The Basics: Health Care and Insurance

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Come To Your Happy Place

Come To Your Happy Place (Oakland, California)

If you are a foreigner traveling in America, it’s a very good idea not only to have extensive health insurance, but to have proof of this insurance on you at all times (and an ability to pay at least some part of emergency treatment). The stories you hear about American hospitals refusing to treat accident victims without insurance aren’t always myths — they’re sometimes true, or at least based on truth. Hospitals are required to treat you in an emergency regardless of your ability to pay, but they are not legally required to treat you beyond the point where your injuries have stabilized, nor to provide continuous non-emergency treatment. And that treatment will never be free for you as a tourist or traveler — it will typically be as expensive as it’s possible to be in the Western world. And all hospitals, regardless of funding, are going to try as hard as they can to recover their charges from you on or before release, so even publicly-funded hospitals will charge you (and pursue you legally for non-payment) unless you can prove indigence or some sort of Federal or State welfare assistance.

If you are injured in an accident and you do not have insurance, or you can’t convince the ambulance or hospital staff that your insurance is going to be able to foot the bill, you will normally be taken to the default County or City hospital — i.e. the one that is fully state or federally-funded. In urban areas, this can be a desperately overcrowded place whose staff tend to be overworked gunshot and drug overdose specialists; in rural areas, it might mean a trip to a hospital a long way from the accident scene. In many cases, you may be sent to one of these hospitals even if you’re insured (it may actually be the nearest and most appropriate place, and for real emergencies they’re as good a place as anywhere for the first few hours); once you’ve been stabilized, you will quickly be transferred to a hospital that takes your insurance (or thrown out). Hopefully your insurance will pick up the bill for the emergency treatment at the first hospital; if not, in a serious accident you’ll probably face bankruptcy unless you’re well-insured (or very rich). Remember, too, that ambulance and other emergency services are often private; you will be charged large amounts of money for using them, even though you may not have been in a position to make any decision one way or another at the time. Normally your insurance will cover this, but if it doesn’t, once again, you’ll be heavily out of pocket. Remember: without good insurance, a serious accident or illness here will probably bankrupt you (and you can still be bankrupted even with good insurance).

What does it take to convince someone that you’re well insured? It depends. In America, proof of insurance is usually given by a credit-card sized card with the details of the insurance provider and your name. If this card is one of the easily-recognized ones (i.e. one of the familiar U.S. or California health care insurers or providers), and the ambulance or hospital staff can find it in your wallet or purse, you’re probably O.K. Otherwise, if you’re conscious you can try to tell the staff who your insurer is; if they’ve heard of it, or can verify the details (by phone), then you’re also probably O.K. For small-scale emergencies, a platinum credit card might be enough, but remember that emergency room treatment is staggeringly expensive (literally thousands of dollars for even the most trivial of treatments), and uninsured people treated by private hospital emergency rooms for serious problems in a real emergency will normally be bankrupted by the experience (unless they’re already too poor to pay, in which case they’ll be ejected from the hospital as soon as is legally possible).

There are a few exceptions to these rules, but as a foreigner, be prepared for the worst: your insurance will probably not be recognized here without a lot of effort on your part, and any default Government or social medical coverage from home will probably not cover the bills here, or provide only partial coverage for bills run up in circumstances that were not clear or well-explained to you (you are likely to “consent” to all sorts of things you didn’t understand the financial implications of at the time, for example).

Almost no doctors here do “walk-ins” or treat patients who have the wrong or no insurance — you can’t just go to the nearest doctor, you have to find one who takes your insurance, and who is taking on new patients. As a foreign tourist or traveler, this means you won’t be seeing a private doctor regardless of how sick or needy you are. For non-emergency treatment (including what might be termed “urgent but not life-threatening” problems), you should try to contact the local county or city health services for a referral to a local clinic or local doctors that do this sort of work without you having to belong to an approved insurance group. Help for finding such a service is available free in many parts of the state 24 hours a day by dialing 211. The resulting medical services will usually still cost you a fair amount of money, but it will be much cheaper than going to a hospital emergency room or even an outpatients facility (your only other choice when no doctors do off-the-street walk-ins). If 211 is no help or not available, the local telephone directory will also usually have a listing of city and county health departments; start with one of the main numbers and keep trying until someone is able to get you the right number or a referral. Alternatively, many hospitals and local doctor’s offices will also give this information if you ask the right questions.


California is remarkably cigarette smoke- and smoker-free, at least by European standards. Few people here smoke, and there are strong legal and moral sanctions against those who do, even in the great outdoors. If you’re used to just being able to light up anywhere you like, you’re in for a shock….

If you’re a smoker, and you don’t want to get into trouble with either the law or the hordes of self-appointed anti-smoking vigilantes like me, smoke only in the privacy of your own home, car, or hotel room (assuming it’s not a smoke-free room or hotel). I’m not sure of the current status of the laws about smoking, but it’s definitely illegal even in public areas in some cities, so don’t just light up on the street and assume you’re safe. It’s almost never legal to smoke in a restaurant or bar nowadays, so check first that it’s O.K. with the management or staff.


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