What happens if a tourist to US needs a medical surgery in U.S and the tourist's travel insurance does not cover the massive expenses?

  • 7
    Most travel insurance companies (that I've used anyway) charge a higher premium to cover travel to the US vs other countries, so that they can include higher liability and medical cover
    – Midavalo
    Jun 1 at 21:45
  • 6
    same as when a non-tourist has the same problem: they go bankrupt
    – njzk2
    Jun 2 at 17:22

2 Answers 2


If you're in a life threatening situation, unconscious and dying - the US hospitals are obligated to treat you whether you can pay them or not. But once you're no longer in a life-threatening condition, if you cannot provide financial guarantees (whether your own money or insurance), you'll be discharged. Whether you're in a state that allows you to travel back home at that point is not their problem.

If you provided guarantees and don't pay - they may end up suing you. Since the amounts may be significant, it may be worth the collectors' while to chase you to your home country with that lawsuit.

If you have an insurance that's anywhere near decent, they'll either cover your costs in the US or will do med-evac back home (depending on what's cheaper for them).

  • Thanks for your response. Could you elaborate how does a say US citizen provide guarantee on behalf of a foreign visitor to US? Jun 2 at 10:27
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    from my home country Sweden "There is no uniform regulation for the recognition and enforcement of foreign judgments. Recognition and enforcement varies depending on the subject matter of the judgment and the country of origin. The general rule is that foreign judgments will not be enforced or recognised unless the Swedish courts are required to do so by law (often based on treaties)"
    – Rsf
    Jun 2 at 12:55
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    @Rsf Even if a US court judgement usually can't be enforced in Sweden, a foreign creditor can file a new claim against you at a Swedish court if you refuse to pay. As long as the creditor can prove your debt according to Swedish standards, a Swedish court will not reject the claim just because the creditor is a foreign entity. Jun 2 at 13:40
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    @Rsf It is of course not easy, but if you have a 6-digit debt (in US$), you can't expect the creditor to give up easily. If you have the money to pay for your debt, the creditor can also more than likely claim all costs related to the debt collection from you later if you are trying to flee from payment. Jun 2 at 16:09
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    @Rsf I'm not familiar with any law in any country that would explicitly disallow foreign debtors to sue. I'm not sure what is the argument you're trying to make here.
    – littleadv
    Jun 2 at 16:33

Depends how they enter the system. Being foreign doesn't enter into it much.

If they see a doctor's clinic (what would be called a GP in the UK), or walk-up service (called "Urgent Care"), the caregiver makes a monetary decision whether to treat them, based on their collectabilty, which includes their insurance.

However, hospital emergency rooms cannot by law turn away a patient, except for very narrow exceptions such as being full. This has the perverse incentive that the uninsured go exclusively to ERs, where treating them for simple things cost 20-30 times as much.

So as a general rule, the hospital will deliver you enough care to stabilize you and get you fit for a flight home. If your condition will require care beyond your leaving their doors, they will probably contact your domestic health care system back home, to understand what followup care will be available to you and to try to line it up for you. Why?

Because some US law and many state laws require a hospital have a discharge plan that provides for your hand-off to others for continued care.

I wouldn't say the money-biz people in hospital administration have no voice here, but they are not going to push too hard against medical advice - the liability is too great. But they certainly will have their finger in the pie. And remember, they're trying to keep their not-for-profit hospital afloat, so they'd rather find a payer and convince them to let you stay longer. They will wheel-and-deal to that end; the price US insurers pay for services is a small fraction of retail price they quote to monied self-insuring foreigners.

However, if no payer can be found, yes, you are ultimately responsible for the expenses... kinda. The thing is, hospitals have insanely high retail prices aimed at wealthy foreigners, who come to the US thinking it's the best healthcare system in the world. This doesn't matter when billing the indigent since they'll never pay anyway, and it gives them a leg up when dealing with those who can barely or fractionally pay. If a service is $400 to Medicare but they bill it at $2000, then they can haggle an uninsured down to $600 - see how that works?

So when those bills start coming in, you have to haggle back with them. At that point it helps to know the "usual, reasonable & customary" insurer rates, or the Medicare rates, so you can base your counter-offer on a fraction of that and then meet at the middle at about UR&C. This works fine, they're used to it.

There isn't a consistent markup at all. Some hospital charges are bonkers, while I see doctors charge rates I feel bad about, like how are they paying their student loans? So yeah, have a sense about that.

  • 4
    and get you fit for a flight home - citation needed. There's a big difference between being stable to walk out of the door without dying and being fit and capable to take a long flight.
    – littleadv
    Jun 2 at 1:52
  • 1
    @littleadv you're travel insurance will likely pay for enough treatment to allow repatriation, then continue treatment at home, unless full treatment in the country you are in is cheaper for them. E.g. if your treatment up to repat in the US costs $10k, repat costs $10k, and treatment at home for the rest $5k, while continued treatment in the US would be $10k they'd pay for full treatment in the US.
    – jwenting
    Jun 2 at 7:03
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    @littleadv “a flight home” is not necessarily a cramped seat in coach. Travel insurance includes repatriation costs, which may, depending on the case, involve getting you a better seat (business class for instance), several seats with assistance and what not, or even a medical flight.
    – jcaron
    Jun 2 at 9:24
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    Thanks for your response. What happens when once the bills start pouring in, and meanwhile the visitor to US leaves US and goes back to home country? Jun 2 at 10:31
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    @FaheemMitha Harper’s guess is 100% correct. I used to work for an emergency case-handling centre for Nordic travel insurances, and I have dealt many times with people from Finland and the Baltics (whose travel insurances generally have hard caps for medical treatment, sometimes as low as €10,000) who had been treated at extortionate prices in the US and were now hounded by debt collectors in their home country. And of course, once your debt has been sold on, there is no haggling – you owe the full amount, which can easily lead to bankruptcy and losing your home. Jun 3 at 14:27

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