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Not overseas

I don’t really have healthcare, not outside the US. Not for anything short of life-threatening.

My employer has been steadily decreasing options, and increasing prices for several years, so after paying the $$$ in order to stay out of an HMO, in the end that’s the choice I’m left with [1].

I’m back in the tender clutches of KP, after swearing Never Again 20 years ago when it took them a year of crippling agony to figure out that I needed back surgery [2].

My options while traveling are:

  • See a doctor. This is considered primary care, and if done out of network, not covered. This is the “You should have gotten sick before you left” option. I’m in Europe. AKA out-of-network. So it’s not covered.
  • Go to urgent care. This is covered. Except see below.
  • Go to the emergency room. This is covered. Unless the accountants decide after the fact that it wasn’t an emergency, then it’s not covered, and you’re on the hook for the very expensive emergency room visit. Good luck with deciding how that’s going to play out when you’re running a 102 F fever and breathing with difficulty. I’m sure your med school residency covered this.

So it seems like the option is b), go to urgent care.

Except that in the civilized world (Europe), there’s no such thing as urgent care.

Urgent care is a make-work that came about in the US because we don’t have single-payer universal healthcare, so the emergency rooms are full of people without insurance, meaning that a not-quite emergency room had to be developed for everyone else who needed to get stitches, or an inhalers, or antibiotics, but didn’t need to wait six hours at the emergency room [3]. It also meant that insurers could basically drop emergency room coverage unless it was the EMTs making the decision to take you there [4].

Anyway, there’s no “urgent care” in Germany. So if you’re really quite sick, but not quite sick enough to pass out and need an ambulance, your choices are a) pay to see a doctor yourself, or b) wait for it to get bad enough that there’s no question you need to be at the ER.

The latter choice has its own consequences – it might get so bad you’re not able to make the call, or it might leave you in the hospital or out of action for months.

Timing is everything.

After four increasingly miserable days (and nights) of decreasing lung function (no sleep, on top of jet-lag, and being told how horrible I looked – I was so sick I only worked one day on the weekend!), I resigned myself to option a) see a doctor and pay for it out of pocket.

I asked my German colleagues who I might be able to get into to see. After persuading them that going to the ER was a really bad idea [5], they told me that they have a company doctor, and in fact, as German law requires, they had taken out a supplemental insurance policy on us as we are there so often, and for such long times!

So in fact, I do have heathcare in Germany, provided for by German law, paid for by our German colleagues. Et voilá, I had antibiotics and inhalers in hand two hours later! I was out 60 euros for the meds.  It would have been less, but I’m not German, so I had to pay full price [6].

That Catch-22, it’s still the best catch there is.




[1] Aside from a flexible healthcare spending account, which seems like a Really Bad Idea for anyone not straight out of college and 25.

[2] Anthem HMO was worse – hard to believe, I know. KP is just slow. Anthem HMO, however, was actively hostile.  KP, for what it’s worth, hasn’t improved – it took from February to September, albeit only in searing pain, not crippling agony, for them to figure out that I really did have a torn meniscus and needed surgery. So I guess they’re 40% better. They’ve pretty much given up on the mysterious foot neuropathy. Nothing to be done.

[3] Even then you can find stories of unconscious people being denied coverage because their insurers decided post-facto that it wasn’t really an emergency.

[4] Instead you can wait three hours at urgent care.

[5] Because, having a real, functioning civilized healthcare system, that’s what they would do. Why on earth not?!? That’s what it’s there for!

[6] I also got a yellow card, which is a note from the doctor saying not that I had permission to not be at work, but a notice that I was not allowed to be at work, at all. [7]

Yellow card small

[8] Luckily this doesn’t apply to me because I’m not a German citizen. So yeah, I’m at work. Only for 10 hours today though, so a short day.

[9] You might think that my employer would pay for a supplemental insurance plan to cover such situations, since they’re sending me over here to work for extended periods of time, and not be sitting in a hotel room too sick to work. Hahahahahahahacoughcoughcoughhahahaha ouch. My employer won’t even pay the full cost of the taxi to the airport when I give them a receipt because they can find a website online someplace that tells them that it shouldn’t cost so much. They will however pay 3x the cost of the plane ticket had they booked it in a reasonable time frame after requested and not 2-3 weeks later when it finally gets through their bureacracy. But not the full price of a taxi because “audits!”

[10] You might also wonder if my employer pays for a similar policy for our German colleagues when they visit us. It really is still too painful to laugh, so, nope. Nopenopenope.