A Host Mom needs advice on how to advocate for an Au Pair who needs surgery.
We are a host family to our second au pair midway through her first year. Our current Au Pair is impressively independent and strong. She’s had a run of bad luck since arriving in the US culminating in her breaking an ankle three weeks ago on some ice on the sidewalk near our house.
We did not realize her ankle was broken until last week, when she saw an orthopedic specialist who advised she have surgery as soon as possible. The Au Pair’s ankle is broken in two places and will not heal on its own.
Based on the doctors advice we scheduled the surgery but have been languishing waiting for the travel insurance company to give prior authorization to pay whatever share they intend to pay towards her surgery.
I have seen several questions on this blog about what happens in the aftermath of an accident that injures an au pair, but our case has an added dimension that we are at odds with the Au Pair Agency.
Our Aupair wants to have the surgery here and is very fearful of what might happen if she is sent back to her home country, where the quality of care is very questionable.
Her particular policy has a cap on outpatient surgeries in the USA. The insurance company has the ability to send them to their home country for treatment. Apparently extended waits for care such as this are the norm and she needs to have the surgery quickly so as not to jeopardize the quality of her recovery. I think this is a legitimate concern.
Throughout this process we have been supportive of her desire to try to have the surgery here and have agreed to make other childcare arrangements with family while she recovers in our home and collects a stipend. As a Host Family, we’re able to cope with her surgery and recovery.
I have been thoroughly disappointed in the agency’s response. They have offered little to no advice to either her or us. I am thoroughly disgusted with the agency’s continuing attempts to talk us into agreeing to send her back to her home country which is clearly not in her best interests.
My perception is that the agency is trying to get us to agree that it’s just easier for everybody if she goes home. And, no one can give an explanation of what will happen with her surgery who will perform it etc. if it takes place in her home country.
Worse — the Agency has made it clear that if she goes home for treatment she will be very unlikely able to return according to visa regulations, and they are obviously not going to do anything to assist.
This is setting up to a show down where she may have to decide to go ahead with the surgery and we try to help her do battle with the insurance company in the aftermath.
It is also setting up to a showdown with the Agency. The Agency called the insurance company and told them she wanted to have the surgery performed in her home country — despite my having told them numerous times verbally and in writing that she wanted to have the surgery here.
I sincerely believe that the Agency is trying to subvert our efforts to get this taken care of here. The Agency stated host families are rarely supportive of injured au pairs and it is generally a “better option” for everyone to just send them home. (The Agency has gone so far as to say she might be depressed if she has to recover here, surgery for her might be better in her home country, it will be much better for us financially etc.).
I have basically given up on the agency giving any consideration to us as a host family. I’m focusing on trying to do the right thing for our Aupair’s health in the absence of anybody else looking out for her interests.
Does anyone have experience with what can be done in this situation vis-à-vis the agency or the insurance company?
I am frankly very upset at the thought of “putting out to pasture” an Aupair with a relatively minor injury that has the potential to escalate into something major without proper care. The Agency’s very callous response in my opinion it is just maddening and wrong. Any advice is greatly appreciated.
Thanks you, Concerned Host Mom
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We had a very similar situation three years ago. Our AP tore his ACL and was not able to walk or drive. He needed surgery. AP and we were agreed that we wanted him to stay and have surgery here. At first, the insurance company agreed that this would work. But every time we called, we got a different story from the insurance company about what they would and would not cover, so I asked the agency (CCAP) to step in and help. When they did, the insurance company changed their tune, and now they would not pay for surgery here but only if AP went home. We then started the issue of him needing to return within a month or his visa would expire. I asked CCAP to help us get the pre-authorizations from the insurance company, so that once AP went home, he could have surgery immediately and come back (our orthopedist here – who is top notch and does these surgeries on many professional athletes – said it would be 10 days until AP could walk and drive), but CCAP actually started advocating that AP should just go home. By the time CCAP was done running interference with eveyrone, there was no choice but for AP to end his year early. We were heart-broken – he was a true rockstar – and he was too, having to end his year being pushed in a wheelchair onto the plane home. At least they sent him home first class so that he didn’t have to bend his leg!
Anyway, long story short, I don’t know that there is anything you can do if the companies have agreed together that your AP should go home. We literally tried everything and didn’t manage it (and I swear it was a fulltime job for me to spend so much time on the phone for a couple of weeks!), so if you can find a way, I will be in awe of your persuasive skills.
Sorry this is happening. It always seems to be the best APs who end up in this kind of predicament and the so-so ones who don’t break anything or have any reason to have to go home early!
I have the same agency. I find it very interesting that you had it on the right track unitl the agency stepped in. That was precisely my experience and one of the reasons I am so upset by all of this. The insurance company was actually really good to deal with (gave straight answers, etc). I know for them it was a purely financial decision but they helped us understand the process and possible consequences. CCAP spent about half of every phone call trying to explain why it was so much better to have the surgery done elsewhere and making it abundantly clear they collect an agency fee no matter what. They did nothing to make it any easier for a family in this tough spot to commit to helping their au pair, quite the contrary. It got even worse when I threatened to not renew with them. I have always known they don’t treat APs with the utmost of concern but I would hope they would have backed up a family on their 3rd year who has paid them tens of thousands of dollars.
Hmm… so is this insurance really a scam if when a situation arises that the insurance has to pay up (and this is a catastrophic insurance specifically for things like this), they are in cahoots with the agency to just get rid of the problem and send the au pair home?
I think you may want to get a lawyer and have him/her contact the agency and put it this way… are they scamming you and getting your business based on false promises and premises? (i.e. there is medical insurance for your au pair in case she really needs it….) Or that they may be in a secret agreement with the insurance company to assist them in sending injured au pairs home and in exchange getting lower rates or possibly incentive payments/kickbacks? Why would they lie to the insurance company and tell them what your au pair wanted was the complete opposite? Looks like you have at least one documented lie here on behalf of the agency.
Could you name the agency so we are forewarned?
The insurance company was very reasonable to deal with, but that doesn’t mean the weren’t dealing under the table with the agency. I was on the phone with the agency who said they don’t interact with the insurance, it is 3rd party, they don’t know anything about it, etc (which I told them sounded like a complete fabrication) and not 30 minutes after that call I got one from the insurance company saying the agency called them to say SHE said she wanted to go home. I almost lost it. They were in tons of communication with the insurance company and all the while telling us they don’t know or interact with insurance. And of course I never got to speak with the agency person who deals with the insurance company. As my attorney father pointed out this is all totally insane, if they charged each au pair $5 more it would cover the few times this kind of stuff comes up. I have some serious questions about agencies not disclosing this kind of risk and giving us a lot of marketing about “family”. who sends a member of their family off to uncertain care when they are hurt? I said that to the agency and they started the whole “well it might really be better for her to go home” bit.
I reviewed in detail our AP coverage this year, for the first time in 8 years. It was very clear to me, that unless this is a life/death situation, the insurance company will not pay for surgery in the USA. Maybe your AP has a different type of coverage, but I think this is fairly common clause for travel insurance (which is essentially what APs carry). I wish you luck if you choose the option to do the surgery in the USA, but I would assume this is going to be a rough road ahead.
This exactly. This is travel insurance, not health insurance (big distinction). It is for when your AP has a trauma or appendicitis that needs immediate attention. Or to transfer the AP back home for longer term medical needs. Just like if you were on a cruise ship off the coast of Brazil and broke your ankle. They would get you home and you would have surgery at home on the dime of your regular insurance. If you burst your appendix, you would have surgery in Brazil and then be transferred home for ongoing care. Same with the APs… sucks but that is how their insurance is structured.
OP: our AP does not have insurance in her home country (hers was attached to school which she completed literally days before coming here, very understandable). Her country runs like ours, no socialized medicine, complicated insurance, etc. It seems there should not be a one size fits all plan since the quality if care available to the APs sent home is very dependant on where they are from.
Also one other comment here. In this process we found some other au pairs who were injured here with no access to insurance in home countries. I think it is safe to say there is legal action pending becuase if it is an on-duty injury they should be entitled to coverage by workers comp, etc, but very ambiguous as is everything with their “work” status. All that would boil down to how much au pairs know about our insurance and legal systems and who they can find to help them and how much they want to fight. I obviously feel quite strongly the agencies should get the policy improved, which shouldn’t cost all that much over the thousands of young health au pairs out there.
I don’t think they get workers comp because they aren’t treated like employees. It’s considered a cultural exchange program.
In certain states the agencies explicitly advise that HF should have workers comp coverage.
I had no idea, hostdcmom.
Ugg. I’m sorry, I feel for you and AP. I think you are being very generous and it is probably in part because you are a good person and in part because this is probably a good AP. But, I’d be terrified if trying to get the surgery here if you don’t have a crystal clear “go” order with agreement to pay. My personal experience with health insurance is that it is so easy for this or that to fall into whatever wiggle room and you get a big bill. In this case, it doesn’t seem improbably that this could be in the ten’s of thousand’s of dollars. It seems very odd to me though that this should make it hard for her to get another visa. That seems sort of reasonable for an AP that flakes and/or is kicked out for breaking the law or abuse of gross negligence. But, this seems to so clearly be no fault of the AP. I think the agency should do more to fix that.
OP here. Late breaking news, they authorized the surgery and it is happening today! For those in this situation or concerned about it:
-Agency was CCAP. From reading previous posts regarding injuries I see at least one wher APA was credited as helping the family with alternate child care and the poster said the agency was great. This is absolutely not the case here and as noted by the first commenter
-This issue exposes a major flaw in the AP process. When they are sick or injured and need someone here to help them the most the deck is totally stacked against them. For the HF you are out care since the injury. You will be out care during recovery if you let them recover with you (6-8 weeks).
As noted by another commenter, this is one heck of a fight. I spent an entire week on the phone with insurance, agency, doctors, surgery centers, etc (this while I did not have childcare, still have to work AND find new childcare for the upcoming weeks). The doctors in this case were horrified at the propsect of sending her and were hugely helpful in calling insurance (both US arm and the decision makers in Europe). Even if you have the desire to help them, this costs HF into the thousands of dollars and tons of time. In my case the thought of sending her back to her home country to have to wait for surgery that might end up with her having a limp for life was not an option for my conscience. This is a really simple procedure here
-No one has ever offered information about what would have happened if she was went home. What doctor would she see? Where would the surgery happen (in her small home town or in a big city where she knows no one? How long would she have to wait? Our agency suggested that the insurance might not have to pay for her surgery there, just to get her there. In her case the surgery needed to happen soon and it is clear it would not have been done soon. The only good thing the agency did in this process is give us the heads up that if she did get sent home she probably wouldn’t come back because the state department wouldn’t authorize the return of someone not fit to work. Though the policy says they have to come back in 30 days, other posts have suggested aps where out of country longer and allowed to come back. I wouldn’t want to try my luck, esp with an unhelpful agency
-Don’t automatically trust your agency in this situation. It is easier for them to have the AP sent home. Deal directly with both them and insurance and send written docuements to both. This started turning around when I got a family member lawyer help me craft some mildly threatening letters. If you want to help the au pair, circle the wagons with the doctors and make a ton of phone calls and back it all up in writing. The insurance company was actually quite helpful in giving straight answers.
-They ended up authorizing the full amount of the surgery (10k) even though the policy is capped at 7k. They will evaluate on a case by case basis
-for anyone still reading…any bright ideas on anything I can do to drag anything out of my agency? From the beginning they made it clear, they collect agency fees no matter what (her sugery here, there etc). I can see APA has pro-rated fees in the past. The agency fee part is totally under their control and it makes me really mad that after going to such great lengths to solve this problem they will do absolutley nothing. They didn’t even call our au pair to see if she was ok until I called them out on it.
-if you read this later and find yourself in this situation please comment and I will subscribe. We have put together a good knowledge base about how to deal with this situation and I want to help anyone finding themselves here.
Thank goodness! I’m so glad to hear how this worked out. Every time I hear someone based in the US say the word “insurance” I freak out for them. It sounds like healthcare is so difficult for you guys, and I’m so glad it got figured out so well in this situation, and your AP hasn’t had her whole year (and… physical health..!) ruined.
It sounds like you’ve been a rockstar family, advocating for her in this way.
As a practical matter, I don’t really know how the medical providers would collect unpaid bills from an AP. They just aren’t here long enough for bill collectors to do anything and they don’t have any assets to go after. It’s expensive to get a judgment and then try to collect it in the AP’s home country and may not even be possible (depending on her home country).
I’m also disgusted by the agency trying to ship an injured AP home to avoid the hassle of getting her appropriate treatment. CCAP pressures APs to purchase some $500 supplemental insurance and I told our AP not to buy it for her extension year because I’m reasonably confident it covers next to nothing. Unfortunately, she’d already purchased it at home for her first AP year.
Best wishes for a speedy recovery!
From the OP: I think you are exactly right. We had made the decision to go ahead with it pre-auth or not. The surgery center basically told us that she would end up paying very little after they neogotiate the bills down with her directly (if it had come to that) and I think some states (ours included) have caps medical bills based on a person’s prior year income, though I don’t know if that is still in effect. The surgery center wasn’t all that concerned about her ability to pay it back on limited income and they were the big portion of the bill. we were just hoping it didn’t come down to us having to cosign as we are already out quite a lot on this. I don’t see what recourse they would have against her other than trashing her credit which they don’t really have anyway.
The bills aren’t real costs anyway. My husband just had surgery. The bill said the cost was $37k, and the negotiated price (because we have insurance) was $7k. I think we had to pay $2k and the insurance paid $5k. But someone who didn’t have insurance would be tagged with $37k, instead of $7k. Same kinds of numbers with my c-section a year ago.
That’s why the surgery center can be flexible about the cost – they never planned to recover the rack rate anyway. In fact, for someone with a low income, they count the difference between the rack rate and what they recover as a charitable expense and they can’t do that with insured patients.
What I still haven’t quite figured out is if this “travel insurance” counts as medical insurance in the US in the normal sense?
You’re really lucky and I am glad it’s working out. IN our case, the doctor’s bill alone was close to 10K, and then there would be hospital, anesthesia, nursing, etc. I could not get firm prices agreed to from any of them with the insurance company, so as I said, in the end, we extremely reluctantly let our AP go.
I should add that his surgery ended up being a really big deal and he could not walk on his own for six months or drive for 8-9 months, so in the end, it was best that he was home. This situation with the OP’s Ap sounds more clear-cut, so hopefully all will go smoothly and insurance will in fact pay for all of it (and not just the doctor, which is what they had agreed to with us, but not the other associated bills which can cost even more).
I’m glad it did end up being the best thing for your AP, thanks for sharing your experience. I think the home country might factor in the decision (are they sending them back to a country with socialized medicine, or one with poor quality of care, does the ap have insurance in home country? etc.). Also in our favor paradoxically was that the injury happened a few weeks prior and needed to get done ASAP, that wouldn’t always be the case. I think this is all very case by case.
Why don’t you send her on a vacation to her home country so she can have the surgery and then come back? Is there any way her family there can expedite getting surgery scheduled?
The OP said the medical care is low quality in the AP’s home country and she urgently needs a complicated surgery.
Plane ticket home would cost more than paying her stipend anyway. Plus she is from a small town, I think she would have to fly to capitol and then take a long bus ride to her home town, not good in a cast. This 30 day rule about them coming back is also complicated. They said she would need a doctors note saying she would be fit to work to come back, not just fit to travel. She would not have been fully fit to work in 30 days.
Curious: In a case like this, would it be possible to establish fitness to work by assigning some duties that the AP could manage during recovery, and simply having the doctor certify that the AP is fit for that job description? E.g., a handful of hours per week of reading stories, folding kids’ laundry, homework help, just talking to the kid about their day (“guidance and emotional support,” or maybe “language/cultural exposure”)? HFs have so much latitude to set tasks and hours (and to modify them over the course of the year), as long as it’s child-care related and doesn’t exceed the maximum limits, that I’d think for most injuries there would still be some job description on which a doctor could sign off…
It seems so unfair.. I don’t know what to tell you, but based on the comments and your letter it just doesn’t sound good. The only thing would be to call a lawyer, but if the policy is being followed then there might not be much a lawyer could do. It’s too bad the au pair can’t go home and then come back. I don’t know how long they are allowed to go home for and still come back and complete their year- is there some limit on that? I do know that if they end their time early then they have to wait 2 years to come back on a different au pair visa, and if they are older than 26 in 2 years then it’s not possible.
Sorry :(
I realize the policy they tell us is that we cannot withhold the stipend for any reason. But, I do believe that if an au pair is in rematch and not working, and say, goes to live with the LCC, the stipend is not paid and the au pair has several weeks to find a new family under these circumstances. Obviously you don’t want to rematch, but I’m wondering if you really have to be paying the stipend for a non-working au pair.
When considering rematch I was recently told I could stop the work and payment immediately.
Agency fees go to the salaries of the (unhelpful) people you’ve been talking with, and the people that support the au pair (LCC, area coordinator …). I would document the extent to which your au pair was not reached out to by the LCC, etc to help her navigate this system, and use it as leverage when you go to renew (or not). If you’re paying fees for people to do their jobs and they’re not, well then they can’t justify the fees.
Once you stop paying the AP, they have two weeks to either find another family or return home. Visa stipulates that you can’t withhold pay for any reason.
As terrible as this may sound, another avenue is home owner’s insurance of whoever owns the property where she slipped and broke her ankle. In many cities and towns, there are laws that make it the property owner’s responsibility to keep sidewalks clear and safe. Their property insurance could be tapped to pay both medical costs and lost wages for her injury. Just a thought.
From the OP: it was on our property and I looked into the Homeowners. Our policy had a max of $5k guest/household employee medical, which they determined the AP to be. will be upping coverages and probably a good thing for all HFs to do since $5k is the norm and only covers a sprained pinkie in this country.
This would have been my recommendation along with negotiations with the clinic doing the surgery. Combined with the homeowners, the insurance company should have covered the difference. We haven’t had this issue, but a few years ago an AP in our group tore her Achilles tendon and this was how they dealt with it. (It still involved some legal sounding communications and bluffing on the part of the HF.) The HF was able to work around the AP’s disability because the HK were older and more independent.
I’m appalled at the way the agency handled this, but I guess it makes sense from a general standpoint. Shame on them. Kudos to you for going the extra mile for your AP!
The bottom line. Tell your AP ahead of time to pay for the best sports insurance possible before she arrives in the US – even if it means paying the differance (I’m with APIA and after 15 years know that their sports insurance covers snow boarding, skiing and ice skating). Want to understand the difference between insurance that barely covers anything and insurance that covers everything? Compare your own insurance with that of your AP!
If your AP comes from a Western European country, then yes, it makes more sense for her (or him) to go home. If not, then medical care in the US might make the most sense. The bottom line – how flexible are you willing to be as the HF?
Here’s my bottom line – if my kids caused the illness, then I pay (strep throat, need for flue shots, etc). If my AP broke her ankle because she was with my kids, then I’d pay (gulp!)
However, in the past 15 years I’ve hosted plenty of women who have picked up mono, STDs, etc, for which I’ve said, “Sorry, but this one is on you.” When I had an AP who twisted her ankle while on a walk on her own time, then sure, I took her to the ER, but a) didn’t feel compelled to stay (and maybe that’s because I have a mentally retarded child who requires total care), and b) was willing to sacrifice my own vacation time until the AP recovered, but made sure the AP understood the cost.And yes, DH and I would have made it work for a great AP, but for a mediocre AP would have said, “Sayonara!”
While I have tons of leave, I also have tons of pressure at work. If I had to take time off right now it would be a huge sacrifice. If I had an AP who was facing surgery, then we would be having a serious discussion about vacation time, sorry to say.
I’m so sorry OP. Our experience when our AP broke her leg last year while skiing over Valrentine’s Day Weeekend was much different. When AP’s bf called me from the ER, I immediately called our LCC and left a message on her vm and then called the emergency assistance number listed on her insurance card. The woman who answered was so helpful and promised to go to work right away. The LCC called me back and offered to help me drive to the AP two hours away (impossible because of a snowstorm & BF was handling situation and not leaving AP’s side).
The emergency assistance team coordinated everything between the hospital and the insurance company, authorizing the surgery etc. Meanwhile the LCC and the AP office were in constant contact with me and AP throughout the process. They worked with me to determine if we could handle keeping the AP, needed a temp AP, or needed to go into REM. My husband and I determined we could keep our AP, work around her injury, and make it work. (Granted we had a superstar AP and were willing to go the extra mile to make it work.) The agency also worked with the AP to determine if she wanted to stay post-surgery or go home for recovery with the option to try to return to the US after she recovered. In the end, the AP stayed with us and we supported her through her recovery. Her insurance paid for everything, including surgery, the follow-up care with a doc here, and months of PT.
The hardest part of the entire experience was convincing her very worried parents that she was receiving the same level of care in DC that she would have received in Barcelona.
Wow! Very helpful to know how this has been handled in the past. Thanks for the comments.
This is really good info to know. We haven’t had a situation with an injured AP and this has made me plan to look into our property insurance later today. I just recall that we for whatever the default is. I do have to say that as much as I love our AP, it would be really tough possibly impossible for us to keep her during a long recovery because we really don’t have easily accessible alternatives such as family in our area at all and my kid are very young. Perhaps if this happened while I was at home for an extended length of time like maternity leave then yes, otherwise would be impossible for us. I can see us fighting for the surgery then going home for recovery in any typical circumstance. Kudos to OP
If she slipped on ice On your property Then maybe You can Get this take Care of through homeowners Insurance just a thought. I would talk with surgen otherwise with Her, have It scheduled in hospital Not surgery center, Then have Her make small payments to hospital till she leaves, she wont be able to pay Bill , but if she Goes home she maybe disabled for life if Not taken Care of , It needs to be done in US, the Ortho can say or write It is emergency and needs done asap and if he schedules here maybe Insurance Will cooperate.i could not let her go home I would do everything possible work every angle, even contact state department if you think Aupair agency mishandling , Jen
LCC here: Sounds like surgery was approved and going ahead? Let us know how she is doing. One of my au pairs just broke her ankle and she was sent home–flown business class so that she could keep her leg up, turned out she tore many ligaments and will need 8-12 weeks laid up. I know it’s so hard to understand (and honestly, Cultural Care au pairs have Aetna insurance and it’s much better than much of what is out there), but sometimes they really are better off with their families for this since they can’t just stay in the US for months and not work. It appears that you got it all taken care of, but her recovery may be rough. Work with your LCC and director to get assistance. Trust me, they want your au pair to be okay! Hang in there and keep us posted.
Hi LCC Julie: OP here. I do sincerely appreciate your comments and totally agree that it is true most times it is better for the APs to go home (for their sake also). Looking back, I would have liked from CCAP what I got from the insurance company: a true case by case evaluation. How quickly is the surgery needed, what does treatment look like in the home country, how will she get to her actual home city, etc. I felt my agency had a one size fits all policy about sending her home regardless of what our wishes are, her wishes are and what was really best for her health and spent most of the time “running interference” as another commenter noted, rather than listening to us or having a real conversation about options. We had a lot of round the table discussions deciding what to do for her health and how to handle the aftermath that were honest and solution oriented. I would have liked to think my agency would have participated and facilitated in that (i.e. what is your childcare plan now, lets help set boundaries and expectations for recovery, since we as a family put in so much they could show even minor consieration in agency fees, etc). There is room for improvement even if the general rule does not change.
I am surprised that no one has recommended that she avail herself of the public health care and charity care available in the country. The way to access this very state-by-state. All hospitals give out a tremendous amount of charity care daily. Most of these are county or academic facilities. As an ER doctor, I give away my services for a significant percentage of the patients that I see. Hospitals cannot restrict that charity care only go to citizens; undocumented immigrants are a little large cohort of the charity care population. In general, there is an application that one fills out listing income and assets.
If one wanted to receive discounted or charity care, one would probably need to be seen in a public health clinic. They could refer to an orthopedic surgeon who could do the necessary procedure. It is slow, and requires a little bit of figuring out how to navigate the system. However, I do not see poor people in America who have permanent limps due to an inability to get appropriate orthopedic surgery. There are a lot of problems with the way we deliver healthcare in America, but in most communities, free or sharply discounted care is available for people who are willing to work the system.
I should have thought of this. As someone who paid for grad school by registering out patients for a medical hospital, I should have recalled that nearly every hospital has a program to pay for medical care for patients who have zero or inadequate medical care. Patients do need to state, at the time that they register for care, that they do not have the ability to pay and need help. As a grad student, any time a patient did not possess health insurance – no matter how much they insisted they could afford for care – I handed them an application.
I do think APs underestimate how much medical care costs in this country. (Nor actually, do most HF with adequate medical insurance!) In my community, the “minute-clinic” at CVS is the best “physician” my APs can afford. Forget hospital bills.
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