HRT: Bioidentical vs Animal
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HRT: A Tale Of Two Approaches
In yesterday’s newsletter, we asked you for your assessment of menopausal hormone replacement therapy (HRT).
- A little over a third said “It can be medically beneficial, but has some minor drawbacks”
- A little under a third said “It helps, but at the cost of increased cancer risk; not worth it”
- Almost as many said “It’s a wondrous cure-all that makes you happier, healthier, and smell nice too”
- Four said “It is a dangerous scam and a sham; “au naturel” is the way to go”
So what does the science say?
Which HRT?
One subscriber who voted for “It’s a wondrous cure-all that makes you healthier, happier, and smell nice too” wrote to add:
❝My answer is based on biodentical hormone replacement therapy. Your survey did not specify.❞
And that’s an important distinction! We did indeed mean bioidentical HRT, because, being completely honest here, this European writer had no idea that Premarin etc were still in such wide circulation in the US.
So to quickly clear up any confusion:
- Bioidentical hormones: these are (as the name suggests) identical on a molecular level to the kind produced by humans.
- Conjugated Equine Estrogens: such as Premarin, come from animals. Indeed, the name “Premarin” comes from “pregnant mare urine”, the substance used to make it.
There are also hormone analogs, such as medroxyprogesterone acetate, which is a progestin and not the same thing as progesterone. Hormone analogs such as the aforementioned MPA are again, a predominantly-American thing—though they did test it first in third-world countries, after testing it on animals and finding it gave them various kinds of cancer (breast, cervical, ovarian, uterine).
A quick jumping-off point if you’re interested in that:
Depot medroxyprogesterone acetate and the risk of breast and gynecologic cancer
this is about its use as a contraceptive (so, much lower doses needed), but it is the same thing sometimes given in the US as part of menopausal HRT. You will note that the date on that research is 1996; DMPA is not exactly cutting-edge and was first widely used in the 1950s.
Similarly, CEEs (like Premarin) have been used since the 1930s, while estradiol (bioidentical estrogen) has been in use since the 1970s.
In short: we recommend being wary of those older kinds and mostly won’t be talking about them here.
Bioidentical hormones are safer: True or False?
True! This is an open-and-shut case:
❝Physiological data and clinical outcomes demonstrate that bioidentical hormones are associated with lower risks, including the risk of breast cancer and cardiovascular disease, and are more efficacious than their synthetic and animal-derived counterparts.
Until evidence is found to the contrary, bioidentical hormones remain the preferred method of HRT. ❞
Further research since that review has further backed up its findings.
Source: Are Bioidentical Hormones Safer or More Efficacious than Other Commonly Used Versions in HRT?
So simply, if you’re going on HRT (estrogen and/or progesterone), you might want to check it’s the bioidentical kind.
HRT can increase the risk of breast cancer: True or False?
Contingently True, but for most people, there is no significant increase in risk.
First: again, we’re talking bioidentical hormones, and in this case, estradiol. Older animal-derived attempts had much higher risks with much lesser efficaciousness.
There have been so many studies on this (alas, none that have been publicised enough to undo the bad PR in the wake of old-fashioned HRT from before the 70s), but here’s a systematic review that highlights some very important things:
❝Estradiol-only therapy carries no risk for breast cancer, while the breast cancer risk varies according to the type of progestogen.
Estradiol therapy combined with medroxyprogesterone, norethisterone and levonorgestrel related to an increased risk of breast cancer, estradiol therapy combined with dydrogesterone and progesterone carries no risk❞
In fewer words:
- Estradiol by itself: no increased risk of breast cancer
- Estradiol with MDPA or other progestogens that aren’t really progesterone: increased risk of breast cancer
- Estradiol with actual progesterone: back to no increased risk of breast cancer
So again, you might want to make sure you are getting actual bioidentical hormones, and not something else!
However! If you are aware that you already have an increased risk of breast cancer (e.g. family history, you’ve had it before, you know you have certain genes for it, etc), then you should certainly discuss that with your doctor, because your personal circumstances may be different:
❝Tailored HRT may be used without strong evidence of a deleterious effect after ovarian cancer, endometrial cancer, most other gynecological cancers, bowel cancer, melanoma, a family history of breast cancer, benign breast disease, in carriers of BRACA mutations, after breast cancer if adjuvant therapy is not being used, past thromboembolism, varicose veins, fibroids and past endometriosis.
Relative contraindications are existing cardiovascular and cerebrovascular disease and breast cancer being treated with adjuvant therapies❞
Source: HRT in difficult circumstances: are there any absolute contraindications?
HRT makes you happier, healthier, and smell nice too: True or False?
Contingently True, assuming you do want its effects, which generally means the restoration of much of the youthful vitality you enjoyed pre-menopause.
The “and smell nice too” was partly rhetorical, but also partly literal: our scent is largely informed by our hormones, and higher estrogen results in a sweeter scent; lower estrogen results in a more bitter scent. Not generally considered an important health matter, but it’s a thing, so hey.
More often, people take menopausal HRT for more energy, stronger bones (reduced osteoporosis risk), healthier heart (reduced CVD risk), improved sexual health, better mood, healthier skin and hair, and general avoidance of menopause symptoms:
Read more: Skin, hair and beyond: the impact of menopause
We’d need another whole main feature to discuss all the benefits properly; today we’re just mythbusting.
HRT does have some drawbacks: True or False?
True, and/but how serious they are (beyond the aforementioned consideration in the case of an already-increased risk of breast cancer) is a matter of opinion.
For example, it is common to get a reprise of monthly cramps and/or mood swings, depending on how one is taking the HRT and other factors (e.g. your own personal physiology and genetic predispositions). For most people, these will even out over time.
It’s also even common to get a reprise of (much slighter than before) monthly bleeding, unless you have for example had a hysterectomy (no uterus = no bleeding). Again, this will usually settle down in a matter of months.
If you experience anything more alarming than that, then indeed check with your doctor.
HRT is a dangerous scam and sham: True or False?
False, simply. As described above, for most people they’re quite safe. Again, talking bioidentical hormones.
The other kind are in the most neutral sense a sham (i.e. they are literally sham hormones), though they’re not without their merits and for many people they may be better than nothing.
As for being a scam, biodentical hormones are widely prescribed in the many countries that have universal healthcare and/or a single-payer healthcare system, where there would be no profit motive (and considerable cost) in doing so.
They’re prescribed because they are effective and thus reduce healthcare spending in other areas (such as treating osteoporosis or CVD after the fact) and improve Health Related Quality of Life, and by extension, health-adjusted life-years, which is one of the top-used metrics for such systems.
See for example:
Our apologies, gentlemen
We wanted to also talk about testosterone therapy for the andropause, but we’ve run out of room today (because of covering the important distinction of bioidentical vs old-fashioned HRT)!
To make it up to you, we’ll do a full main feature on it (it’s an interesting topic) in the near future, so watch this space
Ladies, we’ll also at some point cover the pros and cons of different means of administration, e.g. pills, transdermal gel, injections, patches, pessaries, etc—which often have big differences.
That’ll be in a while though, because we try to vary our topics, so we can’t talk about menopausal HRT all the time, fascinating and important a topic it is.
Meanwhile… take care, all!
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Hormone Replacement
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It’s Q&A Day at 10almonds!
Have a question or a request? You can always hit “reply” to any of our emails, or use the feedback widget at the bottom!
In cases where we’ve already covered something, we might link to what we wrote before, but will always be happy to revisit any of our topics again in the future too—there’s always more to say!
As ever: if the question/request can be answered briefly, we’ll do it here in our Q&A Thursday edition. If not, we’ll make a main feature of it shortly afterwards!
So, no question/request too big or small
❝I cant believe 10 Almonds addresses questions. Thanks. I see the word symptoms for menopause. I don’t know what word should replace it but maybe one should be used or is symptom accurate? And I recently read that there was a great disservice for women in my era as they were denied/scared of hormones replacement. Unnecessarily❞
You’d better believe it! In fact we love questions; they give us things to research and write about.
“Symptom” is indeed an entirely justified word to use, being:
- General: any phenomenon or circumstance accompanying something and serving as evidence of it.
- Medical: any phenomenon that arises from and accompanies a particular disease or disorder and serves as an indication of it.
If the question is more whether the menopause can be considered a disease/disorder, well, it’s a naturally occurring and ultimately inevitable change, yes, but then, so is cancer (it’s in the simple mathematics of DNA replication and mutation that, unless a cure for cancer is found, we will always eventually get cancer, if nothing else kills us first).
So, something being natural/inevitable isn’t a reason to not consider it a disease/disorder, nor a reason to not treat it as appropriate if it is causing us harm/discomfort that can be safely alleviated.
Moreover, and semantics aside, it is medical convention to consider menopause to be a medical condition, that has symptoms. Indeed, for example, the US’s NIH (and its constituent NIA, the National Institute of Aging) and the UK’s NHS, both list the menopause’s symptoms, using that word:
- NIA (NIH): What are the signs and symptoms of menopause?
- NHS: Common symptoms of menopause and perimenopause
With regard to fearmongering around HRT, certainly that has been rife, and there were some very flawed (and later soundly refuted) studies a while back that prompted this—and even those flawed studies were not about the same (bioidentical) hormones available today, in any case. So even if they had been correct (they weren’t), it still wouldn’t be a reason to not get treatment nowadays, if appropriate!
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What happens to your vagina as you age?
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The vagina is an internal organ with a complex ecosystem, influenced by circulating hormone levels which change during the menstrual cycle, pregnancy, breastfeeding and menopause.
Around and after menopause, there are normal changes in the growth and function of vaginal cells, as well as the vagina’s microbiome (groups of bacteria living in the vagina). Many women won’t notice these changes. They don’t usually cause symptoms or concern, but if they do, symptoms can usually be managed.
Here’s what happens to your vagina as you age, whether you notice or not.
Let’s clear up the terminology
We’re focusing on the vagina, the muscular tube that goes from the external genitalia (the vulva), past the cervix, to the womb (uterus). Sometimes the word “vagina” is used to include the external genitalia. However, these are different organs and play different roles in women’s health.
What happens to the vagina as you age?
Like many other organs in the body, the vagina is sensitive to female sex steroid hormones (hormones) that change around puberty, pregnancy and menopause.
Menopause is associated with a drop in circulating oestrogen concentrations and the hormone progesterone is no longer produced. The changes in hormones affect the vagina and its ecosystem. Effects may include:
- less vaginal secretions, potentially leading to dryness
- less growth of vagina surface cells resulting in a thinned lining
- alteration to the support structure (connective tissue) around the vagina leading to less elasticity and more narrowing
- fewer blood vessels around the vagina, which may explain less blood flow after menopause
- a shift in the type and balance of bacteria, which can change vaginal acidity, from more acidic to more alkaline.
What symptoms can I expect?
Many women do not notice any bothersome vaginal changes as they age. There’s also little evidence many of these changes cause vaginal symptoms. For example, there is no direct evidence these changes cause vaginal infection or bleeding in menopausal women.
Some women notice vaginal dryness after menopause, which may be linked to less vaginal secretions. This may lead to pain and discomfort during sex. But it’s not clear how much of this dryness is due to menopause, as younger women also commonly report it. In one study, 47% of sexually active postmenopausal women reported vaginal dryness, as did around 20% of premenopausal women.
Other organs close to the vagina, such as the bladder and urethra, are also affected by the change in hormone levels after menopause. Some women experience recurrent urinary tract infections, which may cause pain (including pain to the side of the body) and irritation. So their symptoms are in fact not coming from the vagina itself but relate to changes in the urinary tract.
Not everyone has the same experience
Women vary in whether they notice vaginal changes and whether they are bothered by these to the same extent. For example, women with vaginal dryness who are not sexually active may not notice the change in vaginal secretions after menopause. However, some women notice severe dryness that affects their daily function and activities.
In fact, researchers globally are taking more notice of women’s experiences of menopause to inform future research. This includes prioritising symptoms that matter to women the most, such as vaginal dryness, discomfort, irritation and pain during sex.
If symptoms bother you
Symptoms such as dryness, irritation, or pain during sex can usually be effectively managed. Lubricants may reduce pain during sex. Vaginal moisturisers may reduce dryness. Both are available over-the-counter at your local pharmacy.
While there are many small clinical trials of individual products, these studies lack the power to demonstrate if they are really effective in improving vaginal symptoms.
In contrast, there is robust evidence that vaginal oestrogen is effective in treating vaginal dryness and reducing pain during sex. It also reduces your chance of recurrent urinary tract infections. You can talk to your doctor about a prescription.
Vaginal oestrogen is usually inserted using an applicator, two to three times a week. Very little is absorbed into the blood stream, it is generally safe but longer-term trials are required to confirm safety in long-term use beyond a year.
Women with a history of breast cancer should see their oncologist to discuss using oestrogen as it may not be suitable for them.
Are there other treatments?
New treatments for vaginal dryness are under investigation. One avenue relates to our growing understanding of how the vaginal microbiome adapts and modifies around changes in circulating and local concentrations of hormones.
For example, a small number of reports show that combining vaginal probiotics with low-dose vaginal oestrogen can improve vaginal symptoms. But more evidence is needed before this is recommended.
Where to from here?
The normal ageing process, as well as menopause, both affect the vagina as we age.
Most women do not have troublesome vaginal symptoms during and after menopause, but for some, these may cause discomfort or distress.
While hormonal treatments such as vaginal oestrogen are available, there is a pressing need for more non-hormonal treatments.
Dr Sianan Healy, from Women’s Health Victoria, contributed to this article.
Louie Ye, Clinical Fellow, Department of Obstetrics and Gynecology, The University of Melbourne and Martha Hickey, Professor of Obstetrics and Gynaecology, The University of Melbourne
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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Top 10 Foods That Promote Lymphatic Drainage and Lymph Flow
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Melissa Gallagher, a naturopath by profession, recommends the following 10 foods that she says promote lymphatic drainage and lymph flow, as well as the below-mentioned additional properties:
Ginger
Ginger is a natural anti-inflammatory, which we wrote about here:
Ginger Does A Lot More Than You Think
Turmeric
Turmeric is another natural anti-inflammatory, which we wrote about here:
Why Curcumin (Turmeric) Is Worth Its Weight In Gold
Garlic
Garlic is—you guessed it—another natural anti-inflammatory which we wrote about here:
The Many Health Benefits Of Garlic
Pineapple
Pineapple contains an enzyme called bromelain which is a unique kind of anti-inflammatory, which we have only written about in passing—we’ll have to do a main feature one of these days!
Citrus
Citrus fruits like oranges, lemons, and grapefruits are rich in vitamin C, which can help support the immune system in general.
Cranberry
Cranberries contain antioxidants and anti-inflammatory compounds, which we wrote about here:
Health Benefits Of Cranberries (But: You’d Better Watch Out)
The video also explains how cranberry bioactives inhibit adipogenesis and reduces fat congestion in your lymphatic system.
Dandelion Tea
Dandelion is a natural diuretic and anti-inflammatory herb, which we’ve not written about yet!
Nettle Tea
Nettle is a natural diuretic and anti-inflammatory herb, which we’ve also not written about yet!
Healthy Fats
Healthy fats like avocado, nuts, and olive oil can help reduce inflammation and support the immune system.
Fermented Foods
Fermented foods, such as kimchi and sauerkraut, contain probiotics that can improve gut health, which in turn boosts the immune system. You can read all about it here:
Making Friends With Your Gut (You Can Thank Us Later)
Want the full explanation? Here’s the video:
Click Here If The Embedded Video Doesn’t Load Automatically!
How was the video? If you’ve discovered any great videos yourself that you’d like to share with fellow 10almonds readers, then please do email them to us!
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Brown Rice Protein: Strengths & Weaknesses
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It’s Q&A Day at 10almonds!
Have a question or a request? We love to hear from you!
In cases where we’ve already covered something, we might link to what we wrote before, but will always be happy to revisit any of our topics again in the future too—there’s always more to say!
As ever: if the question/request can be answered briefly, we’ll do it here in our Q&A Thursday edition. If not, we’ll make a main feature of it shortly afterwards!
So, no question/request too big or small
❝I had a friend mention that recent research showed Brown Rice Protein Powder can be bad for you, possibly impacting your nutrient absorption. Is this true? I’ve been using it given it’s one of the few plant-based proteins with a full essential amino acid profile!❞
Firstly: we couldn’t find anything to corroborate the “brown rice protein powder [adversely] impacts nutrient absorption” idea, but we suspect that the reason for this belief is: brown rice (not brown rice protein powder) contains phytic acid, which is something of an antinutrient, in that it indeed reduces absorption of various other nutrients.
However, two things are important to note here:
- the phytic acid is found in whole grains, not in protein isolates as found in brown rice protein powder. The protein isolates contain protein… Isolated. No phytates!
- even in the case of eating whole grain rice, the phytic acid content is greatly reduced by two things: soaking and heating (especially if those two things are combined) ← doing this the way described results in bioavailability of nutrients that’s even better than if there were just no phytic acid, albeit it requires you having the time to soak, and do so at temperature.
tl;dr = no, it’s not true, unless there truly is some groundbreaking new research we couldn’t find—it was almost certainly a case of an understandable confusion about phytic acid.
Your question does give us one other thing to mention though:
Brown rice indeed technically contains all 9 essential amino acids, but it’s very low in several of them, most notably lysine.
However, if you use our Tasty Versatile Rice Recipe, the chia seeds we added to the rice have 100x the lysine that brown rice does, and the black pepper also boosts nutrient absorption.
Because your brown rice protein powder is a rice protein powder and not simply rice, it’s possible that they’ve tweaked it to overcome rice’s amino acid deficiencies. But, if you’re looking for a plant-based protein powder that is definitely a complete protein, soy is a very good option assuming you’re not allergic to that:
Amino Acid Compositions Of Soy Protein Isolate
If you’re wondering where to get it, you can see examples of them next to each other on Amazon here:
Brown Rice Protein Powder | Soy Protein Isolate Powder
Enjoy!
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The Blue Zones Kitchen – by Dan Buettner
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We’ve previously reviewed Buettner’s other book, The Blue Zones: 9 Lessons For Living Longer From The People Who’ve Lived The Longest, and with this one, it’s now time to focus on the dietary aspect.
As the title and subtitle promises, we get 100 recipes, inspired by Blue Zone cuisines. The recipes themselves have been tweaked a little for maximum healthiness, eliminating some ingredients that do crop up in the Blue Zones but are exceptions to their higher average healthiness rather than the rule.
The recipes are arranged by geographic zone rather than by meal type, so it might take a full read-through before knowing where to find everything, but it makes it a very enjoyable “coffee-table book” to browse, as well as being practical in the kitchen. The ingredients are mostly easy to find globally, and most can be acquired at a large supermarket and/or health food store. In the case of substitutions, most are obvious, e.g. if you don’t have wild fennel where you are, use cultivated, for example.
In the category of criticism, it appears that Buettner is very unfamiliar with spices, and so has skipped them almost entirely. We at 10almonds could never skip them, and heartily recommend adding your own spices, for their health benefits and flavors. It may take a little experimentation to know what will work with what recipes, but if you’re accustomed to cooking with spices normally, it’s unlikely that you’ll err by going with your heart here.
Bottom line: we’d give this book a once-over for spice additions, but aside from that, it’s a fine book of cuisine-by-location cooking.
Click here to check out The Blue Zones Kitchen, and get cooking into your own three digits!
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He Fell Ill on a Cruise. Before He Boarded the Rescue Boat, They Handed Him the Bill.
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Vincent Wasney and his fiancée, Sarah Eberlein, had never visited the ocean. They’d never even been on a plane. But when they bought their first home in Saginaw, Michigan, in 2018, their real estate agent gifted them tickets for a Royal Caribbean cruise.
After two years of delays due to the coronavirus pandemic, they set sail in December 2022.
The couple chose a cruise destined for the Bahamas in part because it included a trip to CocoCay, a private island accessible to Royal Caribbean passengers that featured a water park, balloon rides, and an excursion swimming with pigs.
It was on that day on CocoCay when Wasney, 31, started feeling off, he said.
The next morning, as the couple made plans in their cabin for the last full day of the trip, Wasney made a pained noise. Eberlein saw him having a seizure in bed, with blood coming out of his mouth from biting his tongue. She opened their door to find help and happened upon another guest, who roused his wife, an emergency room physician.
Wasney was able to climb into a wheelchair brought by the ship’s medical crew to take him down to the medical facility, where he was given anticonvulsants and fluids and monitored before being released.
Wasney had had seizures in the past, starting about 10 years ago, but it had been a while since his last one. Imaging back then showed no tumors, and doctors concluded he was likely epileptic, he said. He took medicine initially, but after two years without another seizure, he said, his doctors took him off the medicine to avoid liver damage.
Wasney had a second seizure on the ship a few hours later, back in his cabin. This time he stopped breathing, and Eberlein remembered his lips being so purple, they almost looked black. Again, she ran to find help but, in her haste, locked herself out. By the time the ship’s medical team got into the cabin, Wasney was breathing again but had broken blood vessels along his chest and neck that he later said resembled tiger stripes.
Wasney was in the ship’s medical center when he had a third seizure — a grand mal, which typically causes a loss of consciousness and violent muscle contractions. By then, the ship was close enough to port that Wasney could be evacuated by rescue boat. He was put on a stretcher to be lowered by ropes off the side of the ship, with Eberlein climbing down a rope ladder to join him.
But before they disembarked, the bill came.
The Patient: Vincent Wasney, 31, who was uninsured at the time.
Medical Services: General and enhanced observation, a blood test, anticonvulsant medicine, and a fee for services performed outside the medical facility.
Service Provider: Independence of the Seas Medical Center, the on-ship medical facility on the cruise ship operated by Royal Caribbean International.
Total Bill: $2,500.22.
What Gives: As part of Royal Caribbean’s guest terms, cruise passengers “agree to pay in full” all expenses incurred on board by the end of the cruise, including those related to medical care. In addition, Royal Caribbean does not accept “land-based” health insurance plans.
Wasney said he was surprised to learn that, along with other charges like wireless internet, Royal Caribbean required he pay his medical bills before exiting the ship — even though he was being evacuated urgently.
“Are we being held hostage at this point?” Eberlein remembered asking. “Because, obviously, if he’s had three seizures in 10 hours, it’s an issue.”
Wasney said he has little memory of being on the ship after his first seizure — seizures often leave victims groggy and disoriented for a few hours afterward.
But he certainly remembers being shown a bill, the bulk of which was the $2,500.22 in medical charges, while waiting for the rescue boat.
Still groggy, Wasney recalled saying he couldn’t afford that and a cruise employee responding: “How much can you pay?”
They drained their bank accounts, including money saved for their next house payment, and maxed out Wasney’s credit card but were still about $1,000 short, he said.
Ultimately, they were allowed to leave the ship. He later learned his card was overdrafted to cover the shortfall, he said.
Royal Caribbean International did not respond to multiple inquiries from KFF Health News.
Once on land, in Florida, Wasney was taken by ambulance to the emergency room at Broward Health Medical Center in Fort Lauderdale, where he incurred thousands of dollars more in medical expenses.
He still isn’t entirely sure what caused the seizures.
On the ship he was told it could have been extreme dehydration — and he said he does remember being extra thirsty on CocoCay. He also has mused whether trying escargot for the first time the night before could have played a role. Eberlein’s mother is convinced the episode was connected to swimming with pigs, he said. And not to be discounted, Eberlein accidentally broke a pocket mirror three days before their trip.
Wasney, who works in a stone shop, was uninsured when they set sail. He said that one month before they embarked on their voyage, he finally felt he could afford the health plan offered through his employer and signed up, but the plan didn’t start until January 2023, after their return.
They also lacked travel insurance. As inexperienced travelers, Wasney said, they thought it was for lost luggage and canceled trips, not unexpected medical expenses. And because the cruise was a gift, they were never prompted to buy coverage, which often happens when tickets are purchased.
The Resolution: Wasney said the couple returned to Saginaw with essentially no money in their bank account, several thousand dollars of medical debt, and no idea how they would cover their mortgage payment. Because he was uninsured at the time of the cruise, Wasney did not try to collect reimbursement for the cruise bill from his new health plan when his coverage began weeks later.
The couple set up payment plans to cover the medical bills for Wasney’s care after leaving the ship: one each with two doctors he saw at Broward Health, who billed separately from the hospital, and one with the ambulance company. He also made payments on a bill with Broward Health itself. Those plans do not charge interest.
But Broward Health said Wasney missed two payments to the hospital, and that bill was ultimately sent to collections.
In a statement, Broward Health spokesperson Nina Levine said Wasney’s bill was reduced by 73% because he was uninsured.
“We do everything in our power to provide the best care with the least financial impact, but also cannot stress enough the importance of taking advantage of private and Affordable Care Act health insurance plans, as well as travel insurance, to lower risks associated with unplanned medical issues,” she said.
The couple was able to make their house payment with $2,690 they raised through a GoFundMe campaign that Wasney set up. Wasney said a lot of that help came from family as well as friends he met playing disc golf, a sport he picked up during the pandemic.
“A bunch of people came through for us,” Wasney said, still moved to tears by the generosity. “But there’s still the hospital bill.”
The Takeaway: Billing practices differ by cruise line, but Joe Scott, chair of the cruise ship medicine section of the American College of Emergency Physicians, said medical charges are typically added to a cruise passenger’s onboard account, which must be paid before leaving the ship. Individuals can then submit receipts to their insurers for possible reimbursement.
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He recommended that those planning to take a cruise purchase travel insurance that specifically covers their trips. “This will facilitate reimbursement if they do incur charges and potentially cover a costly medical evacuation if needed,” Scott said.
Royal Caribbean suggests that passengers who receive onboard care submit their paid bills to their health insurer for possible reimbursement. Many health plans do not cover medical services received on cruise ships, however. Medicare will sometimes cover medically necessary health care services on cruise ships, but not if the ship is more than six hours away from a U.S. port.
Travel insurance can be designed to address lots of out-of-town mishaps, like lost baggage or even transportation and lodging for a loved one to visit if a traveler is hospitalized.
Travel medical insurance, as well as plans that offer “emergency evacuation and repatriation,” are two types that can specifically assist with medical emergencies. Such plans can be purchased individually. Credit cards may offer travel medical insurance among their benefits, as well.
But travel insurance plans come with limitations. For instance, they may not cover care associated with preexisting conditions or what the plans consider “risky” activities, such as rock climbing. Some plans also require that travelers file first with their primary health insurance before seeking reimbursement from travel insurance.
As with other insurance, be sure to read the fine print and understand how reimbursement works.
Wasney said that’s what they plan to do before their next Royal Caribbean cruise. They’d like to go back to the Bahamas on basically the same trip, he said — there’s a lot about CocoCay they didn’t get to explore.
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