USA topic -- common mistakes retired expats make

[5633572526]

23 hours ago, Johnnyngai said:

Do expect medical care in developing counties to be at least 20 years behind the USA.   

 

 

And expect medical care in the USA to be massively more expensive.

any medical care is better than inaccessible medical care.

[Airalee]

1 hour ago, Johnnyngai said:

In the USA, we have the posted rate and the insurance rate. 

If you are paying out of your own pocket, make sure you negotiate for the insurance rate.

It is usually 1/3 the posted rate.     

 

I see that you are insured.

 

 I was uninsurable in the US and was a cash pay patient.  I always tried to negotiate for the insurance rate.  I was rarely successful.  UCLA hit me with an $850 bill for a 10 minute consultation with a Gastroenterologist.  It was only after I was raising hell in view of all the other patients that they agreed to lower the bill to $350.  In fact, for some procedures (such as a colonoscopy) I was actually turned away because I didn’t have insurance and they wouldn’t accept a cash pay patient because they didn’t want any exposure to a patient needing to pay for expensive complications (from a procedure/surgery) if needed.

[whaleboneman]

20 hours ago, gamini said:

Your views are even more stupid, you should have most of your assets in the country you live, so  you don't have to deal with currency fluctuations. We transferred all our assets into Thai baht, which is a good strong currency and has appreciated a lot of the time and will continue to do so,  on the other hand the GBP  has gone from 73 bt to 39. In the last 15 years. What you mean by home country? Thailand is our home!

I hope you didn't give this advice to anyone who moved to Venezuela.

[Johnnyngai]

23 hours ago, Airalee said:

I see that you are insured.

 

 I was uninsurable in the US and was a cash pay patient.  I always tried to negotiate for the insurance rate.  I was rarely successful.  UCLA hit me with an $850 bill for a 10 minute consultation with a Gastroenterologist.  It was only after I was raising hell in view of all the other patients that they agreed to lower the bill to $350.  In fact, for some procedures (such as a colonoscopy) I was actually turned away because I didn’t have insurance and they wouldn’t accept a cash pay patient because they didn’t want any exposure to a patient needing to pay for expensive complications (from a procedure/surgery) if needed.

The salaried cashiers at UCLA really don't care who pay how much. 

The doctors who operate their own clinic usually would let you pay the insurance rate

because then they don't have to wait a month for the insurance check to arrive.  

 

I had a gastrointestinal consultation last year, my insurance paid the doctor 280usd.   

[Johnnyngai]

On 6/13/2019 at 10:31 PM, 5633572526 said:

And expect medical care in the USA to be massively more expensive.

any medical care is better than inaccessible medical care.

In the USA big cities, people without insurance usually have to go to a public hospital emergency room and wait up to 8 hours to see a doctor.  

Many low income people can't afford to take a day off from work to see a public hospital doctor.  

In the economically depressed small cities, that is when things really get scary.       

[JSixpack]

On 6/5/2019 at 10:20 AM, cmarshall said:

There's some stupid advice there. 

No.

 

Quote

Yes, currency exposure is a huge risk, more than inflation, but there isn't anything you can do about it unless you retire Ecuador or Panama.

Wrong. As the article suggests, come up with a strategy to manage currency risk, same as you do for many types of situations. And there are several ways of doing that. So, you yourself can't think of any. ????

 

Quote

 No one in his right mind would consider transferring his assets into baht, which would be into a country in which he has neither a right to remain nor to transfer assets back to the home country.

Yes, he would. Nor does the article suggest transferring ALL assets. And yes, you can transfer assets back. That statement is merely the usual attempt to spread FUD partly via the Just In Case fallacy.

 

Quote

General advice like this is seldom valuable.  Conditions change.  We have to be prepared to change with them.

For those unaware of the points raised in the article, it could be in fact valuable as a starting point for strategic planning. If you already know everything, of course, even when you don't, then you'll find nothing valuable.

[Airalee]

10 hours ago, Johnnyngai said:

The salaried cashiers at UCLA really don't care who pay how much. 

The doctors who operate their own clinic usually would let you pay the insurance rate

because then they don't have to wait a month for the insurance check to arrive.  

 

I had a gastrointestinal consultation last year, my insurance paid the doctor 280usd.   

What makes you think (wrongly assume) I didn’t approach doctors who own their private clinics? Those clinics were the majority of the “culprits” that would turn me away as to not bear the risk of future complications (and costs) that I, as a patient might not be able to afford.  Would you like me to name and shame the doctors and clinics?

 

I finally, after much searching, was able to obtain a $2000 colonoscopy from one of those clinics circa 2010 because UCLA, after much insistence, finally told me that a colonoscopy there would start around $7,000.  And how did I find that clinic?  I just got lucky.  It was a numbers game as most of the other private clinics turned me away.  That was after a $5500 colonoscopy from a doctors private clinic in 2005 (I’m on the 5(ish) year plan due to a family history of colon cancer).  I cannot even begin to imagine what it might cost now.

 

My last colonoscopy was here in Thailand (Vichaiyut) almost two years ago, and the “out the door”, all inclusive (cash pay) cost was ฿16,000.  I suspect it wouldn’t be much more than that now.  I’m sure a government hospital would cost much less than that, but I prefer to leave the government subsidized system to the Thais who really need it rather than being another “rich farang” driving up costs (and making for longer waits) due to basic supply and demand.

 

I have always gotten a good laugh from people with health insurance trying to tell me “how it is” for people without insurance (but with assets so, no government assistance for me) 

 

I could fill a book with my horror stories.

Edited June 15, 2019 by Airalee

[lannarebirth]

On 6/13/2019 at 1:45 AM, StevieAus said:

I have never experienced medical care in the US but I have in Australia and for a time in the UK and also in Thailand and the medical care here is excellent.

From what I have read about the US system perhaps you meant to say 20 times more expensive.

When I first moved to Thailand in 2002 medical expenses in the US were about 30 times higher than in Thailand for non government hospitals. Now, I'd say the US is roughly 13 times higher than Thailand, again, for private, non government hospitals.

[Airalee]

1 hour ago, lannarebirth said:

When I first moved to Thailand in 2002 medical expenses in the US were about 30 times higher than in Thailand for non government hospitals. Now, I'd say the US is roughly 13 times higher than Thailand, again, for private, non government hospitals.

My calculations have put it at about 15x higher in the US so pretty close to yours.  That’s at Vichaiyut (BKK).  When I lived in Chiang Mai (2012-2014) the difference was about 20x (Various Hospitals including Ram)

 

And you definitely cannot discount the convenience of not having to see a doctor to get some of the basic prescriptions here in Thailand.

Edited June 15, 2019 by Airalee

[Johnnyngai]

On 6/15/2019 at 8:54 AM, Airalee said:

What makes you think (wrongly assume) I didn’t approach doctors who own their private clinics? Those clinics were the majority of the “culprits” that would turn me away as to not bear the risk of future complications (and costs) that I, as a patient might not be able to afford.  Would you like me to name and shame the doctors and clinics?

 

I finally, after much searching, was able to obtain a $2000 colonoscopy from one of those clinics circa 2010 because UCLA, after much insistence, finally told me that a colonoscopy there would start around $7,000.  And how did I find that clinic?  I just got lucky.  It was a numbers game as most of the other private clinics turned me away.  That was after a $5500 colonoscopy from a doctors private clinic in 2005 (I’m on the 5(ish) year plan due to a family history of colon cancer).  I cannot even begin to imagine what it might cost now.

 

My last colonoscopy was here in Thailand (Vichaiyut) almost two years ago, and the “out the door”, all inclusive (cash pay) cost was ฿16,000.  I suspect it wouldn’t be much more than that now.  I’m sure a government hospital would cost much less than that, but I prefer to leave the government subsidized system to the Thais who really need it rather than being another “rich farang” driving up costs (and making for longer waits) due to basic supply and demand.

 

I have always gotten a good laugh from people with health insurance trying to tell me “how it is” for people without insurance (but with assets so, no government assistance for me) 

 

I could fill a book with my horror stories.

I see that your situations is much different due to your family medical history. 

I am basically simple and healthy.    

Your "out the door”, all inclusive (cash pay) cost was ฿16,000 / 550usd " for a colonoscopy,  

my insurance paid 2500usd for mine 8 years ago.        

[jimmyyy]

Interesting article thanks for posting it.

[Airalee]

2 hours ago, Johnnyngai said:

I see that your situations is much different due to your family medical history. 

I am basically simple and healthy.    

Your "out the door”, all inclusive (cash pay) cost was ฿16,000 / 550usd " for a colonoscopy,  

my insurance paid 2500usd for mine 8 years ago.        

Doesn’t matter what your insurance paid.  I cannot get those prices.  I have seen the articles written where it is always suggested that one “negotiate to get the insurance rate”.  I’m just here...as a person who has experienced it first hand for 19 years with no insurance to say that it’s really not that easy.  I couldn’t even qualify for “Obamacare”.

[Jingthing]

I'm not saying I totally agree with this guy's comments, but I think watching this may be useful for Americans planning to expatriate to get some idea of the various issues with keeping U.S. accounts. In my experience, these issues are very, very real. You've got to have a plan about your U.S. based accounts. In my experience, have BACKUP plans as well. Banks close. Banks get bought up. Banks change their policies on expats. But there are things you can do later if your original plans go south. Such as open a State Department Federal Credit Union account. 

 

 

[cmarshall]

On 6/17/2019 at 8:40 AM, Jingthing said:

I'm not saying I totally agree with this guy's comments, but I think watching this may be useful for Americans planning to expatriate to get some idea of the various issues with keeping U.S. accounts. In my experience, these issues are very, very real. You've got to have a plan about your U.S. based accounts. In my experience, have BACKUP plans as well. Banks close. Banks get bought up. Banks change their policies on expats. But there are things you can do later if your original plans go south. Such as open a State Department Federal Credit Union account. 

It's pretty general information.  I think there is better and more specific info here on TV, but maybe the video would be useful for someone just beginning to contemplate expatting.

 

For one thing, you definitely need more than one bank.  They close; they change policies.  Also, they change the mix of services and the cost of those services.  State Department Federal Credit Union is currently my preferred US bank/cu.

 

As far as the vpn goes, the best solution is to have a custom vpn server at a friend's in the home country, but that requires some IT skills.  Failing that, put a cheap laptop at the friend's that is always on and running teamviewer and you can connect in to conduct your banking in a way that perfectly conceals your location.

 

By the way, the banks and brokerages are getting better at figuring our where you are even if you have the best private vpn.  Your pc browser and your cell phone both have highly accurate location services even when using a vpn.  So, I noticed that the banks are starting to require that those location services be turned on before allowing you to perform certain transactions.  So far, I have stepped on this when using my cell phone with a wire transfer and with Zelle and with one bank while using a browser on my pc.  This trend is only going to continue.  

 

So, be sure location services are turned off except when you actually need it, for instance with a mapping program.