Getting caught without health insurance

The crisis is past and it seems time to tell the tale. My recent problem with health insurance was remarkably unpleasant, could easily have been fatal, and was largely caused by my own stupidity. This is a cautionary tale to perhaps save others from going through anything like it. In a nutshell, procrastinating about health insurance can turn out to be a serious mistake.

Getting health insurance in China, especially if you are over 60, can be difficult. Other threads here give what appear to be some good leads on both international plans (one is http://raoulschinasaloon.com/index.php?topic=83.msg867#msg867) that cover evacuation and treatment abroad if required and Chinese-only plans that cover less (one is http://raoulschinasaloon.com/index.php?topic=5583.0). I'd read the threads and looked up the Shanghai address for the most promising company, but had not actually done it.

In late October, I got some pain in my right side bad enough to head for the emergency room, They diagnosed a gallstone needing surgery. This was not too bad, relatively minor surgery with only quite moderate risk and a cost of 11,000 rmb. Still, I'd already have been much better off with insurance.

I'd actually checked in for that surgery when things suddenly got much more difficult. Their pre-operative scans turned up an abdominal aortic aneurysm (http://en.wikipedia.org/wiki/Abdominal_aortic_aneurysm). This is a swelling in the largest artery in the body, one of the two main ones coming out of the heart, carrying the blood supply for basically everything below the lungs. It may rupture and if it does, chances of death are 70 to 90% depending which web site you check; you bleed to death internally in minutes. Chinese doctors advice was immediate surgery costing 200,000 rmb which I did not have. Also, the time remaining on my visa was less than I'd need for recovery (several months) and I had insufficient financial reserves to carry me through the recovery without any income expected. The plan became to evacuate to Canada immediately, since Canada has good "universal" health care; the situation might be harder for Americans, or people from other places without such a plan, not sure.

The risk that air pressure changes on the plane will pop the thing is not large, but it is definitely non-zero, so at this point I am forced by lack of insurance to take a risk that may kill me; hardly an optimal situation. Anyway, fly back in early November and arrive OK.

Canada's health insurance system, though, turns out to be not quite "universal". Everyone is covered, but the provinces, who each run their own system, have a residency requirement. At least in the three provinces I checked (Ontario, Quebec & BC), the insurance does not kick in until three months after you take up residence. That meant three months of feeling like Damocles, a distinctly unpleasant sensation and largely caused by my own procrastination.

Now I have got the insurance, have had the surgery, and seem to be recovering well. I seem to have dodged a bullet, but I strongly suggest others avoid taking similar avoidable risks.

this is an excellent example Pash, and glad things worked out for you in the end. One word of caution though for those of you who think that the repatriation clause in travellers insurance is a good thing. As Pashley found out, even in Canada, you have a 3 month residency criteria. Travellers insurance with a repatriation clause is to bring you back to your own country  (as they determine if costs are too high) where you will then fall under your own country health insurance. If you have no insurance back home this clause will actually leave you uninsured.
Read the clauses carefully when choosing your policy. Travellers insurance and expat insurance are different - as are the premiums.

In Ontario, if you tell the Health Insurance people, you are going abroad to work and have documents to prove a job, you can keep the Health Insurance and it is valid immediately when you return.

This is only for up to 5 years.  After that time, you must wait the 3 months.

I went this route, however, I ended up working in China for 6 years.  When I returned I had to wait the 3 months.   

Glad to hear that things worked out well for you Pashley.   My family paid private health Insurance when we were young and when I left home, I also paid and have paid all my life. It is usually only when a big problem hits, that people realize that healthwise, anything can happen and it often does and boy can it be expensive.
In Australia, my observations are that we are getting more refugees and other overseas folk who often bring health problems with them. Our public health system is being stretched to the limit and people are now forced to wait years for surgery such as hip replacements as an example. Ambulances are lined up in emergency bays as people wait hours for emergency treatment. The reason I am commenting about this is in the hope that folks without the proper health insurance, will ensure that they not only look into it, but actually ensure that they have it when they return to their Country of origin.

In Ontario, if you tell the Health Insurance people, you are going abroad to work and have documents to prove a job, you can keep the Health Insurance and it is valid immediately when you return.

I did not do that. The first Chinese employer provided insurance here & I expected to be gone more than five years.
 

This is only for up to 5 years.  After that time, you must wait the 3 months.

I had been in China for ten.

Pashley,

Oh my goodness, I'm so glad you're on the mend now. What a relief. Losing another respected and highly valuable member of this distinguished forum would have just been unthinkable. 

Pashley,
Good God almighty! Forget the health insurance aspect for the moment, what a horror and what a terrible scare for you. I am really happy to hear you are 'on the mend', take care and recover well.
Rxx

Consider getting screened for aortic aneurysms, especially if you have one or more of the risk factors -- if you are male, over 60 or Caucasian, have ever smoked or have high blood pressure. Risk is not zero for other groups, but it is much lower. The things are reasonably common. (Using wikipedia figures) 15,000 deaths a year in the US, making them 13th most common cause of death overall, and 10th for men over 55. All it takes to detect one is an ultrasound scan, though CAT scans are used for detailed diagnosis.

However, most aneurysms are discovered either accidentally during other testing (as mine was) or after a rupture. Those are both dangerous; ruptures are usually fatal and accidental discovery may be a bit late. For example, the usual rule is to do surgery on aneurysms over 5.5 cm, the point at which the risk of surgery is typically less than the risk of leaving it alone. Mine was at 6.6 when it was discovered, larger by the time I got surgery. This meant I needed the higher risk (the hospital quoted a 4% death rate) open surgery rather than lower-risk alternative treatments which might have applied if we'd found it sooner.  

This appears to be an avoidable risk. Details on US & UK screening programs are at:
http://en.wikipedia.org/wiki/Abdominal_aortic_aneurysm#Screening

Pashley, glad you are okay now

Another thing to consider when you are looking for a job. Don't just look at the salary! There are other things to consider. My company provides me with European health insurance so I have $50,000 American per year which covers mostly everything.