Medical Care for your Au Pair: Your responsibility?

by cv harquail on July 16, 2009

What happens when your Au Pair gets sick and needs some medical care?

We already know that as good host parents we need to provide them with reasonable ‘sick time’ off and not dock their pay (although I think it’s fine to reschedule their hours in the same week). But what about the cost of medical treatment?

200907160024.jpg Over all our 11 au pairs, we only had one with a ‘serious’ health problem– actually a dental problem — and I was able to cajole my dentist into treating her at a reduced rate. This turned out to be an interesting professional experience for him. As he described it: "Her dental care was state of the art– in 1959 in the Soviet Union."

Other times, we have had Au Pairs who needed OB/GYN care (cramps, etc.) and I sent them to the Planned Parenthood clinic. And, when they’ve had bad coughs, sprained wrists, and so on they’ve gone to the ‘Doc in the Box’ emergent care center, for $75. But, thank goodness, never anything serious or expensive.

And I’m relieved about that too, because you only realize how expensive even the most basic health care can be until you see someone trying to pay for it ‘out of pocket’.

So what’s a host parent to do, when their au pair actually gets sick, and does need care? Here’s one host mom’s concern…

We have currently have our second au pair, and have had very good experiences with both of our au pairs to date. Some ups and downs, but generally very positive. However with each au pair I have had an uncomfortable situation in terms of a medical issue and health insurance.

In each case the au pair had a relatively mild viral illness (my husband and I are doctors and felt pretty confident that this was nothing worrisome). In each case our AP has wanted to see a doctor and has complained extensively about the symptoms.

We didn’t feel comfortable telling her not to see a doctor and ultimately each has gone to a local MD and has come out with a prescription for a medication (inhaler and antibiotic in one case, antibiotic alone in the other) of dubious value for her condition.

Both au pairs were shocked at:
1. the size of the medical bill
2. how little the au pair insurance covers
3. the cost of prescriptions drugs.

Each has then asked me to either try to get the medications from my work (I don’t work in an office, and don’t have samples available) and/or pay part of the bills.

One had a mild allergic reaction to the drug she was prescribed and landed in a local emergency room, generating an additional bill of $350, which really distressed her (she has the money saved, but had planned to use it for other things). With or without antibiotics the illnesses have been over within 1-2 weeks.

In general, I believe in treating our au pairs as a member of the family while they are with us. But I admit, I don’t like the idea of being expected to help with these medical bills or with obtaining prescriptions. I was an exchange student abroad in college (when I was younger than my au pairs) in a program where I lived with a family. It would never in a million years have crossed my mind to ask for their help with medical bills. I have considered both of our au pairs adults and expect them to be responsible for their own health care. Has anyone else encountered a similar situation??

200907160026.jpg Last year there was a story in the New York Times about a family with an au pair who had cancer, and they not only paid for her treatment but also housed her and her mother while she recovered from surgery and chemo. This was wonderful of them, but really above and beyond what is or should be expected.

I agree with this host mom — medical costs are not the host family’s responsibility. This is one of those areas where having an au pair be ‘like a family member’ is not the same as if she were your daughter. (Unless of course you have a lot of money and would not be challenged to pay for her medical care.) But what do you think?

What medical care & costs are the host parents' responsibility? (Accidents excluded.)

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Jenny July 16, 2009 at 2:14 am

Eeek. This scares me a bit to think about, as I’m expecting my first au pair in about a month. Is this something we should talk about before she gets here? I think both of us were under the assumption that the medical insurance (a highly advertised “pro” of having an au pair vs other types of caregivers) provided by the agency would take away the need to worry about such things. If I expect her to pay for her own medical expenses, should I let her know that before it happens? Do all the agencies provide poor coverage?

Talliecat July 16, 2009 at 5:16 am

I am glad that someone brought this up. My husband and I just dealt with a unique situation with our au pair ( I hope it is unique anyway). Our last au pair was here for a little over three months. She had been complaining of neck pain, head pain, migranes and stomach pains. She had been to the doctor 5 times and the ER 3 times and then ended up getting admitted into the hospital. Obviously there was not a lot of child care going on and she had basically stopped working for about 3 weeks. I had her pay for her co-pay to each visit to the doctor ( 25$) and the medications. Also when she was released from the hospital I encouraged her to pay for her ER visits (250 each) which she did. As everyone can imagine she became my third child which in the end exhausted me and I also had to become her medical advocate. In the end she was diagnosed with a serious case of depression and a nurse came and picked her up and brought her back to her home country.

Amy July 16, 2009 at 8:18 am

Our aupair has needed a couple of office visits for usual winter illness. Bronchitis, pharyngitis, etc. The insurance was actually pretty good (we use Euraupair). I had looked into this while were contemplating having an aupair and the company Euraupair uses is a company that a lot of colleges use to provide coverage to students who have no parental coverage. She had a typical copay- $25. Many prescriptions are now available in generic form which keeps the cost low. Learning to take financial responsibility for medical issues is part of the growing process and navigating the US health care system is part of the cultural experience.

Anonymous July 16, 2009 at 9:02 am

Our agency offers a basic and advance insurance plan. I have always encouraged by au pairs to take the better plan and go to the dentist before they arrive in this country. I make sure that they know that medical care is very expensive and it is not the host family responsibility. We contribute toward the health insurance in the fee we pay the agency.

Anonymous July 16, 2009 at 9:45 am

Oh how timely this issue is for us!! Our AP, who is absolutely super, healthy and just extended for 12 months, was in the ER on Monday. We came home from a weekend away with the kids on Sunday evening to find her unable to get out of bed. She had severe pain in her chest, neck and back. From what she was describing it didn’t sound like anything heart related, but by the following morning she still couldn’t get out of bed – so we insisted she go to the ER. They checked her heart (EKG?) and did x-rays. I have no idea what the total bill is or what the insurance (AVI through Au Pair Care) will cover. We wanted to take her to a local physician or walk-in clinic, but NO ONE takes that insurance except the ER, so we had no other choice.

In the end, they diagnosed severe muscle strain, gave her vicodin and sent her home. This brings up another issue, though – she didn’t really want to go to the doctor or the ER – she told me “I’m fine, I’m fine”, but I knew she wasn’t, and she definitely couldn’t have worked in that condition chasing after our 3 year old when she couldn’t get out bed. So we insisted. Does that then obligate us to pay for the cost of the ER visit since we’re the ones that told her she had to go?

My hope is that insurance will cover it, and we won’t have to worry about it, but I’m not holding my breath. I think anytime an AP says they need medical treatment and asks to go – they should then be responsible for the associated costs – but what if the host family INSISTS that she go for whatever reason (i.e., she can’t work like in our case, or perhaps if the family thinks whatever she has may be contagious?)? Does that change things?

TX Mom July 16, 2009 at 10:55 am

This post has helped me realize I need to add something about medical expenses in my manual! :) We buy OTC household meds that the AP can use, but they are responsible for their other medical expenses. (The AP with cancer is lucky she didn’t live with us; I can’t imagine that experience either for the AP or HF.) We’ve had 2 AP’s who have gone to the ER in addition to the usual Doc in a Box visits (strep, etc.) Their insurance has been good (both the basic plan and the upgraded plan.) However, paying their deductible, paying upfront to the Doc in a Box and for the prescriptions while waiting for the insurance company to reimburse them set them both back financially. (In one case I paid for the prescription and the AP gave me the insurance reimbursement.) I have had to really help them navigate the insurance and in both cases they went to the ER within weeks before leaving the country and the paperwork became my hassle in their absence. I have spoken with their insurance company that they should process the claims and reimburse the AP’s faster (to no avail.) Several of our cluster HF’s are MD’s and in one case I asked one of them to examine the AP (to ensure the ear infection had cleared after antibiotics.) HD is always worried when the AP burns the candle at both ends because she’ll get sick and we get in a child care bind. (We do have a curfew on “work nights” but sometimes the weekend is one big party.) It’s always a challenge to sort out childcare at the last minute but I think I miss less work due to a sick AP than if my children were in daycare and getting sick themselves…

Franzi July 16, 2009 at 12:32 pm

this is something that you need to address during her first days with you. also put it in your manual.

make sure she understands that she needs to have a minimum amount of $ saved for things like medical care, car accident, some other emergency. let her know she will have to pay costs up front when she is sick. this is a concept very uncommon in some countries so the AP might not understand at first. give her a run through of a typical situation (bad cold or sth the like). explain that there’s a doc in the box ($), the prescription ($), after care if needed ($) etc.

it also helped me as AP to understand the medical costs when i took the kids to the dentist and my HM gave me the check for the appointment to pay at the doctors office. you know, i saw the price for basic check ups as well as for dental emergencies (soccer….)

if you have an AP who still has medical coverage at home (many Germans for example) it might be cheaper to fly home for a week or 2 and get treated there. i know several APs who did this for dental problems. she’d be required to use her vacation time but maybe you come to an agreement where she works longer hours to “gain some vacation time back” (i’m not a fan of that but in this case it might be a good trade off for the lost child care time you face.

Jillian July 16, 2009 at 12:53 pm

Hello again ladies! (I’ve been away and missed you all!) I voted that our AP is welcome to anything we have on hand for ourselves and the kids but that we don’t pay for medical expenses. I was actually shocked that I was in the majority. I’ve been active on this site for 5 or 6 months now and from everything I’ve read I can honestly say that I think all of the HMs and HDs on this site are incredibly generous and loving. So for some reason I thought that we would be in the minority and that all of the other parents would say that they pay for all of their APs’ medical needs and I would feel a tinge of guilt because we don’t. I’m so thankful to find out that other host families expect their APs to pay their own.

If my daughter went to another country to be an AP I would not expect her host family to pay for her med needs. As her parent, I would. I fully understand that many girls come from places where their parents can not pay the exorbitant costs of US medical care. Unfortunately, neither can I; which is why AP agencies have medical insurance. If money were a given for our family I would be happy to pay for all of our AP needs, but that is not the case. And, I am so happy (and feel very validated) to find out that other host families feel something along the same lines.

TX Mom July 16, 2009 at 1:23 pm

One thing I may add is that in addition to providing assistance with processing insurance claims, I have also acted as the “patient advocate.” Going to the ER/doctor is scary; not knowing what to expect from the US system is scary and the medical terminolgy is (usually) unknown to the AP’s. In this sense, the AP is cared for like a daughter. It’s one of those times when we may have embarrassing conversations or experience scary things (one of my AP’s had a spinal tap!) but we have always come out respecting eachother more. When I took our AP to the doctor at the end of the day, then the ER and we finally pulled into the driveway just in time to wake my daughter for school, my AP felt like a family member. A mom sacrifices alot for her “children.”

Anonymous July 16, 2009 at 1:54 pm

Since all of the agencies advertise health insurance as a benefit, I am wondering why this is such a big issue. I do know that it is sometimes hard to find a doctor to accept an assignment and I would caution anyone against going to the ER – the copays are exhorbitant.
Do most host families need to pay the doctor and then get reimbursed ?

Emma July 16, 2009 at 2:02 pm

As an AP who knows in advance that I am going to need to see a doctor every 3-4 months because of a preexisting problem (dysplasia =[ ) I’ve already set aside money for my appointment- I would never expect, let alone ask, my HF to help out on medical bills, just OTC stuff that they probably already have in the house (anything they don’t have I’d buy myself.)

MominPA July 16, 2009 at 2:37 pm

I think this is a really great topic and very timely considering our political situation at the moment. My husband is an MD and we have been lucky as well. Our current AP had lyme disease earlier this year which could have been a nightmare, but because we caught it early my husband prescribed the antibiotics and we paid for the prescription. She was bitten by the tick in our back yard after all… She recovered almost immediately and things have been peachy since.

I think we are very blessed with our healthcare system and the knowledge of our practitioners. I think it is a priviledge to utilize the US healthcare system and receive care from American physicians. Like was said by AMY it is part of the cultural experience to navigate the system. This is not to say we should not be there to support and care for our APs when they need our help. I would never dream of sending an AP to the ER on her own or not be there if she needed my help.

The financial component is complicated because I do believe that many times APs are here to grow a bit and part of that is managing money. I think it varies with the medical issue, AP family situation and the HF situation, but some things simply need to be the AP responsibility for her own good. Just like I would treat one of my children (a much older one!) away at college learning about co-pays and budgeting money. So in the end, it is like part of the family, an older, more responsible part that is earning money, on her own, and should be able, with support to manage her own financial issues.


My 2 cents July 16, 2009 at 2:50 pm

It’s not the host family’s responsibility to take care of medical bills. It is the AP’s (and arguably her parents’). However, I do agree that many agencies do not at all prepare APs for the reality of the American insurance system and how they actually get care. So, if your LCC doesn’t do a good job of explaining it to your AP, then IMO it’s your job to step in at the very beginning and explain to the AP in clear terms what she will need to do to get care, how she will need to find a doctor “in plan,” how much her copay will be for the standard visit and how much for the ER. Explain to her that while you will help her find a doctor and, of course, take her to hosptial if it gets to that level, you do not pay bills. They are hers just like any other personal expense. She can use a credit card if need be.

Our LCC gives the APs their very first week a handout she put together that puts in plain English what they can expect and what they should do. She makes them read it as part of their “homework” and report back that they did. It wouldn’t surprise me if she quizzed them on what they read either!

Anonymous July 16, 2009 at 4:44 pm

So many of the aupairs go to that weekend college in Long Island to completer their education requirement. It would be a really good idea for that program to include a class called ” Health Care Issues In The US “.

Calif Mom July 16, 2009 at 8:55 pm

Great discussion! Our AP made sure to plan her trip home to see her family in between her first and extension years so that she could use vacation time for the trip, wouldn’t jeopardize her ability to get back into the country because of that tricky visa requirement–and see all her doctors and dentist. I’m more glad than ever!

Anonymous July 16, 2009 at 9:11 pm

Thanks for all the comments- this was my original post. I had the same reaction as many of you in that I felt that our agency did not prepare the au pairs for the out-of-pocket cost of their health care. Apparently our au pairs have a very basic insurance policy- for example the insurer paid only $100 on the $350 ER bill, and nothing on prescriptions. This led to substantial expense for our au pair. I thought it might be worthwhile for the agency to give the au pairs an idea of what an office visit or ER visit might cost, what would be reimbursed, and also some guidelines on what symptoms do and don’t require an immediate trip to the doctor- ie if you have a runny nose and congestion, but no fever or other symptoms it’s probably OK to wait a few days and see if it gets better on its own. Personally, I don’t ever visit a doctor for symptoms of that kind (or take prescription meds) because it’s typically a virus and there’s not much you can do other than wait to feel better.

Hula Gal July 16, 2009 at 11:30 pm

I’d like to see some discussion on use of sick time and whether your au pairs abused it and how you handled it so it would not be abused or to nip it in the bud if it is. Our au pair early on was having chronic headaches and sometimes she’d claim to have vomiting and feel sick. Initially we were very concerned and supportive and gave her two days off. But when this happened two more times we spoke to our area director (LCC) who told us that we could make her work, that she did not have sick days and if she continued to be sick she could end up getting sent home. That sounded harsh and we were still wanting to be sympathetic but couldn’t decide if we were being taken advantage of. On the third incident I told our au pair that she was going to have to work through the illness and get treatment from a doctor. We figured if she had some out of pocket expense for these sick days than it might nip it in the bud. And her vomiting and headaches have not reappeared since. Imagine that!

Natt July 17, 2009 at 4:55 am

We don’t hire our aupairs through an agency, but we do stipulate that they must have their own health/travel insurance.

Our first aupair was from Germany, and had fairly regular colds or headaches, but she never asked for time off ever! I always either supplied pain killers, cold & flu tabs etc, or would suggest a particular brand and she would purchase this herself.

MTR July 17, 2009 at 9:33 am

We are on our third au pair now. Out of the three, the second one had constant colds, but she always worked through them. Only once, when she got a flu and had a fever we gave her a day off and my husband stayed home with kids. The au pair felt better the next day, meaning no fever, but still had coughing and congestion, and then she worked. This second au pair has also complained about menstrual cramps every month, but I have quickly tought her that Aleve is the best way to get rid of them; forget Pamprin and Midol, it’s Aleve all the way. :)

None of our au pairs so far needed to see doctors.

We have freely allowed au pairs use of our medicine cabinet which is stocked with Advil/Tylenol/Motrin/Aleve, Anti-itch cream, Anti-inflammatory cream, cough drops, band aids, etc. The basic first aid kit. That’s about it. I have no plans to cover au pairs medical bills should there be a need for her to be treated by a doctor. The most I would be willing to do is to lend her some money, if she cannot cover her bill upfront, and then take this money out of her weekly checks over a period of a few weeks.

My 2 cents July 17, 2009 at 11:04 am

Hula girl: I think the way you handled your AP is perfect. While you want to be sympathetic and a nice host, if you had an employee who called in regularly with these kinds of symptoms you would do the same thing. If the headaches, etc. are that bad then she really does need to see a MD who can then provide a note and if things continue from there you can figure out together whether she is physically capable of continuing employment. I’d also be considering whether these illnesses were happening during weekend hours and evenings as frequently as on-duty times in my sniff test.

Anonymous July 17, 2009 at 12:34 pm

I am not sure what rules any of the agencies have regarding sick days . Do aupairs get any sick days ? If someone has the flu , for instance, must she work. And , finally , if an aupair really is sick and simply cannot take care of the kids for a couple of days , is that grounds for rematch.

Anonymous July 17, 2009 at 4:12 pm

My ap went to the er once and applied for charity care to back up her ap insurance. She was approved and had no out of pocket expense for that visit

AZ HM July 17, 2009 at 5:20 pm

Our current (and first) AP jut had her first “real” illness. She has worked through the sniffles, etc…but this time she woke up and said she really didn’t feel well. By noon the situation seemed to be getting worse and she started saying that if things didn’t get better she might go see a doctor. I was unfamiliar with her coverage, it was a Friday and I advised her to make some calls NOW to determine her options and how much would be out of pocket. She found out about an urgent care center but didn’t find out about RX. I explained that she should tell the doc that she may have to pay for the RX herself so that they would prescribe a less expensive drug. She did end up needing an antibiotic and had to pay $75 out of pocket (don’t know why they didn’t give her something cheaper unless she didn’t ask). I felt bad about her expense but didn’t feel we should feel obligated to pay (I was told by a doc that there are $4 antibiotics available).

Medical costs can be extremely high and I feel bad for the sick AP…but the families are paying quite a bit to the agencies with the understanding that the AP will be covered.

With regards to time-off. We knew our AP was really sick and that she needed time to rest and recover (yes, moms rarely get to do this…but she is the AP and not the mom). I didn’t expect her to make up the time, but I did schedule a couple longer than usual days for her once she was better so I could try to get caught up on my lost work. I was bothered that our AP never once acknowledged that her being sick was an inconvenience to us (she couldn’t help being sick…but just recognizing the impact would be nice).

Aussie_aupair July 17, 2009 at 11:00 pm

I think if you are with a good agency this may not be such a big problem. My agency (who for the sake of identification will stay hidden) was very clear with their medical policy. Each au pair was required to pay for comprehesive insurance – no if, buts, or maybes. There is no deductable for basic doctor visits, and prescriptions must first be paid for, but costs are refunded when claimed back. It also covers basic dental and the entire ER bill if the au pair is admitted as an in or out patient. Obviously it does not cover certain things, but we spent over an hour going over the policy at orientation. Overall the cover is a level at which I think is reasonable for au pairs – in terms of how much we could afford to pay in deductables when required. I think that if an au pair has not looked into their insurance and made sure what they need to be covered is covered, then it is their responsibility to cover all costs.

I am actually very surprised to hear that insurance offered by the big two agencies (and you all know who I’m talking about!) leaves au pairs in such a bad position if they fall ill! I would have thought they would have more comprehensive cover included.

Calif Mom July 18, 2009 at 5:14 pm

Our APs have never wanted to take the better but pricier insurance package. We’re on AP # 5.

TXMom July 18, 2009 at 7:13 pm

We had one AP who took the pricier insurance and it even covered her digital camera when it broke. I do think the APIA insurance has been good (haven’t had a dental emergency though – yet!) Although the AP’s have never used a provider “in network” and had to wait to be reimbursed.

PA au pair mom August 25, 2009 at 10:09 pm

We use Cultural Care and their insurance is pretty good. Our AP has been to urgent care twice. She ended up only having to pay the $25 copay each time.

The problem is prescriptions. She has to pay upfront, submit numerous forms and then she “might” get reimbursed (they denied antibiotics for a UTI).

Luckily, I am a nurse practitioner so I can get samples/generics from my office when needed.

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