This is a post for our enquiring minds, to answer a question we often get which is:
Q: What do you do about medical care?
So far we haven’t had to do much. We completed a full battery of checkups before we cast off about two years ago, and that has tided us over. But, now it’s time for follow up exams.
We carry health insurance through GeoBlue’s Explorer Premium policy, but it isn’t cheap. For approximately $800 per month, we get coverage in the U.S. and outside the U.S. for doctors and hospitals in the Blue Cross and Blue Shield Network. In the U.S. we have a substantial deductible and significant co-pays; outside the U.S. it’s basically free. It also includes evacuation from remote areas if adequate care isn't available.
A quick search of our in-network doctors shows the best place for us to get checkups completed is Kuala Lumpur, Malaysia. We find the website for medical tourism at the Prince Court Medical Center and each sign up for “Executive Wellness Exams.” I didn’t know what to expect. We’ve all heard how different medical care is in other countries, but I didn’t have a total grasp on how different it could be.
We arrived in Kuala Lumpur, a city roughly the size of New York City, to find our $100 per night hotel room to be far more luxurious than we needed. A white marble facade, a valet wearing a pith helmet, a gracious door man in white gloves, a wildly large bouquet of flowers in the lobby, and in the air, that perfume “Eau d’ Expensive Hotel” they use in the Palazzo in Las Vegas. There is an orchid conservatory on the second floor, and restaurant with a maitre'd in a tuxedo with tails. A woman in a red dress sings jazz with three men playing a base, piano, and snare drum. The whole thing dazzles my eyes, currently not adjusted to such finery. Our room overlooked the purple night sky of the city.
We arrive five days earlier than our appointments were scheduled, so we took that chance to explore the city. We find the city to be clean and quite safe. Skyscrapers stretch into the sky all around us, water features shoot up in the morning sun, and Uber drivers are happy to cart us around for about $2US per trip.
We visit the Petronius Towers, currently the 7th tallest two buildings in the world and the only structure with a two story floating sky bridge. (When they say the sky bridge floats, they mean it isn’t connected on either side to the buildings except through the giant beams attached in the “X” shape. This is to allow the large buildings to sway and move in the wind without crushing the sky bridge.) One building is used as offices for Petronius - Malaysia’s national oil company. The other building is leased out to other businesses for use.
Since we are on a “health tour,” we find a Chinese herb tea shop on the outer edge of the China Town market. “What do you want?!” The purveyor asks us as we sit down. On the wall is a sign boasting the health benefits of the herbal jelly (Improves iracibility!) - so we order a cup of that. It’s served with diluted honey water in a little tea pot to make it palatable. Down the street, we obtain serious coaching on the making and consumption of real Chinese Oolong.
We explore a Taoist Temple where people burn their own weight in incense.
We enjoy dinner at Old China Cafe with a rich history as a meeting space for hundreds of years. The decor has changed minimally over time. This becomes Andrew’s favorite spot and we return multiple times over the week.
We sample Indian food in Little India and eat from a banana leaf with our hands.
We try Malaysia’s famous Teh Terik - or “pulled tea” - a process of pouring tea in a rather showman like fashion in order to improve the taste and mix the tea, evaporated milk, and sugar added for deliciousness. (Not my video. Pulled from Youtube for an adequate example.)
We toured the K.L. bar scene where Grandmas keep watch from windows. Then, we met some fun friends who happened to be from Indonesia, but working in K.L. They hosted us for a night of the “local’s bar” scene. It is here that Andrew is overjoyed to find his "cheapest beer yet" at a cost of only $0.25US. One quarter. He was so happy.
The morning of our appointments, we grab a $2.00 Uber to the Prince Court Medical Facility. A full service hospital, we walk in to an enormous lobby with skylights that open through the center of several stories. Marble floors, a cafe and dining center, a gift shop to buy flowers for someone who might be ill. It looks in every way to be as clean, modern, and high tech as our hospitals in the United States, if not more so. A concierge directs us toward the Executive Wellness Center, and we arrive at the front desk at the appointed time of 9:00 a.m.
After finishing our paperwork, I hand the woman behind the desk my clipboard, and turned to go back to the waiting room. “Oh no,” she says, “right this way.” She immediately takes me back to a room where we make our way through a series of stops to complete blood work, hearing and vision checks, heart EKGs, body composition calculations, a women's examination, and a discussion with the doctor about my current health and fitness routines.
Then, I'm shuttled to radiology where they take a chest X-ray and a variety of ultrasounds. A full fledged doctor runs the ultrasound wand over my body as she talks to me about what she sees. “Can we add a thyroid ultrasound? It’s been recommended that I have ultrasounds on my thyroid every couple of years.” I ask, worried that I should have mentioned this much earlier.
“Sure.” She tells me, pokes a few bits of information into the computer and turns her wand on my throat.
Once this is finished, I am taken back to the main office where Andrew and I are both given a coupon for a meal at the hospital cafeteria and told to return in two hours when we will meet with the doctor about our results. We enjoy salmon caesar salads and a tea. We walk the hospital grounds, then we return to the office.
Sitting with the doctor everyone fully clothed and seemingly in no rush, she walks us through each of the results of our tests. “This looks good, that looks good, I’d recommend you stop letting Sonrisa talk you into all those rum based cocktails at happy hour…” All is going well until she says to me “I would recommend that we do a CT Scan with and without contrast to check out something going on with your liver/gall bladder.”
“Oh really. Hmmm….” I say. “When can we do that? We are only in town another two days, then we are flying to the States to visit home. Maybe I will have to do it there…” She sees the concern on my face, trying to figure out the logistics of this grand problem. I once had to have an MRI in the US and it took six months to convince the insurance company that it was medically necessary and three weeks thereafter to schedule the damn thing.
“Why can’t you just do it now?” The doctor asks.
“Is that possible?” I say, Andrew sitting next to me, his mouth also agape.
“Why not? We can take you downstairs now. Or, actually, you should be fasting so let’s do it tomorrow morning before your dermatology appointment.” She opens up a computer program to type in the information.
I start sweating, now. I must be dying. There can’t be any other reason she could get me in for a CT Scan at a moment’s notice.
“Okay,” I say uneasily, “Can we get it approved by insurance that fast?”
“You'll probably have to pay for it out of pocket then submit for reimbursement,” she suggests. Sitting there in the moment, I don’t know how much a CT scan w/ and w/o contrast in the U.S. costs, but my MRI was in the neck of the woods of $1,500 as the insurance negotiated price. CT scan has to be in a similar amount. I guess I could pay it, but geez I really don’t want to… As I fret about this, the doctor scans a list of prices. “Oh, yes, it’s right here. $250US. Can you do that?
The next morning when I return, it’s the same deal. I hand in my paperwork and I’m immediately taken to radiology to get my CT Scan. Approximately fifteen minutes after I walked in the door, I’m laying on that cold table, an IV in my arm filling my body with radio active fluid. The table buzzes as it rolls into the white donut of the CT machine and a robotic man’s voice talks to me to tell me to stay still and enjoy the strange heat that burns inside my body as the machine completes its tests. I roll back out, I’m monitored for fifteen minutes to make sure I don’t have an allergic reaction, then I am sent on my way to the dermatology appointment on the third floor.
After dermatology, I’m shuttled directly back to my doctor to have her explain what the CT scan determined. As I peek my head into her office door, I try to gauge her facial expression. Am I sick? Sonrisa will be really upset with me if I am sick. I sit in the chair across from the Doctor’s desk and she smiles at me. “All is well." I breathe a sigh of relief, then the doctor and I chat for fifteen minutes more about our sailing trip and her upcoming travels. Then she releases me out to the city to have more fun.
We visited the Textile Museum (and its cafe) where we learned more about all the cool weaving and complex fabrics made throughout this area of the world that I can’t resist and seem to buy reams and reams of any time a cute little grandma or Iksan offers to sell it to me.
And, we take a spin through the National Mosque and the Arabic History and Arts Museum to learn more about the Muslim religion and culture. This deserves it’s own post, one I will save until we finish sailing through this Muslim majority part of South East Asia.
We cap off the trip with noodles for lunch in China town and a delicious dinner at a fancy (and apparently dimly lit restaurant) of crispy duck in curry, filet in a delicious lemongrass sauce, and Pedeng leaf pudding with agar agar and coconut milk.
If only all medical checkups were this much fun. As we fly back toward Sonrisa, Andrew and I mulled over the financial details. For us, this entire extravaganza cost only $2,400 total, out of pocket, before the insurance company reimburses us our $900 in medical expenses. We searched online for flight prices from the U.S. and realized it would take less time away from work and less money to fly ALL THE WAY FROM THE UNITED STATES to take a week’s vacation in Kuala Lumpur and get medical checkups completed.
In the end, our insurance company picked up the $900 in medical costs. This is a pittance and seems rather off balance when you realize we pay them $800 per month. But, of course that imbalance in cost represents the hope that we will be able to access health insurance in the U.S. upon our return without pre-existing conditions limitations and the other falderal that may inflict itself upon us if we don’t continuously carry qualified coverage in the U.S. I left Malaysia with an uneasy feeling and so many questions. What’s going on here? Why can Malaysia provide medical services equivalent to our technology, but with so much less hassle and 25% the cost? It just doesn’t seem right.
P.S. I tried to determine the cost of CT Scans of the Abdomen w/ and w/o Contrast in the U.S. The quote range is between $1,500 and $2,600, but some companies offer to negotiate these prices on your behalf claiming to get the cost down to $193 US. I have no experience or knowledge to know if this is actually possible; somehow, I doubt that it is.