Helping Your Au Pair Navigate Health Care Costs & Insurance

by cv harquail on February 24, 2014

When an au pair is injured or gets ill, their health insurance is supposed to cover their care. But sometimes managing the both getting care and getting it paid for is more than any of us can handle.   

Even those of us host parents who have “good” health insurance can get beaten down by copays, out of network problems, out of pockets costs, overcharging, and more.  And as annoyed as I get every single time I open a medical bill or contest the cost of a prescription at CVS, it has to be worse for an au pair. Many of them come from countries that have simpler and/or better basic health care, and none of them come prepared to navigate our US system.

What can we do to help our au pairs when they seek medical care?

How can we help them find the right care, and also help them find care that they can afford?

Focusing just on health care (not dental care) can you all share some of the experiences you’ve had, and what you’ve learned about how to help?

This question comes from an email related to earlier posts about au pairs who’ve gotten ill:

Dear AuPairMom-

Our recently departed au pair injured her ankle playing soccer. She went to a general practitioner, who treated her for a sprain.  When she didn’t feel like she was getting better, she went to a doc-in-the-box for an x-ray, then off to an orthopedist for a cast. Luckily we didn’t need her to drive, and she was going home soon, so we (or reatherm, she) hobbled through her last few weeks and then flew home.

She asked me to open her remaining medical bills and scan them for her– and I’ve been appaled by what she’s being charged and also by the number of (what seem to me to be) unnecessary procedures.

And it wasn’t just for her ankle. She had also gone to an ob/gyn for some physical issues she was having related to birth control. The ob/gyn ordered every single test you can imagine — to the tune of $1700. These probably would get covered under “well woman” visits under regular insurance. But, I am positive that the CISI policy our Au Pair had will not cover these– it explicitly excludes everything related to ob/gyn that’s not illness-related.

Our Au Pair was very careful to choose someone who takes the CISI insurance– she called ahead to confirm, and seemed to have it all in hand. But, she just didn’t know enough to realize that labs and prescriptions are not part of the medical provider coverage.  I am so angry at the doctor right now for not checking with our Au Pair and with her insurance before ordering all these tests.

And, I’m upset because it never occurred to me to warn her about all of this. It’s a lot of money for an au pair, and I know that this au pair takes her responsibilities seriously and won’t want to ignore the bills– but I wonder how she’ll pay them.

What should I have done to help?  Is there a procedure that au pairs should go through? Are there ways to work around the system, or to get help with the insurance, so that the au pairs can get the coverage they need and not bankrupt themselves (or wait until they go home for treatment)?

I’d love to know what other host parents and au pairs have done.  Thanks for your ideas, ~  OutOfNetworkHostMom


Emerald City HM February 25, 2014 at 4:35 am

I’d be questioning whether or not your au pair was actually a victim of billing fraud. The doctors can easily find out what is covered and what is not and this office might have been taking advantage of the fact that she did not know how to navigate the system.

I have had an obgyn office claim they did more than they actually did. I tried to argue it and did not win, however because my insurance in excellent I didn’t have to pay out of pocket.

Other than having the au pair take in the list of what is not covered and saying they do not authorized those tests I’m not site there is much we can do to protect them from scammers that come in the form of doctors.

I haven’t needed to read over the paperwork yet, but I thought our area director said something about making did to get approval for procedures first? This is one I would go to the agency for (given it wasn’t an emergency) and require that they help or so pair navigate the terrible health care plan the agency chose.

HRHM February 25, 2014 at 12:08 pm

As a physician, let me assure you that I personally have no idea what is or is not covered by each of my patient’s insurance! LOL that is a lot of information and my head is already full of medical stuff that needs attention paid to it. It is my policy (and that of most practitioners that I know) that the patient is FULLY responsible for their medical bills. This includes knowing what is and isn’t covered, getting pre-approval where required, and paying the difference if they either choose to forgo the aforementioned, or if they want the care regardless of cost. In most practices, there is a statement of this policy at the check in desk. The only practices I know that get heavily involved do so because they NEED to in order to get paid (plastics, weight loss surgery, lasik, cosmetic dentistry, etc) due to their elective nature.

Which is why I NEVER let my AP navigate healthcare issues in the US alone. Not even for a simple cold. Because their healthcare system (in most countries, all that I’ve hosted) is ENTIRELY FREE to their young eyes. They have never paid a copay, never seen a statement, never bought insurance. Would your Mom and Dad have allowed you to engage in multiple visits, labs, imaging while you were a freshman in college? No. Now add the language barrier and social construct differences.

When I choose what to order for a patient, it is in total disregard of what their insurance covers. I do what I think is in the best interest of the patient’s health needs at the time. It really is up to the patient to figure out (our office is glad to help when asked) what is covered and what it will cost OOP. The good news is, if she chooses to ignore the bills, now that she is home, it will not effect her in any way shape or form. If she and you don’t want to go this route, try calling the office and explaining the situation. Most have a system in place for reducing bills and forgiveness.

And yes, the insurance provided for them sucks. It is TRAVEL insurance and as such is meant to cover if she gets hit by a car, not actual medical issues.

Emerald City HM February 25, 2014 at 1:19 pm

That was a bit of a typo up there. I didn’t mean the doctor’s themselves wuld know what is covered and what is not, but the offices can easily find out. Even as a patient, you might go in knowing your insurance, but you don’t know how the office is going to code it, which can change things. That’s essentially what happened to me.

The office claimed that as part of my well-woman exam one year, they did an 11 point review of systems, which wasn’t covered under the well woman part and actually took away an allotment for general physical exams. I went back and forth with the office and with my insurance. The doctor herself signed a letter (she probably didn’t write it) stating that was what she did. In reality, I filled out a questionarre before my appointment as part of the check in paperwork and she looked at my answers.

I don’t feel the onus in this system should really be the patient that does not know how medicall billing, medical coding, doctor offices and insurance companies work. As a society we can do better. As a business, medical providers can do better. I don’t walk into a department store and purchase an item without knowing how much the item is going to cost me.

German Au-Pair February 25, 2014 at 7:43 am

With APC their insurance had the policy that you had to ask them before you get any procedures done. We knew that before. When I broke my ankle I didn’t call them before the lrocedure and only a whole day after because I was not in the physical state (as in high on narcotics all the time) to do it before. They were fine with that.
After that I called them before every single step that was taken.
I also called them before going to the doctor’s for a long lasting cough. The doctor himself (or his people) called the insurance before considering any tests (and they declined).
You can make sure to let her know to contact the insurance before having anything done but the agency also did that at the orientation.
And I’ve said that in the other post but I really want to stress that: if your au pair is not really fluent in English DON’T let her talk to the insurance alone when it comes to anything more than a cold. I had to talk to people from France and had quite a bit of trouble understanding them in the beginning. It’s so hard to understand others’ accents on the phone if it’s not your native language (and even then sometimes) and I think I can say my English is very fluent. I know many of my friends would have been lost discussing everything with them. (And for serious cases, try to get a direct number to someone higher up in the food chain. I eventually gave up becauss no one really knew what the other one had already discussed. It was a mess. So I just talked to the case manager in the end and everything was fine.)

Multitasking Host Mom February 25, 2014 at 12:43 pm

You mentioned the language barrier, and I agree that this is an issue. Medical terms are not always taught in language classes, nor are they necessarily learned even in an immersion setting. At the hospital I work at, we have people on staff that have been certified not only at a fluent level in their language, but also they are tested on their ability to explain medical/health care situations. And if we do not have a staff member on hand certified in the language needed, we can call a translation service where almost all languages are available. I would encourage au pairs to ask if a translation service is available; I would think most hospitals would have this set up. When you are hurt, stressed, scared, etc., you do not want something lost in translation.

German Au-Pair February 25, 2014 at 4:28 pm

Well, that is IN the hospital. Even though I was in the ER with a broken ankle, I had no problems whatsoever. TV educates…hours and hours of Greys Anatomy paid off that night :D
What was much more difficult , were the many phone calls to the insurance. The APC insurance headquarters are located in France. So I talked to tons of people with French accents (which is hard) on the phone (which makes it harder). They wanted to know stuff, they gave me pretty cryptic answers, I had to explain the case and necessity of procedures over and over again. One hand didn’t know what the other was doing (does that expression exist in English?) and it was such a drag until I managed to get the contact of the case manager who spoke much better English and actually knew what she was doing. Someone less fluent would have had a lot mor trouble than I did and since everything is very confusing already, I can only encourage HP to help their au pairs with that.

Dorsi February 26, 2014 at 4:17 pm

Hospitals (including ERs) are required to provide translation services free of charge. Most do this with video teleconferencing now. I would encourage Au Pairs to ask for this to help with any clinical problems (explaining their symptoms or understanding the home care instructions). However, as alluded to above, the people delivering the care will have no clue how it will be charged or paid for, and the translator cannot help with that.

hostmominco February 25, 2014 at 9:08 am

As soon as our au pairs arrive, I take them to the local low-income clinic to get registered as a patient. This is after one of our au pairs went to the “regular” doctor for a birth-control prescription which her insurance didn’t cover. She didn’t pay the $500 doctor’s bill.

This way they can see a doctor for a cold, birth control, and other minor issues and pay a very minimal fee (usually less than what the copay on their insurance would be). However, our current au pair broke her wrist and I spent many, many hours on the phone with her insurance company, the agency, and our LCC-all of whom were very discouraging, telling me it wouldn’t be covered. Our au pair’s English is marginal, even after 9 months, and she could never have even begun to understand our complicated health care system. She needed surgery to place a plate and realign her bones. We went ahead and scheduled everything because it was an acute case and I was prepared to just shred all the bills that came after she left. The night before her surgery (5 days after our first contact with insurance co.), the insurance company finally called to “pre-authorize” her care. Au pair had already been to the emergency room, had seen a orthopedic surgeon, and was prepping for surgery the next day.

While on the phone to the person at ins. co. authorizing her care, I told them that the surgery center was “in network,” but the the surgeon was not. She said that the au pair would be responsible for 20% of the surgeon’s fees. However, when I told her they did not have an “in network” ortho surgeon within 40 miles of us, she said “Oh, then it will be covered 100%” This information was not offered and unless I had mentioned the lack of providers in our area, I would be shredding bills.

NONE of the information regarding the limited number of providers and this exception was in the information the agency gave us. In fact, they sent her with a brochure for the policy they had for the 2012-2013 year (she’s here 2013-2014) so initially, I was calling the wrong company.

What makes me angry is that NOT ONE PERSON from the agency, who I’m sure deals with this much more often than us, is assigned to be an advocate for the au pair or the host family. Given the fact that we all KNOW how convoluted the American system is, that should be a service offered. So my advice is, sign them up at planned parenthood or similar clinic with sliding scale (if available) and be prepared to spend many hours on the phone with insurance companies if something happens.

Multitasking Host Mom February 25, 2014 at 12:45 pm

We had an au pair who fainted in our house one day. Her head hit a tile floor, and she needed stiches. After stopping the bleeding and getting her bandaged up the best I could, I called her insurance company to make sure that the hospital, I was planning to take her to, was part of the insurance network. I was told it was. And here enters the joy of the American health care system…. The actual hospital visit including stiches and exam was covered, but the doctor who read the head scans was not, and she ended up with a $300 bill. She was use to a health care system from her country where everything was covered, and was frankly in denial that she should still be getting a bill. Once I did mention to her that this situation is not unusual and that there are consequences for not paying. I wanted to support her in any way I could, but she was so insistent that this shouldn’t be happening, because that wasn’t how insurance based on her experience was supposed to work, that I decided to stay out of it. AP did talk to the billing people at the hospital and with her insurance several times, and they did tell her several times that she had to pay it. I honestly do not know if she eventually did before she left. (Side Note: I found out the reason she fainted was that she had been upset about an event taking place back home, and due to the stress had lost her appetite. I hadn’t noticed because she was still eating dinner with us every night, but apparently that was the only meal she had each day for almost a week. I must say that our LCC really did a great job swooped in and handling the problem. She gave her a great talking to about taking care of herself for not only her own sake, but also for the children that she was taking care of in case this had happened when I was not around. She did take that to heart, and she didn’t have any more health issues.)

Taking a Computer Lunch February 25, 2014 at 1:14 pm

Our LCC, during her initial home visit, stresses to each AP that the healthcare system in the United States is different than in their home country and warns them that their health insurance will not cover a visit to the hospital that is not a true emergency. She verifies whether or not they have paid for sports coverage (and discourages those who have not from attempting risky winter sports, like snowboarding).

I will say up front that I reimburse my APs 100% when the kids make them sick enough to see a doctor (the year The Camel had strep throat 11 times in 8 months made it inevitable that the AP was going to have it at least once – not to mention child #2).

Most of my APs have been very healthy, but almost all have experienced a need to visit a doctor at least once in their year. When they talk to me about it, I am able to triage and offer advice – head to the pharmacy minute-clinic for that sore throat that has lingered for several days – don’t go to a physician because it will be quadruple the price. Go to the free clinics early in the day. Head to Planned Parenthood for birth control because they offer a sliding scale fee. Don’t decide at 5 pm that you really absolutely must see a doctor when you’ve been sick all day – because now you have HP who are fully engaged in childcare, and you’re on your own to find a clinic with evening hours.

Only one AP has ever required a trip to the ER, and unfortunately I had to leave her there alone because I had too much to juggle at home. I felt bad, but all I could offer her was a drop off and pick up. (I went through a similar experience when I broke my ankle in another country – although I had to take the bus there and back myself, so I could sympathesize.)

German Au-Pair February 25, 2014 at 4:32 pm

I was left alone, too and I was actually pretty happy about that because the situation is uncomfortable enough, no need to have your employer waiting for you on top of everything…
But I’m curious: how did you take a bus with a broken ankle? I couldn’t even lift my foot…

Taking a Computer Lunch February 25, 2014 at 11:02 pm

Old injury trick – tie a pair of boots tightly. I had reinjured an ankle that had been rebuilt, so while it was incredibly painful, it wasn’t the first time.

AnotherSeattleHostMom February 25, 2014 at 1:37 pm

Our Au Pair was billed for some blood tests that the insurance doesn’t cover (to the tune of several hundred bucks) and she’s simply decided not to pay it. She tried to call the insurance and the hospital but both gave her the “tough luck” speech so she is just ignoring the bills until she goes home. What are they going to do? It seems pretty ridiculous that they wouldn’t work with her to at least reduce the amount she owes. American healthcare! I know for a fact (because I work at a hospital in clinical research) that the tests cost the hospital less than $25 total. If they’d reduce her bill to $50 I think she’d pay it…she’s just not willing to be out a week and a half’s salary. And as much as I’d like to advocate responsibility…I don’t blame her!

Should be working February 25, 2014 at 2:07 pm

Our last AP found a separate travel insurance from her home country, paid for out of her own money apart from agency fees, and it was GREAT. She needed some non-urgent medical care while on a vacation trip and had to pay up front, but it got reimbursed no problem. I will always recommend this to APs from now on.

Should be working February 25, 2014 at 2:08 pm

“Pro Trip”, German, not sure if it works in other countries, BTW.

Returning HM February 25, 2014 at 2:31 pm

We had a similar situation with surgery our son had, where I confirmed that both the surgeon and the site where the surgery was located was covered by insurance, but the anesthesiologist who did the anesthesia for the surgery turned out not to be. Ridiculous, since we never even knew this person’s name prior to him administering drugs to our then toddler, but we subsequently got to know him well when he billed us 3,000 for the anesthesia for the surgery! Even though we argued with United Healthcare that we had called and confirmed the doctor and site, and that we should not have been responsible for tracking down which anesthesiologist was being assigned to our son’s case, we ended up having to pay, though I think they reduced it a whole 1,000 so we paid 2,000. Anyway, after that, I now ask tons of questions with every thing – and for our au pair ask extra ones and then ask them three times each, to confirm I get the same answers each time I ask.

We’re actually in the middle of AP healthcare hell right now because our beloved AP – so fabulous we sang his praises in one of the “appreciations” CV posted last week – got injured last week playing soccer. We are seeing the orthopedist tomorrow – his knee was too swollen last week for an MRI – but the one we saw at the ER last week told us he thinks it’s probably a torn ACL. So as you can imagine, I have been on the phone with Cultural Care’s Aetna several times, trying to ensure that the MRI will be covered, that the orthopedist is covered, that the site itself is covered, etc. We are just praying it’s something else in the knee and not the ACL, because we know a torn ACL will need surgery, and that may mean our amazing au pair will have to go home for that….(and if this is the case, you all will hear the sounds of our sobs echoing through the computer when I have to tell the children and when this sinks in to me as well). Please send out good vibes to him for the appt tomorrow!

Momma Gadget February 25, 2014 at 4:11 pm

Oh No! I hope not, sending you possitive vibes!

German Au-Pair February 25, 2014 at 4:39 pm

The APC insurance does have a list of covered hospitals but they told me that ANY doctor and any necessary procedure that a doctor deems necessary ist covered with them. Not tests for chronic things obviosuly but when I went to a doctor and he said I needed X-Rays, I needed X-Rays and that’s it. The doctor said I needed an ankle brace and the insurance paid for it, no questions asked. It is wildly know that APC has the best insurance for au pairs and while I had to constantly remind them to pay, they actually are very good.

Emerald City HM February 25, 2014 at 5:06 pm

APC just switched insurance companies this year. We got the notification a few months ago. So your experience may end up completely different from any au pairs starting now.

Host Mom X February 27, 2014 at 4:29 pm

Our APC Area Director told us she thought the insurance had changed for the better. And she said that her own AP had recently had some serious issue that was completely covered, but that yes – you definitely have to call first to get pre-approved.

What’s odd is that our previous AD’s with APC all told us that the insurance was the worst, and she’d advise AP’s to just go to the emergency room for all issues, where they’d get treated, but could avoid the bills once they got home. Probably not the best advice….

Anyway, I have found that with our APs (thank goodness we haven’t had any serious injuries yet), they really need preventive care (e.g. gyn visits, other women’s health issues), and the insurance of course doesn’t cover that at all. As TaCL mentioned, Planned Parenthood is great for that. Not all of them offer the sliding scale for all things, so you have to check out which ones in your area offer which services, but our APs have gotten free services from Planned Parenthood because the stipend is at the bottom of the sliding scale. Great place to go for women’s health check-ups, birth control.

AuPair F February 25, 2014 at 2:38 pm

Wow, it really does sound like a bit of a nightmare. In my experience with the insurance Cultural Care gets for us, it did take a bit of extra work to get the insurance to actually cover what they were supposed to cover but in the end, while I had to pay upfront for some things (prescriptions), after filling some forms, I got a check in the mail with the money I’ve paid before hand-
I have to say I wouldn’t have been able to do it without my HostMom’s help though -even when before heading to the immediate care clinic we checked online if it was one in the insurance network, upon getting to the clinic we were told they wouldn’t take the insurance (they didn’t recognize it, had no idea what it was) but since it was a real emergency they saw me anyhow and in the end took the insurance card and didn’t make me pay a dime that day. HostMom did most of the talking tho and pretty much MADE them see me, even made a call to the insurance HQs, so yeah…pretty hectic but turned out okay…
I can absolutely see how this can become a nightmare for aupairs on their own. I wish we were told a bit more about this during training…

Returning HM February 25, 2014 at 2:41 pm

Oh absolutely – we have been with our AP every moment in the hospital and will continue to be right by his side and doing all the talking/negotiating all the way through. I also can’t imagine an AP having to go through this alone (I wouldn’t want to go through it alone either…). I’m glad your HM was there for you too, AuPair F.

Momma Gadget February 25, 2014 at 4:33 pm

I had mentioned before in another post that one of our great APs had to have emergency surgery. She was a native English speaker from SA. The Insurance company told both her and myself that she was covered. What no one mentioned was that the agency was in the process of switching insurance companies so after seeing several specialists, having multiple tests, and ultimately surgery, the insurance company felt under no obligation to pay… to the tune of 12K! I am sure the insurance would have negotiated that down, but it is far easier for the hospital etc just to go after the patient. There was no way she would have been able to take such a long flight home for treatment either! It was so close to her departure date, that she left without paying. We forwarded her bills to the agency hoping they could help with the insurance company to no avail. We continued to get notices for a year afterward. It finally stopped after returning the bills “no longer at this address” multiple times each.

Though none of my other APs have had anything more than a cold. But god forbid something more serious happen! I strongly suggest to all APs, if you can get extra insurance from your country, you should!

exaupair February 25, 2014 at 5:13 pm

I have been an au apir in England and compared to what you’re all saying health insurance system over there is pretty easy to manage. During my stay I had to make one urgent appointment, when I found out my international insurance has expired. Went to the local GP and after almost 1.5 hrs of standing there and talking (or should I say…begging) the doctor agreed to see me, got me a prescription for some stuff that turned out to be fully covered so I didn’t even have to pay for it, as long as I promised they will never see me again. It was breeze.

Aussie mum February 25, 2014 at 6:27 pm

Wow. I really don’t get why so many people are opposed to your new health care changes, we are so lucky in Australia. This sounds like such a stressful thing to deal with when you are already in a stressful situation and vulnerable.

Emerald City HM February 25, 2014 at 6:41 pm

The sad part is, even the new health care changes won’t help au pairs. Insurance companies are allowed to give J-1 visa holders plans that are not ACA compliant.

Gizmo February 28, 2014 at 3:18 pm

AP #4 had kidney stones that came on suddenly (aka within hours she went from uncomfortable to ashen and incoherent). I called our AD for APC and she was completely clueless as to what insurance did and didn’t cover and what to do. I called insurance before our AP became completely overwhelmed with pain and figured out that taking her to an emergency clinic would be less expensive and quicker than going to the hospital ER. It didn’t take long for them to treat her quickly with xrays, a morphine drip and prescriptions for Vicodin and antibiotics. She was in and out in 3 hours or less and we ultimately didn’t have to pay for anything relative to the emergency clinic visit. For that, I’m very grateful.

Now – the after-care meds were another story. Those I was told I’d need to pay out of pocket and get reimbursed for later. Good thing I filled them at Costco, because good luck getting reimbursed. As someone above said, you have to talk to the reps who are based in France. Get this – they ask for a bunch of original receipts, a doctor’s signature verifying the meds were required (if they weren’t, why would he write the prescription in the first place?). Then, you have to MAIL all the originals to FRANCE, they told me! After following up much later I was told we could have simply scanned and sent the information in, but by that time, it wasn’t worth the hassle to get my $50 back. I suppose I should be grateful that the lion’s share of the treatment was covered with no questions asked, but I was disappointed in the prescription coverage and, most of all, my AD’s inability to help. She had the nerve to call me later to find out how I handled the issue so she’d “know what to do next time!”

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