system. Being foreign doesn't enter into it much.

If they see a doctor's clinic (what would be called a GP in the UK), or walk-up service (called "Urgent Care"), the caregiver makes a monetary decision whether to treat them, based on their collectabilty, which includes their insurance.

However, hospital emergency rooms cannot by law turn away a patient, except for very narrow exceptions such as being full. This has the perverse incentive that the uninsured go exclusively to ERs, where treating them for simple things cost 20-30 times as much.

So as a general rule, the hospital will deliver you enough care to stabilize you and get you fit for a flight home. If your condition will require care beyond your leaving their doors, they will probably contact your domestic health care system back home, to understand what followup care will be available to you and to try to line it up for you. Why?

Because some US law and many state laws require a hospital have a discharge plan that provides for your hand-off to others for continued care.

I wouldn't say the money-biz people in hospital administration have no voice here, but they are not going to push too hard against medical advice - the liability is too great. But they certainly will have their finger in the pie. And remember, they're trying to keep their not-for-profit hospital afloat, so they'd rather find a payer and convince them to let you stay longer. They will wheel-and-deal to that end; the price US insurers pay for services is a small fraction of retail price they quote to monied self-insuring foreigners.

However, if no payer can be found, yes, you are ultimately responsible for the expenses... kinda. The thing is, hospitals have insanely high retail prices aimed at wealthy foreigners, who come to the US thinking it's the best healthcare system in the world. This doesn't matter when billing the indigent since they'll never pay anyway, and it gives them a leg up when dealing with those who can barely or fractionally pay. If a service is $400 to Medicare but they bill it at $2000, then they can haggle an uninsured down to $600 - see how that works?

So when those bills start coming in, you have to haggle back with them. At that point it helps to know the "usual, reasonable & customary" insurer rates, or the Medicare rates, so you can base your counter-offer on a fraction of that and then meet at the middle at about UR&C. This works fine, they're used to it.

There isn't a consistent markup at all. Some hospital charges are bonkers, while I see doctors charge rates I feel bad about, like how are they paying their student loans? So yeah, have a sense about that.