US healthcare
October 29, 2016 7:48 AM   Subscribe

A relative of mine is visiting the US without travel insurance, and their child has been hospitalised in New York and is receiving treatment. This relative does not have the means to pay for the hospital stay or treatment, so what will the consequences be?

The relative and their child are not US citizens, though their mother is. The state is New York, and the child is under 6.
posted by anonymous to Travel & Transportation (14 answers total) 2 users marked this as a favorite
 
You'll need to tell us what country they reside in by sometimes national health plans will reimburse costs.
posted by bq at 8:53 AM on October 29, 2016 [2 favorites]


In a a strict legal sense, the child's parents will be liable for all the bills. All hospitals will have some kind of charity care program for forgiving the balances of people who don't have the means to pay their bills, but most of them will be poorly set up for verifying the eligibility of people not from the US.

In a practical sense, most hospitals have fairly limited means of actually pursuing a collection action from somebody who doesn't live in the US or have US income or assets. Hospitals have a ton of bad debts to track down all the time, and they mostly tend to prioritize the ones they actually have some hope of collecting. Country of residence matters here too - if they're from somewhere like Canada with a legal system more closely tied to and accessible to the US, a legal action is much more likely than if we're talking, say, India or Cameroon.

Another factor in all this is that if the hospital is one of the big-name Manhattan or Brooklyn academic medical centers, then they probably do have more experience and resources for international collections, but they would also have more experience with international charity care applications.

Overall, I would say the most likely outcome if your relative just never pays the bill, returns to their home country at the end of their trip, and they and any other parent don't try to reside or take a job in the US in the next couple years, is that eventually the balance ages out into bad debt and is written off as uncollectable, and the matter ends there. There's no harm in them talking to a hospital social worker or financial counselor right now and explaining the situation - if they are turned down for charity care, there no worse off than right now.
posted by strangely stunted trees at 9:16 AM on October 29, 2016 [9 favorites]


Sometimes people have travel insurance on their travel credit cards, or through work. Has your relative explored that option?
posted by St. Peepsburg at 9:33 AM on October 29, 2016


This totally depends on how health care in the home country works.
posted by mr_roboto at 9:46 AM on October 29, 2016


All hospitals will have some kind of charity care program for forgiving the balances of people who don't have the means to pay their bills, but most of them will be poorly set up for verifying the eligibility of people not from the US.

My understanding is that hospitals in general do this as a PR move and put a minimal percentage of their revenue into it. Hospital charity programs haven't stopped many, many thousands of uninsured (and insured) people in this country from going bankrupt over medical bills. Investigate, but don't expect much.
posted by cnc at 10:45 AM on October 29, 2016 [1 favorite]


Most hospitals are happy to work out a payment plan as well.
posted by jeffamaphone at 11:28 AM on October 29, 2016


if they are turned down for charity care, there no worse off than right now.

Without wanting to be too alarmist, if their foreign insurance won't cover it and the hospital realizes they're just not going to get paid, isn't there some vaguely realistic chance that they'll stabilize the patient and kick him or her out?

I mean, people from outside the US often don't get this, but "Stop treating the patient and the patient dies" is a thing that really, truly happens in the US.

They should be in contact with whatever their foreign insurance is. They can reasonably expect that without insurance they will be looking at a bill somewhere between "Brand new Mercedes" and "Large house."
posted by ROU_Xenophobe at 1:33 PM on October 29, 2016 [3 favorites]


Most 'foreign' state or private health care will explicitly exclude costs incurred in the USA even if some foreign destinations are covered. As will a lot of travel insurance that is not specifically designed for travel to or expressly includes travel to the USA.
posted by koahiatamadl at 2:06 PM on October 29, 2016


Echoing koahiatamadl's comment, if your relative's child is from Australia, unfortunately our reciprocal healthcare agreements do not cover medical treatments received in the US.
posted by brushtailedphascogale at 2:25 PM on October 29, 2016


Hospitals can and do sell debts internationally to people like intrum justitia
posted by lalochezia at 2:28 PM on October 29, 2016


The hospital could eventually sue them if they didn't pay. If they don't show up in court, it's a default judgment and they'll be in contempt of court if they don't pay it. I'm not sure exactly what that means for coming back into the US at any point; a lawyer should answer that. If the mother works for a US company, I'd imagine her wages could be garnished, and definitely her US tax refunds.
posted by AFABulous at 9:58 PM on October 29, 2016


The hospital could eventually sue them if they didn't pay. If they don't show up in court, it's a default judgment and they'll be in contempt of court if they don't pay it.

This is not accurate. It is actually not easy (though not impossible) to serve foreign individuals with no U.S. assets who don't return to the U.S. so that the court even gains jurisdiction over them to grant a judgment. And, assuming the hospital got the default judgment, failing to pay a default judgment does not, in itself, put you in contempt of court.

It's really difficult to tell from the scant details here how difficult it would be for the hospital to collect on the debt, and thus how likely they are to try to do so. I would note, though, that the absence of the debtor from the U.S. might toll the running of the statute of limitations on the debt, which means that it might be collectable longer than you might ordinarily think.
posted by praemunire at 8:22 AM on October 30, 2016 [1 favorite]


This sounds well worth a call to their home country's embassy in the U.S. The staff there should be familiar with both any coverage their home country's national health plan might provide and the experience of others who were in a similar situation.
posted by Mr.Know-it-some at 6:12 AM on October 31, 2016


Without wanting to be too alarmist, if their foreign insurance won't cover it and the hospital realizes they're just not going to get paid, isn't there some vaguely realistic chance that they'll stabilize the patient and kick him or her out?

No, this is not how it works. Patients who need to be in the hospital will stay in the hospital. Patients who are stable enough to be discharged will be discharged. Unless the child is in an ICU and expected to stay for months, this won't be an issue at all. Source: Doctor who worked at a bunch of NYC hospitals.

It is very important that your relative talk to the social worker or case manager on the child's floor ASAP (usually they come to you). It is likely that your relative may be eligible for emergency Medicaid in NY, which should cover most if not all costs of the hospitalization. If not, as others have discussed, the hospital will probably knock something off the bill as charity and then nominally bill your relative, but without much hope of actually collecting anything.
posted by The Elusive Architeuthis at 10:41 AM on October 31, 2016 [2 favorites]


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