Vincent Wasney and his fiancée, Sarah Eberlein, had never visited the ocean. They had never even been on a plane. But when they bought their first home in Saginaw, Michigan, in 2018, their real estate agent gave them tickets to a Royal Caribbean cruise.
After two years of delay due to the coronavirus pandemic, they set sail in December 2022.
The couple chose a cruise to the Bahamas in part because it included a trip to CocoCay, a private island available to Royal Caribbean passengers that included a water park, hot air balloon rides and a swimming with pigs excursion.
It was that day at CocoCay that Wasney, 31, started feeling ill, he said.
The next morning, as the couple planned in their cabin for the last full day of the trip, Wasney made a painful noise. Eberlein saw him having a seizure in bed, with blood coming out of his mouth while biting his tongue. She opened their door to find help and came across another guest, who woke up his wife, an emergency room doctor.
Wasney was able to get into a wheelchair brought by the ship’s medical crew to take him to the medical center, where he was given anticonvulsants and fluids and monitored before being released.
Wasney had had seizures in the past, going back about 10 years, but it had been a long time since his last one. Imaging at the time showed no tumor and doctors concluded he probably had epilepsy, he said. He initially took medication, but after two years without another attack, he said, his doctors took him off the medication to prevent liver damage.
Kristen Normand
Wasney had a second seizure on the ship a few hours later, back in his cabin. This time he stopped breathing, and Eberlein remembered that his lips were so purple they seemed almost black. Once again she ran for help, but in her haste she locked herself outside. By the time the ship’s medical team entered the cabin, Wasney was breathing again but had broken blood vessels along his chest and neck that he said looked like tiger stripes.
Wasney was in the ship’s medical center when he had a third seizure – a grand mal seizure, which typically causes loss of consciousness and violent muscle contractions. By then the ship was close enough to port that Wasney could be evacuated by lifeboat. He was placed on a stretcher to be lowered by ropes over the side of the ship, with Eberlein descending a rope ladder to join him.
But before they disembarked, the bill arrived.
The patient: Vincent Wasney, 31, who was not insured at the time.
Medical Services: General and enhanced observation, blood test, anticonvulsant medications and remuneration for services rendered outside the medical institution.
Service provider: Independence of the Seas Medical Center, the medical facility aboard the cruise ship operated by Royal Caribbean International.
Total bill: $2,500.22.
Which give: As part of Royal Caribbean’s terms and conditions, cruise lines “agree to pay in full” for all expenses incurred onboard before the cruise ends, including those related to medical care. Additionally, Royal Caribbean does not accept “land-based” health insurance plans.
Wasney said he was surprised to learn that, in addition to other fees like wireless internet, Royal Caribbean required him to pay his medical bills before leaving the ship — even if he was being evacuated urgently. .
“Are we being held hostage at this point? » Eberlein remembered this question. “Because, obviously, if he had three seizures in 10 hours, that’s a problem.”
Wasney said he had little memory of being on the ship after his first seizure — seizures often leave victims groggy and disoriented for a few hours afterward.
But he certainly remembers being shown a bill, the bulk of which was $2,500.22 in medical bills, while waiting for the rescue boat.
Still groggy, Wasney remembers saying he couldn’t afford it and a cruise employee responding, “How much can you pay?” »
They emptied their bank accounts, including money saved for their next house payment, and maxed out Wasney’s credit card, but they were still short about $1,000, he said.
Eventually, they were allowed to leave the ship. He later learned his card was overdrawn to make up the deficit, he said. Once on land in Florida, Wasney was taken by ambulance to the emergency room at Broward Health Medical Center in Fort Lauderdale, where he incurred thousands of additional dollars in medical bills.
He still doesn’t know exactly what caused these seizures.
On the ship, he was told it could have been extreme dehydration – and he said he remembered being very thirsty at CocoCay. He also wondered whether trying snails for the first time the night before might have played a role. Eberlein’s mother is convinced the episode was related to swimming with pigs, he said. And not to be overlooked, Eberlein accidentally broke a pocket mirror three days before their trip.
Wasney, who works in a stone workshop, was uninsured when they set off. He said that a month before they left on their trip, he finally felt he could afford the health plan offered by his employer and signed up, but the plan didn’t start until January 2023, after their return.
They also didn’t have travel insurance. As inexperienced travelers, Wasney said, they thought it was about lost luggage and canceled trips, not unexpected medical expenses. And because the cruise was a gift, they were never asked to take out insurance, which often happens when purchasing tickets.
Kristen Normand
The resolution: Wasney said the couple returned to Saginaw with virtually no money in their bank account, several thousand dollars in medical debt and no idea how they would cover their mortgage payment. Because he was uninsured at the time of the cruise, Wasney did not attempt to obtain reimbursement for the cruise bill from his new health plan when his coverage began weeks later.
The couple set up payment plans to cover the medical costs of Wasney’s care after leaving the ship: one with two doctors he saw at Broward Health, who billed separately from the hospital, and one with the ambulance company. He also made payments on a bill with Broward Health itself. These plans do not charge interest.
But Broward Health said Wasney missed two payments to the hospital and that bill was ultimately sent to collections.
In a statement, Broward Health spokeswoman Nina Levine said Wasney’s bill was reduced by 73 percent because he was uninsured.
“We are doing everything in our power to provide the best care with the least financial impact, but we cannot stress enough the importance of taking advantage of private health insurance plans and the Affordable Care Act, as well as travel insurance, to reduce the risks associated with unforeseen medical problems,” she said.
The couple was able to pay for their house with $2,690 raised through a GoFundMe campaign set up by Wasney. Wasney said much of that help came from family as well as friends he met while playing disc golf, a sport he picked up during the pandemic.
“A lot of people came out to support us,” said Wasney, still moved to tears by this generosity. “But there’s still the hospital bill.”
Takeaways: Billing practices differ by cruise line, but Joe Scott, chair of the cruise ship medicine section of the American College of Emergency Physicians, said medical charges are typically added to the passenger’s onboard account. cruise, which must be paid before leaving the ship. Individuals can then submit receipts to their insurers for possible reimbursement.
He recommended that those considering taking a cruise purchase travel insurance that specifically covers their trips. “This will make it easier to reimburse if they incur costs and potentially cover a costly medical evacuation if necessary,” Scott said.
Royal Caribbean suggests that passengers who receive onboard care submit their paid bills to their health insurer for possible reimbursement. However, many health plans do not cover medical services received on cruise ships. Medicare sometimes covers medically necessary health services on cruise ships, but not if the ship is more than six hours from a U.S. port.
Travel insurance can be designed to cover many out-of-town incidents, such as lost luggage or even the transportation and accommodation of a loved one if a traveler is hospitalized.
Travel medical insurance, as well as plans offering “emergency evacuation and repatriation,” are two types that can specifically help in the event of a medical emergency. These plans can be purchased individually. Credit cards may also offer travel medical insurance among their benefits.
But travel insurance plans have limits. For example, they may not cover care associated with pre-existing conditions or what plans consider “risky” activities, such as rock climbing. Some plans also require travelers to first file with their primary health insurance before requesting reimbursement from travel insurance.
As with other insurance, be sure to read the fine print and understand how reimbursement works.
Wasney said that’s what they plan to do before their next Royal Caribbean cruise. They’d like to return to the Bahamas for virtually the same trip, he said: There’s a lot about CocoCay they haven’t been able to explore.
Bill of the Month is a crowdsourced investigation by KFF Health News and NPR that dissects and explains medical bills.
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