My family had just arrived at a seaside village on the east coast of Spain, where I was sitting on a white sand beach looking out at the implausibly blue water. The scene was straight out of a Mediterranean daydream, and yet I was panicking.
My head was throbbing and had been since I’d slammed it into the bottom of a metal hotel safe a few days earlier. The pain and pressure had been keeping me up at night, along with the anxiety that came from Googling my symptoms. I’d tried every kind of medication I could find, but nothing could ease the pounding in my skull.
After returning to our Airbnb, my husband urged me to make a telehealth appointment through our international health insurance. (As an American family living in France for the year, we were required to purchase this as part of our visa application.) A few minutes later, I described my symptoms to a Spanish doctor via chat using Google Translate. Hearing how long the pain had persisted, he advised me to see a doctor to rule out a brain injury.
I frantically researched doctor’s offices nearby, but the remote region had limited options, and I wasn’t even sure how or where to secure an appointment. So, instead, we decided to go to the nearest emergency room.
Leaving our son with his grandparents, my husband drove us to a small city about 35 minutes inland. As we pulled into the hospital’s parking deck and then walked toward the front desk, I was struck by how similar it looked to hospitals in the U.S. My husband, thankfully fluent in Spanish, took the lead as we checked in, but the receptionist switched to English when she realized that I didn’t speak Spanish.
The receptionist asked for proof of our public healthcare coverage, but I explained that I have private international travel healthcare coverage — essentially expat insurance. She apologized, explaining that I would have to pay out of pocket for the ER visit and then request reimbursement from our insurance company since I hadn’t secured prior approval for the hospital visit.
I braced myself, thinking back to past experiences in American hospitals: The ER visit for chest pains that came with a $2,500 surprise bill a few months later. The breast biopsy, where I was forced to pay nearly $3,000 for the privilege of finding out whether or not the lump in my breast was cancerous. Of course, all of these charges were on top of the $12,000 insurance premium my family paid annually.
Thankfully, I didn’t have to wait long to find out what we’d be paying. The receptionist explained that there was a 200€ flat fee for ER visits, pointing to a poster beside her desk that listed the hospital’s costs in clear detail. She noted that if I needed additional tests or procedures, the total could increase. I released the breath I’d been holding, handing over my passport as insurance I would pay at the end of my visit.
“I released the breath I’d been holding, handing over my passport as insurance that I would pay at the end of my visit.”
Inside the hospital, things progressed as expected. We sat in a sterile room in uncomfortable plastic chairs with dozens of other uncomfortable-looking people. I briefly spoke with a hospital worker (in English), who assessed the severity of my situation and added me to the queue. I waited close to two hours before my name was called, and a young doctor led me into a room that looked like every American hospital room I’d ever been in — besides the fact that the posters on the wall were in Catalan.
He took my vitals, asked about my symptoms (in English, with a bit of translating from my husband for clarity), and said he was going to order a CT scan just to be safe. We waited another hour for the scan, which was conducted using an ultra-modern machine by two efficient female techs.
Shortly afterward, the doctor returned to share my results: No brain damage. He suspected that my headaches were being exacerbated by the anxiety and tension I had developed as a result of the injury, and he handed me a prescription for a common Spanish painkiller. He instructed me to return if my symptoms worsened or didn’t clear up.
Checking out at the front desk, I braced myself for the grand total, knowing from bitter experience that a CT scan can cost thousands of dollars in the U.S. I was pleasantly surprised when the receptionist told me that the final tally for my ER visit was 729€. After I paid, she handed me a disc with a copy of my CT scan for my records. She also gave me the documentation I needed to provide to my insurance company for reimbursement.
Walking back to our car, I was overwhelmed with relief — both that I didn’t have a brain injury and that we didn’t have to pay thousands of dollars to confirm that I was going to be OK. Although an unexpected 729€ bill is indeed a hardship for most people (myself included!), I was comforted by knowing that it would be reimbursed and that it wasn’t as much as it could have been back in the States.
I also felt sad and frustrated thinking about the extreme shortcomings of our healthcare system in the U.S. — how even a basic doctor’s visit comes with the worry of not knowing how much you’ll have to pay to get the care you need. Far too often, Americans must choose between prioritizing their health or financial stability.
The cost of an emergency room visit can vary greatly depending on the location; the average bill can easily be over $2,000 without insurance. Even with insurance, the numbers can be astronomical for the average American family. If critical care is required or surgery is performed, those costs could skyrocket to $20,000 or more.
It’s no surprise, then, that recent polls found that 40% of Americans carry some healthcare debt, despite more than 90% of the U.S. population having health insurance.
How do you prepare for an emergency before going abroad (and what to do if it happens to you)?
If you, like me, are an American with hospital bill-related anxiety, it’s a good idea to do some research on your destination before traveling abroad. Find out what type of facilities are available at your destination, if travel insurance is recommended there, and how to contact emergency services should the need arise.
Additionally, Johns Hopkins Medicine advises that you know your blood type before you go abroad, carry documentation of any pre-existing conditions and medications, and fill out the information card in your passport with details like your address and phone number.
The Centers for Disease Control and Prevention recommends getting in touch with the nearest U.S. embassy or consulate for help locating medical services, as well as enrolling in the Department of State’s Smart Traveler Enrollment Program (STEP) before going abroad. Consuls can also help you transfer funds from loved ones back home if you need them to pay for medical services.
You can also check out the International Association for Medical Assistance to Travelers’ directory of healthcare professionals around the world.
Accidents and emergencies can happen anywhere, anytime, and you should always have a game plan ready to go. And whatever you do, don’t delay care if you suspect the problem is serious. The outcome could be catastrophic.
