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.

More from Bill of the Month

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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.

Bill of the Month is a crowdsourced investigation by KFF Health News and NPR that dissects and explains medical bills. Do you have an interesting medical bill you want to share with us? Tell us about it!

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

Subscribe to KFF Health News’ free Morning Briefing.

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  • Ozempic vs Five Natural Supplements

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    Natural Alternatives

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  • 5 Steps To Quit Sugar Easily

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    Sugar is one of the least healthy things that most people consume, yet because it’s so prevalent, it can also be tricky to avoid at first, and the cravings can also be a challenge. So, how to quit it?

    Step by step

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  • Are Waist Trainers Just A Waste, And Are Posture Fixers A Quick Fix?

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    Are Waist Trainers Just A Waste, And Are Posture Fixers A Quick Fix?

    Yesterday, we asked you for your opinions on waist trainers and posture-fixing harnesses, and got the above-depicted, below-described set of results:

    • The most popular response was “Waist trainers are purely cosmetic, so useless. Posture-fixers have merit”, with a little over a quarter of the votes.
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    The sample size was smaller than usual—perhaps the cluster of American holiday dates yesterday and today kept people busy! But, pressing on…

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    True, simply. Honestly, they’re not even that great for cosmetic purposes. They will indeed cinch in your middle, and this shape will be retained for a (very) short while after uncinching, because your organs have been squished inwards and may take a short while to get back to where they are supposed to be.

    The American Board of Cosmetic Surgery may not be an unbiased source, but we’re struggling to find scientists who will even touch one of these, so, let’s see what these doctors have to say:

    • Waist training can damage vital organs
    • You will be slowly suffocating yourself
    • Waist training simply doesn’t work
    • You cannot drastically change your body shape with a piece of fabric*

    Read: ABCS | 4 Reasons to Throw Your Waist Trainer in the Trash

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    • organs: necessary! (long-term damage possible, but they’re not going away)
    • muscles: slightly restrictable! (temporary restriction; no permanent change)
    • fat: very squeezable! (temporary muffin; no permanent change)

    Posture correctors have merit: True or False?

    True—probably, and as a stepping-stone measure only.

    The Ergonomics Health Association (a workplace health & safety organization) says:

    ❝Looking at the clinical evidence of posture correctors, we can say without a doubt that they do work, just not for everyone and not in the same way for all patients.❞

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    That’s not very compelling, so we looked for studies, and found… Not much, actually. However, what we did find supported the idea that “they probably do help, but we seriously need better studies with less bias”:

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    Health Audit Time

    Here at 10almonds, we often cover quite specific things, ranging from “the effect of sodium on organs other than your heart” to “make this one small change to save your knees while driving”.

    But, we’re each a whole person, and we need to take care of the whole organism that makes up the wonderful being that we each are. If we let one part of it drop in health too much, the others will soon follow suit because of the knock-on effects.

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    Mental Health

    We’re doing this audit head-to-to, so let’s start it here, because mental health is also just health, and it’s difficult to tackle the others without having this one at least under control!

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  • The S.T.E.P.S. To A Healthier Heart

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  • What is AuDHD? 5 important things to know when someone has both autism and ADHD

    10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.

    You may have seen some new ways to describe when someone is autistic and also has attention-deficit hyperactivity disorder (ADHD). The terms “AuDHD” or sometimes “AutiADHD” are being used on social media, with people describing what they experience or have seen as clinicians.

    It might seem surprising these two conditions can co-occur, as some traits appear to be almost opposite. For example, autistic folks usually have fixed routines and prefer things to stay the same, whereas people with ADHD usually get bored with routines and like spontaneity and novelty.

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    Kosro/Shutterstock

    1. Having both wasn’t possible a decade ago

    Only in the past decade have autism and ADHD been able to be diagnosed together. Until 2013, the Diagnostic and Statistical Manual of Mental Disorders (DSM) – the reference used by health workers around the world for definitions of psychological diagnoses – did not allow for ADHD to be diagnosed in an autistic person.

    The manual’s fifth edition was the first to allow for both diagnoses in the same person. So, folks diagnosed and treated prior to 2013, as well as much of the research, usually did not consider AuDHD. Instead, children and adults may have been “assigned” to whichever condition seemed most prominent or to be having the greater impact on everyday life.

    2. AuDHD is more common than you might think

    Around 1% to 4% of the population are autistic.

    They can find it difficult to navigate social situations and relationships, prefer consistent routines, find changes overwhelming and repetition soothing. They may have particular sensory sensitivities.

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    Studies suggest around 40% of those with ADHD also meet diagnostic criteria for autism and vice versa. The co-occurrence of having features or traits of one condition (but not meeting the full diagnostic criteria) when you have the other, is even more common and may be closer to around 80%. So a substantial proportion of those with autism or ADHD who don’t meet full criteria for the other condition, will likely have some traits.

    3. Opposing traits can be distressing

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    For example, it can be upsetting when you need your things organised in a particular way but ADHD traits result in difficulty consistently doing this. There can be periods of being organised (when autistic traits lead) followed by periods of disorganisation (when ADHD traits dominate) and feelings of distress at not being able to maintain organisation.

    There can be eventual boredom with the same routines or activities, but upset and anxiety when attempting to transition to something new.

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    Autism can result in quickly being overstimulated by sensory input from the environment such as noises, lighting and smells. ADHD is linked with an understimulated brain, where intense pressure, novelty and excitement can be needed to function optimally.

    For some people the conflicting traits may result in a balance where people can find a middle ground (for example, their house appears tidy but the cupboards are a little bit messy).

    There isn’t much research yet into the lived experience of this “trait conflict” in AuDHD, but there are clinical observations.

    4. Mental health and other difficulties are more frequent

    Our research on mental health in children with autism, ADHD or AuDHD shows children with AuDHD have higher levels of mental health difficulites than autism or ADHD alone.

    This is a consistent finding with studies showing higher mental health difficulties such as depression and anxiety in AuDHD. There are also more difficulties with day-to-day functioning in AuDHD than either condition alone.

    So there is an additive effect in AuDHD of having the executive foundation difficulties found in both autism and ADHD. These difficulties relate to how we plan and organise, pay attention and control impulses. When we struggle with these it can greatly impact daily life.

    5. Getting the right treatment is important

    ADHD medication treatments are evidence-based and effective. Studies suggest medication treatment for ADHD in autistic people similarly helps improve ADHD symptoms. But ADHD medications won’t reduce autistic traits and other support may be needed.

    Non-pharmacological treatments such as psychological or occupational therapy are less researched in AuDHD but likely to be helpful. Evidence-based treatments include psychoeducation and psychological therapy. This might include understanding one’s strengths, how traits can impact the person, and learning what support and adjustments are needed to help them function at their best. Parents and carers also need support.

    The combination and order of support will likely depend on the person’s current functioning and particular needs. https://www.youtube.com/embed/pMx1DnSn-eg?wmode=transparent&start=0 ‘Up until recently … if you had one, you couldn’t have the other.’

    Do you relate?

    Studies suggest people may still not be identified with both conditions when they co-occur. A person in that situation might feel misunderstood or that they can’t fully relate to others with a singular autism and ADHD diagnosis and something else is going on for them.

    It is important if you have autism or ADHD that the other is considered, so the right support can be provided.

    If only one piece of the puzzle is known, the person will likely have unexplained difficulties despite treatment. If you have autism or ADHD and are unsure if you might have AuDHD consider discussing this with your health professional.

    Tamara May, Psychologist and Research Associate in the Department of Paediatrics, Monash University

    This article is republished from The Conversation under a Creative Commons license. Read the original article.

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