Christine Norman/KFF Health News
Vincent Wasney and his fiancée Sarah Eberlein have never been to the sea. They had never even flown on a plane. But when they bought their first house in Saginaw, Miss., in 2018, their real estate agent gave them tickets to a Royal Caribbean cruise.
They set sail in December 2022 after two years of delays due to the coronavirus pandemic.
The couple chose the Bahamas-destination cruise in part because it included a trip to CocoCay, a private island accessible to Royal Caribbean passengers that features a water park, balloon rides and swimming with pigs excursions .
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It was that day at CocoCay that Vosney, 31, said he started feeling sick.
The next morning, as the couple sat in their cabin making plans for their final full day of travel, Vosny made an anguished sound. Eberlein saw him having a seizure in bed, biting his tongue and bleeding from his mouth. She opened the door to ask for help and happened upon another guest, who woke his wife, an emergency room doctor.
Vosny climbed into a wheelchair brought by the ship’s medical staff, who took him to a medical facility, where he received anticonvulsant medication and fluids and was monitored before being discharged.
Vincent had had seizures in the past, starting about ten years ago, but it had been some time since his last one. Imaging tests at the time showed no tumors, and doctors concluded he might have epilepsy, he said. He initially took the medication, but after two years without another seizure, he said doctors told him to stop taking it to avoid liver damage.
A few hours later, Vosny suffered a second seizure in his cabin on the ship. This time he stopped breathing, and Aberlein remembered that his lips were so purple they almost looked black. She ran for help again, but in her hurry she locked herself out. When the ship’s medical team entered the cabin, Vosny was breathing again, but he suffered ruptured blood vessels in his chest and neck, which he later said resembled a tiger’s stripes.
Wasni was in the ship’s medical center when he suffered his third seizure, a grand mal seizure that often results in loss of consciousness and violent muscle contractions. By then, the ship was close enough to the port for Vosny to be evacuated via a rescue boat. He was placed on a stretcher and lowered over the side of the boat on a rope, and Eberlein climbed down the rope ladder to join him.
But before they even got off the boat, the bill came.
[documentcloud url=”https://www.documentcloud.org/documents/24662397-may-2024-botm?responsive=1&title=1″]
patient: Vincent Wasney, 31, had no insurance at the time.
medical service: Costs for general and intensive observation, blood tests, anticonvulsant medications, and services performed outside a medical facility.
service provider: The Independence Medical Center of the Seas is an onboard medical facility 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 the ship until the end of the cruise, including medical-related expenses. Additionally, Royal Caribbean does not accept “land-based” health insurance plans.
Vosney said he was surprised to learn that, in addition to other charges such as Wi-Fi, Royal Caribbean required him to pay for medical treatment before disembarking – even though he was being evacuated.
“Are we being held hostage now?” Eberlein remembers asking. “Because, obviously, if he has three seizures in 10 hours, there’s something wrong.”
Wasni said he has little memory of being on the boat after his first seizure – which often leaves victims groggy and disoriented for hours.
But he certainly remembers being presented with a bill while waiting for the rescue boat, most of which was $2,500.22 in medical bills.
Still groggy, Vosney recalled that he couldn’t afford the payment, and a cruise ship employee responded: “How much can you pay?”
He said they drained their bank accounts, including money saved for their next home purchase, and maxed out Wasney’s credit cards, but were still about $1,000 short.
Eventually, they were allowed to leave the ship. He said he later learned his card had been overdrawn to cover the shortfall.
Royal Caribbean International did not respond to multiple inquiries from KFF Health News.
After arriving on land in Florida, Vosney was taken by ambulance to the emergency room at Broward Health Medical Center in Fort Lauderdale, where he incurred thousands of dollars in additional medical bills.
He’s still not entirely sure what caused the seizures.
On the boat, he was told it was probably extreme dehydration — and he said he did remember being particularly thirsty at CocoCay. He also pondered whether trying escargot for the first time the night before might have played a role. Eberlein’s mother is convinced the incident was related to swimming with pigs, he said. Not to be underestimated, Eberlein accidentally broke a small mirror three days before the trip.
Wasni worked in a stone shop and had no insurance when they set sail. He said that a month before their departure, he finally felt he could afford the health plan provided by his employer and signed up, but the plan did not start until they returned home in January 2023.
They also lack travel insurance. As inexperienced travelers, Vosney said, they assumed it was due to lost luggage and canceled trips rather than unexpected medical bills. And because the cruise was a gift, they were never prompted to buy insurance, which often happens when buying plane tickets.
resolution: The couple returned to Saginaw with essentially no money in their bank account, thousands of dollars in medical debt and no idea how to pay their mortgage, Wasney said. Because Vosney was uninsured when he sailed, he didn’t try to collect cruise reimbursement from his new health plan when his coverage started a few weeks later.
The couple worked out a payment plan to cover Wasney’s medical bills after he left the ship: Each would pay with the two doctors he saw at Broward Health, who would pay separately with the hospital, and one who would pay separately with the hospital. One paid the bill with the ambulance company. He also paid bills to Broward Health itself. There is no interest charge on these plans.
But Broward Health said Vosney missed two payments to the hospital and the bill ended up being sent to collections.
Broward Health spokesperson Nina Levine said in a statement that Wasney’s bill was reduced by 73% because he was uninsured.
“We make every effort to provide the best care with minimal financial impact, but cannot stress enough the importance of utilizing private and Affordable Care Act health insurance plans as well as travel insurance to reduce the risks associated with unplanned medical issues,” she says.
The couple paid for the home by raising $2,690 through a GoFundMe campaign started by Wasney. Worsney said much of the help came from family and friends he met playing disc golf, a sport he picked up during the pandemic.
“There was a group of people who stood up for us,” said Vosney, who is still moved to tears by their generosity. “But there are hospital bills.”
Key points: Billing methods vary by cruise line, but Joe Scott, president of the American College of Emergency Physicians’ Cruise Medicine Section, said medical bills are typically added to a cruise passenger’s onboard account and must be paid before leaving the cruise ship. The individual can then submit the receipt to the insurance company for possible reimbursement.
He recommends that those planning to take a cruise purchase travel insurance that specifically covers their trip. “If they do incur expenses, this will help with reimbursement and potentially pay for expensive medical evacuations if needed,” Scott said.
Royal Caribbean advises passengers who received onboard care to submit paid bills to their health insurance company for possible reimbursement. However, many health plans do not cover medical services received on a cruise ship. Health insurance will sometimes cover necessary medical care on a cruise ship, but not if the cruise ship is more than six hours away from a U.S. port.
Travel insurance is designed to cover many out-of-town mishaps, such as lost luggage, or even transportation and accommodations to visit loved ones if the traveler is hospitalized.
Travel medical insurance and plans that offer “emergency evacuation and repatriation” are two types that specifically help respond to medical emergencies. These plans can be purchased separately. One of the benefits of a credit card also includes travel medical insurance.
But travel insurance plans also have limitations. For example, they may not cover care related to pre-existing conditions or activities the plan deems “hazardous” activities, such as rock climbing. Some plans also require travelers to first submit primary health insurance before seeking travel insurance reimbursement.
As with other insurance, be sure to read the fine print and understand how reimbursement works.
That’s what they plan to do before the next Royal Caribbean cruise, Vosney said. He said they wanted to go back to the Bahamas on essentially the same itinerary — there was a lot in CocoCay that they didn’t get to explore.
Emmarie Huetteman of KFF Health News edited the digital story and Taunya English of KFF Health News edited the audio story. NPR’s Will Stone edited the audio and digital story.
KFF Health NewsFormerly known as Kaiser Health News (KHN), it is a national newsroom specializing in producing in-depth news on health issues and is one of the core operating projects of Kaiser Health News Cave —An independent source of health policy research, polling, and news.