When Travel Insurance Isn’t Enough

Some thoughts on whether digital nomads and other long term travellers need more than just travel insurance.

I had a bad health scare recently and it has left me with a lot of questions about health insurance. Like most people who travel frequently or anyone with a small child, we had put a lot of thought into travel insurance. On our trips to SE Asia, we used World Nomads and were happy with that choice. After my son was born, we had also taken out a “starter” private health insurance policy in our home country of Ireland. I should have paid more attention.

At the end of April, we travelled to Spain so that I could attend a travel blogging conference and explore more of one of my favorite countries. After the conference, we headed South toward the Costa del Sol for some much needed relaxation. There had been some stress in the past few weeks trying to find a fast internet connection for work and we were all feeling a little run down.

In May, we went to Granada where we had planned to stay for several weeks. My lower back had been hurting a small bit and I chalked it up to uncomfortable hotel beds. Then it got a lot worse. A new pain started under my navel and seemed to spread throughout my lower abdomen. Still, I wasn’t worried. I thought it might be something like a kidney infection and decided to visit a local doctor. None of the local doctors would see a non-resident and referred me to the emergency room of a local hospital. Still no worries. My Irish health insurance also entitles me to an European Health Insurance Card that covers emergency room visits in any EU country.

There was a long wait at the hospital and I was now in pretty severe pain. When the doctor told me she thought I might have kidney stones, I thought that sounded like a possibility. She did a urine analysis which showed no bacteria (ruling out a bladder or kidney infection) but a small amount of blood and then ordered an abdominal x-ray to look for stones. There were no stones. She then advised me that blood in urine is often the first sign of bladder cancer and I would need to go back to my home country to have my regular doctor do more tests. I asked if I could just have an abdominal ultrasound now and she said no because they only treated emergencies. Possible cancer is not an emergency. I offered to pay cash for the ultrasound but they still would not do it. She gave me an injection for pain, advised me to drink lots of water, and to see my doctor when I got home.

This was a terrible mental state to be left in. We weren’t sure what to do. Was it really serious? The pain lessened after a couple of days and I was starting to wonder if the doctor had simply been wrong. Then my hair started falling out in chunks. Back up a second. For the past month, I had been noticing a little more hair coming out in my hairbrush but it didn’t seem important. I attributed it to using a different brand of shampoo, or hard water, or just plain stress. But now it was really falling out. When I washed my hair, thick clusters of hair would fall at my feet. This was not a good sign.

A large clump of hair.
Average amount of hair that was coming out every time I brushed.

I wanted to talk to a doctor in English (not my bad Spanish) before we decided to go home to Ireland. We decided to leave Granada early and go back to the Costa del Sol so that I could see another doctor there. There is a large expat population on the Costa and I knew that there would be more doctors that spoke fluent English.

It is difficult to convey just how stressed out and worried I was at this time. I started having nightmares. When the next doctor in Benalmadena told me to go back to Ireland to have an ultrasound and more tests done to check for bladder cancer, I really started to panic. I looked up flight prices back to Ireland which are always expensive on such short notice. I looked up my health insurance policy to find out the details about getting referred for an ultrasound. And that is when I learned that my “starter” health insurance was completely useless for this situation. My policy was not going to cover most diagnostic testing. It would only cover 50% of the consultant’s (specialist) fees and those are are outrageous in Ireland (although far less than in the United States). If I upgraded to a more expensive policy, more things would be covered but I would be subjected again to a 6 month waiting period and it would not cover pre-existing conditions even if it would have been covered on the old policy. I was screwed. Everything was going to be coming out of my own pocket so it didn’t really matter what country I was in.

I was angry with myself for not making better financial decisions about health insurance. I worried about what would happen to our son if something happened to me. If I was sick, it was certainly too late to buy life insurance.

We decided to go visit a friend in Madrid before returning to Ireland because we did not know when we might have a chance to see him again if I turned out to be really sick. I spent a lot of time with Doctor Google trying to find alternate (non-cancer) explanations for my symptoms. The back and abdominal pain was gone for the moment but what was really worrying me was the hair loss. My hair was now so thin that I was considering cutting it off short and buying a headscarf soon. Again and again, I went over lists of possible reasons that your hair could suddenly fall out until finally a light dawned. There was a type of hair loss called Telogen effluvium that occurred months after a period of extreme stress or severe illness. I hadn’t had any extreme stress until after my hair started falling out and I haven’t had a severe illness. Wait. Did Dengue Fever count as a severe illness? I searched the internet for information about hair loss after Dengue Fever. Ding! Ding! Ding! We have a winner. It is very common for your hair to fall out 2-3 months after recovering from Dengue Fever. One study said 45% will lose large amounts of hair after Dengue. The photos I saw were similar to the amount of hair I had been losing. I was so damn happy to have found a reason that I cried.

What about the back pain and blood in urine? More online research led me to the possibility that I had experienced granular kidney stones that were too small too be seen on the x-ray and the large amounts of water with lemon that I had been drinking per the doctor’s suggestion had flushed them out. The doctor should have known that. Why did she consider the possibility of cancer when granular stones were the more likely possibility? Long story short, I did end up getting a complete blood workup and another urinalysis. Results? No blood in urine, new doctor unconcerned and agreed that granular kidney stones had likely caused my previous symptoms. Blood work showed that I was low in iron which probably contributed to my fatigue. An iron supplement and an injection of b-12 would cure that.

My health worries were over. I could sleep at night again. Now all I need to do is find a better health insurance policy and buy life insurance so that this situation never occurs again. Because sometimes travel insurance isn’t enough.

What I Learned From This Experience:

  1. Even if you are young and healthy, you need health insurance that will cover a long term illness.
  2. Most private health insurance in Ireland really doesn’t cover much above a private hospital room.
  3. The VZP health insurance that I had when I was living in the Czech Republic was brilliant and worth every penny. It covered everything. The quality of healthcare was excellent. Any nomads looking for a country to setup a business in, should consider Prague for a homebase.
  4. There is no excuse for not having life insurance when you have a child. Get it now and save yourself a lot of worry.
  5. Spanish doctors jump to conclusions too quickly.
  6. Hats are my new friend until my hair grows back.

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