Medical care in Ecuador…

Attractive cactus tree in the Galapagos Islands.

Many travelers often mention that Ecuador has good medicalcare, especially when many expats settle in the country for that reason, along with the lower cost of living than many other countries. Today, we’re sharing information about this topic, coupled with a smidgen of information from our recent experience.

From the US Embassy site on medical care in Ecuador:

“Medical Assistance

The Embassy cannot provide health care or medical facilities for private U.S. citizens in Ecuador. We can, however, provide a list of names and addresses of doctors and facilities for you to choose from. Should you be injured or become seriously ill while in Ecuador, the Consular Section can assist you by providing a list of medical practitioners and hospitals and informing family and friends, at your request, of your well-being.

Health Insurance Overseas

We strongly recommend acquiring Overseas health insurance before traveling to Ecuador. If you have Medicare, we advise you that Medicare does not cover health coverage outside the U.S. In addition, we also recommend looking for a Health Insurance plan with Medical Evacuation coverage since evacuations may be expensive, from $ 10,000.00 and up.

Prescription Medications

While you travel, we always recommend that you take enough medication, if required to take any, at least for the length of your trip. If you happen to run out of your medication, unfortunately, the U.S. Embassy or Consulate can’t help you by receiving any medication.

Also, please note that special laws and regulations might be in force for sending medication to Ecuador. It does not matter if the package was sent with a courier company, cargo company, or regular mail. Some medications may even need a written import permit issued by the Ecuadorian Ministry of Health or may be restricted by the Ecuadorian National Council of Control Substances. Packages detained by Ecuadorian Customs can’t be released by having someone from the Embassy or Consulate call in. We recommend you research what local options you can get for your prescription medication in case of emergency before traveling.”

International Living Magazine published an article regarding medical care in Ecuador, inspiring many foreigners to visit the country for care and procedures. Here is the article in part from this site:

“One of the great perks for foreign residents living in Ecuador is high-quality, low-cost healthcare. Bloomberg recently rated Ecuador as having the 20th most efficient healthcare system among advanced economies, while the U.S. ranked near the bottom in 46th place.

An internet comparison of healthcare costs worldwide found that Ecuador’s costs are the lowest—lower than those in China, Malaysia, India, Mexico, and Panama. Generally, you can expect to pay 10% to 25% of what you would in the U.S. For major surgery, we’ve seen several cases in which costs were even less than 10% of comparable procedures in the U.S. You will find similar savings for dental care.

Lots of iguanas on the walkway. (Repost).

Although Ecuador is a developing country, you will find first-rate medical care here, particularly in the major cities. Many doctors are educated in the U.S., Europe, Argentina, Chile, and Cuba and continue to train around the world. In many respects, the medical system is reminiscent of that in the U.S. in the 1950s or 1960s. House calls are still possible; most doctors do not have nurses, and the average office visit is 30 to 45 minutes. Another throwback is that Ecuadorian doctors don’t expect to become instant millionaires, and the average income for doctors, according to a Quito medical association, is about $65,000 a year.

A visit to a general practitioner costs $20 to $35, while a visit to a specialist runs anywhere from $40 to $80. For follow-up visits, there is usually no charge at all. A psychiatrist will charge $40 to $50 for a half-hour session. Simple, ambulatory procedures are equally inexpensive. For example, the removal of a small lump (under local anesthesia) and a biopsy cost about $125. Brand name medicines usually cost less than in the U.S. Generics, which are widely available and are much cheaper.

Health Insurance in Ecuador

In 2017, Ecuador passed new laws making some type of health insurance mandatory for all citizens under 65 years of age and all residents under 65 who had their visas registered after February 6, 2017. However, laws were also passed, making it illegal for private insurance companies to exclude clients based on age, sex, or pre-existing conditions.

Health insurance remains a bargain in Ecuador. A review of comparable insurance policies for a 60-year-old man in the U.S. and Ecuador tells the story. In the U.S., the man would pay a monthly premium of $1,200; in Ecuador, he may pay as little as $70. A woman aged 50 to 60 would pay $72 for the same policy in Ecuador, while coverage for a dependent child between two and 17 years of age costs $15.69 monthly.

Turtles at Cerro Colorado Tortoise Reserve in San Cristobal Island in the Galapagos

The policy cited is offered by Salud S.A. (website:, Latin America’s largest health insurance company, and pays 80% of doctor’s visits, 60% of medication costs, and 100% of hospitalizations. It also offers extra coverage for walk-in procedures and accidents.

Although international health insurance is available from several local companies, costs can be considerably higher than Ecuadorian policies. Remember that international policies must cover high-priced countries like the U.S.

The Social Security Healthcare Option

Ecuador has invested hundreds of millions of dollars to upgrade its national social security healthcare system (Instituto Ecuatoriano de Seguridad Social, or IESS) and, as of January 2014, allowed foreign residents of any age a “buy-in” option. Following a change in 2017, expats now must provide proof of income for the rate of their IESS insurance to be set. That figure will be used if your visa is based on your pension. For other types of visas, you will need to provide documentation to verify your income.

The rates for IESS coverage are based on the income claimed. The primary enrollee (or spouse) will pay a monthly fee equal to 17.6% of their income. A spouse and other family members may be added for an additional 3.41% per month. So, if you have a pensioner’s visa for the minimum amount ($800 + $100 for dependents), your monthly fee as a couple would be $168.08. Remember that you don’t need to disclose all of your income, just what you are claiming to participate.

This is still a bargain, as the public healthcare system covers in-hospital care, outpatient care, extended care, home care, prescription drugs, dental care, and eye care. Again, please note that the healthcare regulations are still under debate and could change anytime. Keep up with International Living for up-to-date information as this develops.

Dental Care in Ecuador

Dental care in Ecuador is also a bargain, costing 80% to 90% less than similar care in the United States. As with physicians, you will find that most dentists are well-trained and have access to the latest technology. Many of them also speak English.

Checking prices for dental care, a cleaning costs $30 to $45. Cavity repairs and fillings cost $25 to $35. Partial plates cost $325, and a complete set of dentures costs about $900, including office visits, fittings, lab work, and impressions.”

For the balance of this article, please click here and scroll down.

Baby turtle enjoying the water at the sanctuary.

As for our personal experience with medical care thus far, although very limited, with only one visit to the cardiologist in Manta (returning for a second visit next Wednesday), the office, his staff, and the doctor were all very professional. The doctor spoke no English, but one of his staff members spoke excellent English and was my translator.

The office was impeccably clean and organized and appeared to have the latest equipment and supplies from what I could determine. Nothing in the office or building was in ill repair, as one may expect. A guard greeted patients at reception, and we were asked to wait in the lobby before heading up the elevator to the office facility. Once in the doctor’s reception area, I was taken in to see the doctor immediately.

There are countless articles on healthcare in Ecuador, and if you are interested, please type “medical care Ecuador” in a Google or other search engine to read further.

As for our current location, we would advise staying closer to a big city for medical care rather than staying at a remote location such as Guayaquil, Cuenca, etc. See this list of population statistics for Ecuador here. (Scroll down the page).

We’ll report back after my next cardiology appointment.

Be well.

Photo from ten years ago today, November 16, 2013:

Flying from country to country in Africa is no simple task. Check out this map illustrating the size of the African continent compared to the US and other countries. For more, please click here.

Seven years ago…Accomplishing tasks feels good!…

On this date in 2014, similar to the main photo in this post of December 14th, once again, we looked toward the driveway to discover giraffes coming our way. What a glorious sight! Click here for the post from this date.

We knew we embarked on a long journey when we left Minnesota to begin our world travel on October 31, 2012. We never imagined we’d be traveling in 2020 or beyond.

We began a road trip to Arizona, where we rented a holiday home for two months, thinking it might be a good idea to stay for future reference. Would we consider Arizona as a possible permanent home when we decided to end our journey? 

We stayed in Old Towne in a condo where we worked on the balance of the tasks we had ahead of us for two months before we could officially leave the US on January 3, 2013, seven years ago. 

Yesterday, Tom reminded me of this fact after I’d already uploaded the post. At that time, we didn’t know how to take photos and barely included photos in our posts until later on.
As a result, we decided to write this story today.
During this period, we also rented another holiday home in Henderson, Nevada, where Tom’s sisters and spouses stayed with us during Christmas while other family members came to spend time with us: son Richard from Henderson, cousin Phyllis from Massachusetts, and her two adult daughters, Robin and Wendy and, my sister Julie, all from California. We had a fantastic time.

After the holidays we returned to the condo in Arizona and spent the remainder of December continuing to complete the tasks we had on the agenda including purchasing and setting up new digital equipment.

On New Year’s Day, we headed to San Diego and spent two nights with niece Kely and her husband Dennis at their lovely home in San Diego where our first cruise on the Celebrity Century was sailing away on January 3, 2013.

We’d never been on a cruise, but as boaters in Minnesota, we had no doubt we’d enjoy being on the water. Also, we were confident we’d never be seasick. Our assessment was correct. We love cruising and have never been seasick.

Here’s the link to the day we boarded our first cruise.

Our mouths were agape during the entire cruise. Not only were we in awe of the outstanding itinerary and beautiful ship, but we were also enthralled by the social interactions that continued day after day. 

Those first few days, we were so naive about cruising we booked tables for two at dinner in the main dining room. We were having a great time together, but in only a few days, we got into the groove and started booking “shared dining” in the main dining room, and the good times escalated.

If you’d like to read about this first cruise, please click the above link or visit our archives on the right side of the page beginning January 3, 2013. You will easily be able to read through the excitement of that first cruise which ultimately shaped our opinion of cruises which hasn’t changed much over the years.

As a part of my tasks mentioned in yesterday’s post, I needed to start updating our new 2020 Excel spreadsheet, including a page for cruises only. At this point, we have five cruises booked, including the upcoming cruise from Mumbai, India on April 3, 2020, which ends in London on May 2, 2010, an entire 29-day cruise.

We cringed when it was required to pay for the entire expensive Mumbai cruise fare at the time of the booking, but now, we’re happy to have that behind us. Now, it’s imperative to begin booking holiday homes for the six-months between the Mumbai cruise and the cruise returning to Africa for which we’ve yet to be provided a visa waiver. 

On Monday, with the holiday season over, we’ll start making phone calls to find an immigration lawyer in South Africa to assist us with the issue. That item was on yesterday’s to-do list. The time difference is quite an issue.

As a matter of fact, from the seven items we’d listed in yesterday’s post, we are down to only four things when we immediately got to work accomplishing these tasks. More on this later.

Last night, we had a happy hour get-together at our place with the family and our two new neighbors. Today, there’s a party by the pool at 3:00 pm, which we’ll attend with the family and other locals who’ll gather around our table.

And then, there were nine! Tonight, at 10:00 pm, we’ll pick up Margie from the Mesa airport, and our family group of seven will be complete. However, within the next few weeks, another of Tom’s sisters, Rita, will arrive from South Dakota and, Mary and Eugene’s son Kevin (Tom’s nephew) will also come. The good times continue.

May you be experiencing good times with your family and friends in the New Year!

Photo from one year ago today, January 4, 2019:

One year ago today, we spotted young zebras running around a circular path playfully chasing one another. For more photos, please click here.

Making a list…Checkin’ it twice!…

On this date in 2016, we posted this photo of a vegetable stand where we purchased most of our produce during the 28-day stay in Pacific Harbour, Fiji. For more from that date, including final expenses for Fiji, please click here.

With the new year upon us and only 26 days remaining until we leave for India, we’ve begun to put the wheels in motion to get everything for our departure.

Last night, I began compiling for our departure, including the following:

1. Compile a box of cold weather clothing and ship it to our mailing service in Nevada to hold until we need it again. We are glad we’d purchased warm items in Minnesota, Nevada, and Arizona with the cold weather. This morning it was 35F (1.7C). It makes no sense to bring these items to India, but we may need them again during the year.
2. Order the box of supplies we have awaiting us at the mailing service in Nevada.
3. Contact an immigration attorney to begin working on our visa waiver for South Africa.
4. Contact United Healthcare Global with questions, and purchase an annual health insurance policy for the two of us.
5. Reorganize our supplies suitcase to lighten the load.
6. Purchase a list of items we’ll need for India and in the future; socks for both of us, a belt for Tom, and cool summery tops for me.
7. Start transferring data from our current Excel spreadsheet to our new workbook that is relevant for 2020 only.

Each of these items could take some time, but I must get to work with the days ticking down. The list falls into the categories of tasks that I perform, not Tom. He has “other fish to fry,” and his time will come soon enough to get to work.

Traveling the world isn’t a laid back as some may perceive. Last night while we had Shark Tank on the TV in the background, I scrolled through over 500 listings in for Portugal. 

With our next cruise departing from Lisbon, it makes sense to spend the last few months near Portugal before we sail away on November 10th. Last night’s research proved fruitful when I found dozens of possibilities in and around Lisbon. Today, Tom and I will go through these together.

With the European Schengen visa restrictions, we have to be very careful not to stay in Europe too long, especially when part of the cruise will be visiting a few ports of call in the Schengen area that count toward our total allowable days.

It was these restrictions that caused us an immigration problem in Australia when we’d been on the continent a few days too long due to being on a cruise. The cruise was considered a “closed-loop” when sailing from Perth to Sydney (with several ports of call in New Zealand), and all the days we were cruising counted toward our maximum time on the continent. We won’t let this happen again.

They are making lists that have always been helpful to me. Although they are hardly New Year’s resolutions, our timing precipitates getting them done.

Today, we’ll work on more research, and I’ll try to knock off a few items on the “to do” list. So far, there are no plans for social activities tonight, but one never knows. They often pop up at the last minute in this senior community.

May your New Year list provides you with a sense of accomplishment we’re looking forward to over the next several days.

Photo from one year ago today, January 3, 2019:

In Marloth Park, one year ago today, one of our two favorite frogs took up residence in this cute little decorative basket near the pool on the veranda. We couldn’t stop laughing! For more photos, please click here.

Happy 4th of July to all our friends in the US…How do I get health insurance now?

Bay view on a sunny morning in Connemara.

“Fascinating Fact of the Day About Ireland”
“Many Irish names begin with “Mac,” which translates to mean “son of.”

Firstly, let’s start today with wishes for a safe and festive July 4th weekend to all of our friends and family members in the US. With the holiday falling on a Thursday, it may be a four-day weekend for many workers.  
In our old lives, we celebrated the Independence Day of America with considerable enthusiasm. We had 300 small flags lining the lakeshore, which Tom had put in place the previous night; I baked an American flag sheet cake using strawberries and blueberries for the stars and stripes, and we often had a party for friends and family.
Today, here in Ireland, this is another lovely Thursday in Ireland. To celebrate the day, early this morning, we took a drive in the countryside, taking photos along the way.
We spotted lots of cattle on a morning drive but few sheep.

It is still a cool day at 10C, 59F, but the winds were light and the sky sunny. Now a few hours later, the clouds have rolled in, and there isn’t a spot of blue in the sky.  But the weather doesn’t keep us from reveling in the scenery we see out any window in our vacation home, constantly reminding us of this beautiful country.

As I had promised myself over a month ago, on the 4th of July, I’d be able to walk up the hill from the driveway on my own with no help from Tom. This morning, I gleefully accomplished this task and have decided to repeat it at least five times a week to build my stamina for walking up steep hills.

That is not to say my healing is complete. At a little over 4½ months from the bypass surgery and three months since the two-leg surgeries, I’d be deluding myself to say the healing process is complete. I still have pain and discomfort in my sternum and legs. I’ve read that some patient’s chests don’t heal for over a year.

Flowers blooming on the side of the road.

I don’t think it will take me a year, but I will progress considerably by the six-month mark. The wound in my left leg should be closed within a month. The other already-closed incisions are still tender to touch and feel painful at night in bed.  

The hematoma in my right thigh is starting to look a little better but requires a pillow between my legs at night to avoid keeping me awake from the pain. I’m hopeful, and when I think we’ll be on a cruise in 5½ weeks, I continue to exercise, try to get enough sleep, and eat a healthy diet.  

While on the upcoming cruise from Amsterdam to Amsterdam, we have a very busy and active two-day small group tour to St. Petersburg, Russia. I’m working hard to prepare myself for this tour. In the evenings, we’ll return to the ship for the night meeting with the van at the pier the following day.

The online translation of this monument was tricky to accomplish. Can any of our new readers in Ireland translate this for us?  If so, please send an email or comment at the end of the post.

Speaking of my health situation once again (apologies for the repetition), we’ve been busy the past several days searching for a health insurance policy that accepts pre-existing conditions. We weren’t hopeful.

And, not surprisingly, we cannot find insurance for me that would include anything to do with my heart and arteries. In the worst case, I may qualify 12 months after no further treatment was required. This 12-month period would begin on May 10, 2019, when I no longer needed any medical care.

We still have coverage with the company that isn’t paying our claims, and until they provide us with formal notification, everything else is covered. The rate is almost Euro 709,  US $800 a month, which doubled after the surgery.  

A bull in a field with lots of what appeared to be pregnant females.

There’s nothing we can do at this point, short of returning to live in the US to get Medicare, Part B, and a supplement (they don’t pay outside the US). We are not willing to do this at this time and forfeit this wonderful life.  We’re eager to take the risk.

You may think we’re nuts for not moving back to the US for this reason. But, we all have to make choices for our own lives. This works for us. Quality of life is an essential factor, motivating us to continue joyfully. I could make myself stressed thinking of this, but I choose not to. Instead, we’ll continue to dream and make plans for the future.

As mentioned above, may all of our readers in the US have a safe and fulfilling holiday weekend.  And may the remainder of our readers have an equally good day and upcoming weekend.

Photo from one year ago today, July 4, 2018:
This parade of elephants consisted of more than 30. For more photos, please click here.

We have to let it go and move on…You may not agree…How to identify fake scallops…

Chef Ramsay might be pleased with the color from browning these scallops in butter. “Inside, you will also find a vivid orange roe (also called coral), which is often discarded but is edible. Rinse (don’t drench) several times in cold water to remove sand or grit. Once shucked, scallops can be cooked. If scallops are mushy to the touch, they’re undercooked. If they’re firm, they’re overcooked.” They are delicious!  For more on “fake” scallops that are often sold throughout the world. Please click here.  Scroll to the end of this post for details on this topic.

“Fascinating Fact of the Day About Ireland”
“The guillotine was used in Ireland before it was used in France. The earliest use
dates back to 1307.”

The battle with the insurance company is coming to an end. We’ve concluded they aren’t going to pay, nor will we be reimbursed for any of the bills we paid out-of-pocket.  

The stress of dealing with this has the potential to harm my future health. It simply isn’t worth it. At times, we all have had to face the reality that we’re losing money we shouldn’t have had to lose. Such is the case here. We need to move on.

We considered a lawsuit but here again, more stress and focus on the negativity that not only may affect both of us but also prevent us from truly enjoying our plans with this hanging over our heads.  

We can only imagine the endless conversations with a solicitor/attorney in the UK, where the company is based, and how those calls would impact the quality of our experiences. These types of phone calls could transpire while we’re on a cruise or touring. We need to move on.

A Connemara Pony a few doors down from us.

Why do they deny the claim? In 2007 I had a cardiac ablation in the cath lab (in Minnesota) by an “electrical” cardiologist to remove a genetic tiny extra electrical valve which suddenly caused tachycardia.  

Once he removed the tiny valve (no replacement necessary), he explained I wouldn’t need further treatment, medication, or any follow-up. I didn’t have a “heart” condition. I was not a heart patient.

Less than a week later, I was back at the health club pounding it out, feeling great with no residual symptoms. It was over. During this period, I was on a low-dose hypertensive drug that kept my blood pressure totally under control.  I still wasn’t considered a “heart” patient.

When we applied for the insurance, I knew it would be construed as a heart condition if I disclosed this. The doctor who did the ablation told me specifically not to make a deal of this when applying for insurance. I didn’t have a heart condition.

Another Connemara Pony and her colt.  The dad was nearby, and he was a dark brown like the colt.

When our current annual travel insurance discovered the ablation, they denied the claim, stating I had a pre-existing heart condition. During all the tests I’d had before the bypass surgery, I was told over and over there was nothing wrong with my heart itself.  

From a lifetime of working out, my heart was comparable to that of a healthy 35-year-old. My arteries are the issue, and I did not know, no prior treatment and no medication for this genetic condition, inherited from both sides of the family.  Heart disease, arteriosclerosis, diabetes, spinal disorders, and other inflammatory diseases were rampant on my mother’s side of the family.

One can argue I should have disclosed this when applying for the insurance because I had no known heart disease. I saw no reason to disclose it.  Would one admit every sprained ankle, every infection, and injury when applying for insurance, only to have those recovered body parts excluded from the policy?

I had disclosed I’d had back surgery in 1995, and they excluded any possible claims for anything to do with my spine, neck, and vertebrae even though I no longer had pain or was on treatment for any of this. My restrictive diet rid me of any pain, and at the time of application, shortly after we began traveling the world, I disclosed this condition in the application.

This insurance is not Medicare and has nothing to do with insurance in the US.  Medicare doesn’t pay outside the US, nor is it possible to be reimbursed for any claims. The policy was “major medical” only and didn’t cover doctor visits, dental, vision, or prescriptions.  

We had so few doctor appointments over the years of travel, up until the recent surgery.  Prices were so low for office visits in other countries, such as Euro 30.44, US $40 for an office visit. There was no need to cover office visits.

So there it is. Right or wrong. Delusional or realistic. This is the situation, and we have to live with it to avoid the above stress.

But, a new problem comes out of this. How do we get insurance for me now with the recent four surgeries?  We’ll share what we’ve discovered in tomorrow’s post.

Authentic scallops with the orange roe connection piece, which in itself is delicious!

Moving right along…tonight, we have scallops again. We can’t get enough of these. Although I’ve reduced my beef consumption to once a week, we have the scallops with steak for a quasi “surf and turf” dinner. It’s no special occasion.  We’re just enjoying good food along with coleslaw, baby asparagus, and cooked spinach (for me). Tom will have rice with his dinner.

Following is the article we found online about “fake” scallops, which we’d wondered about for years. After eating the scallops here, delivered each week by fish guy John, I doubt we’ll ever trust scallops in other countries, including the US. I never recall them tasting so delicious or having the little reddish/orange pouch on its side.  Wow!  Unbelievable flavor and texture.

“Identifying Fake Scallops (from this site)

While you can’t always trust labels, you can trust your eyes. Here are a few tips to help you decipher if scallops are authentic or fake.

Scallops from nature will vary in size and never have a perfect cylinder shape to them. Fake scallops have an identical circumference because they are made using a cookie-cutter device. Also, if you see one edge thicker than the other, it’s either stingray or skate wings that taper significantly from one side to the other.

*Look at the texture. Genuine scallops have distinct grains or fibers running lengthwise, as the edible part of scallop meat serves as a muscle that holds the two scallop shells together. A fake scallop will have fewer fibers and appear more solid and dense.

And finally, look at the thickness and see if it’s the same on all sides. If it’s made from a stingray or skate, it will be thicker on one side because their wings taper significantly from one side to the other.”

Next time you purchase scallops, you may want to check for authenticity. Enjoy the day!

Photo from one year ago today, July 3, 2018:

Notice the pellet crumbs on Ms. Bushbuck’s nose. Often, there are lots of crumbs in the enormous bags of pellets. Most wildlife is happy to lap up the crumbs if we place them on the tile steps. For more photos, please click here.

Macronutrients…What am I doing in an attempt to avoid future heart issues?…

A calf on a hill overlooking the sea.

“Fascinating Fact of the Day About Ireland”
Over 80% of Ireland’s people are Roman Catholic.”
Last night was one of those magical occasions when I slept through the night without awakening until 6:00 am. Tom didn’t do quite as well. But, we bolted out of bed, showered and dressed for the day, and made ourselves scrambled eggs with sauteed onion, grated cheddar cheese, and bacon.

I only had one piece of bacon and one tablespoon of cheese with my eggs adding one of those tiny cans of tuna on the side. This will hold me until I have my required protein smoothie sometime this afternoon.

An old abandoned building facing the bay.
Lately, with all the confusion and lack of good research on how much fat a heart patient can eat, I’ve been keeping track of everything I consume in the free app, Cron-O-Meter, found at this link.
I’m attempting to keep my fat consumption under 70 grams per day, protein at 120 grams (As recommended by the plastic surgeon. I’ll lower this after my legs fully heal), and carbs under 50 grams per day (all sourced from vegetables and fruits as mentioned below: avo and tomatoes).  
An occasional sunny day gets us out to take photos.

Note:  Carbohydrates provide four calories per gram, protein provides 4 calories per gram, and fat provides 9 calories per gram.

Thus, my macronutrients are as follows:
Carbs:  4 x 50 + 200
Protein: 4 x 120 = 480
Fat:   9 x 70 = 630

Total calories:  1310
This amount leaves room for a little red wine and an occasional snack after dinner, all of which will increase the above totals bringing it up to a maximum of 1500 calories per day.

Wildflowers are surrounding our holiday home.

Using this app enables me to keep easy track of the above macronutrients and adjust my diet during the day if I end up grabbing something unplanned. I continue to avoid all starches, grains, fruit, and sugar. Although I continue to enjoy tomatoes and avocados, both of which are the only fruits I consume.

My caloric consumption is an ample amount and yet will keep me from gaining weight. Not that I necessarily pay much attention to calories but based on my age, activity level, and current weight this caloric amount is sufficient.

Exciting rocks and seashells line the outdoor ledge of the window.
Perhaps this method won’t have a positive impact on my cardiovascular health in the long run. But add in, walking 8,000 to 10,000 steps a day, not sitting in one position too long, attempting to sleep well, and currently taking vitamins recommended by the doctors:  Vitamin C, CoQ10, Magnesium, Selenium, Zinc, and Vitamin D3. (Please see your nutritionist, dietician or doctor for vitamin doses).

I don’t know what else I can do other than keeping stress at a minimum which is more of a contributor to failing arteries than from diet based on what I’ve researched thus far. 
(These comments are not intended as medical advice.  Please see your doctor for recommendations befitting your medical health).
Stunning view of the bay from our garden.

The only stress I am experiencing now is the ongoing issues with the health insurance company and their refusal to pay, claiming I had a pre-existing heart condition (which I did not).  

Each time I get an email from any of the parties involved, I can feel my heart beating faster with frustration and anger over this unbelievable situation. I can’t wait until this is finally resolved. Each time I think this way, I get up, walk around the house and take lots of deep breaths.
As for today, we’re busy online planning our upcoming trip to the US in less than five months. The time goes quickly, and this has become a priority. Soon, we’ll report back with plans we’ve booked for November.
Have a stress-free and pleasant day!
Photo from one year ago today, June 11, 2018:
The rhino’s skin looks a little too large for their bodies. From this site: Members of the rhinoceros family are some of the largest remaining megafaunas, with all species able to reach or exceed one tonne in weight. They have a herbivorous diet, small brains (400–600 g) for mammals of their size, one or two horns, and a thick (1.5–5 cm) protective skin formed from layers of collagen positioned in a lattice structure.” For more details, please click here.

Tricky situation…

Happy on a hill.

“Fascinating Fact of the Day About Ireland”
Beer is widely popular in Ireland. It first originated in the country and can be found in Pubs and grocery stores.”

It’s challenging to decide on how to begin describing this dilemma. We encounter such challenges in our world travels and usually can figure out a solution. But, the situation we describe here today is challenging.

Picture this…we purchase SIM cards in each country we visit, resulting in our getting a new phone number each time we move to new lands. For us, this works well, avoiding the cost of paying for a US contract we’d never use nor want to use, based on international roaming.

Wildflowers in the garden.

As described in yesterday’s post here, based on the fact our international health insurance isn’t paying my medical bills, we are delivering the outstanding bills out-of-pocket, hoping to get reimbursed at some point which is highly unlikely.

We’ve been able to pay the outstanding bills using credit cards, for which we call the payee and provided credit card information over the phone, except for one.  Thus, this is the dilemma we describe.  

Pretty pink flower in the side garden of our holiday home.

The only way this particular provider will accept payment is through a bank transfer. This is well and good under normal circumstances. However, this morning our bank informed me they require verification of the wire transfer through a verifiable US phone number.  

We don’t have such a number, nor can we receive texts through Messenger on Facebook or locally on our Irish SIM card. For friends and family worldwide, this has worked perfectly. We do have a Skype number but cannot receive texts via this means.

Excuse the tilted photo taken while the car was moving.

When we arrived in the US, we’ve decided to purchase two Google phones. These phones can have a US number and be used at affordable rates for calling and texting worldwide. If we had those phones now, it wouldn’t be an issue.

However, we didn’t want to order the phones to be shipped to us to avoid the possibility of theft and high customs fees. While in the US, this won’t be an issue. We’ll order the phones to be delivered before arrival in the US to be shipped to our hotel in Minneapolis.  

Overcast day view of the Twelve Bens (mountains).

Upon receipt of the Google phones, we won’t ever need to purchase a SIM card again. One weird factor of these phones is that it is expensive for us to call one another. Subsequently, we can use Whatsapp at little cost using the included data plan we’ll select with Google, which may be around Euro 26.53, US $30 a month.

While living in the US before traveling in 2012, our Verizon phone bill with unlimited data, text, and calling was approximately Euro 199, US $225 per month.  If we had a US contract these days, we’d spend more than we can imagine.

Unusual markings on this cow who looks pregnant.

Another benefit of using Google phones is that as soon as we land in a new country, we can call Uber instead of grabbing an expensive taxi waiting outside the pier or airport. Plus, we’ll always have the availability of MAPS the moment we drive off in the rental car.

However, the above is a moot point. For now, we can’t receive a text, nor will our bank accept a phone number belonging to a family member. They will only accept a phone number in our name in the US.  

Her calf is suckling.

How will we pay this bill? I have contacted the payee’s billing department, asking them to suggest an option such as PayPal or, can we mail them a check? Our bank doesn’t handle BillPay payments outside the USA. But we can send a check to our mailing service and have them snail mail the payment, which seems to be our best option.  

We’ll see how this rolls out. We’ll report back.

Have a happy, healthy day!

Photo from one year ago today, June 10, 2018:
Mongooses stay close to one another, often seen grooming and cuddling one another. For more photos, please click here.

The health insurance debacle…Not everything is as it seems…

What a face!

“Fascinating Fact of the Day About Ireland”
The Irish famine in the 1840s led to a population decline of two million people because of immigration and starvation.”

When we purchased our annual international health insurance policy from a company in the UK almost seven years ago, we’d hoped we’d never have to make a claim. The policy was issued for “major medical” only, meaning it covered hospital stays, surgeries with in-hospital treatment, and medication but not routine doctor appointments, urgent care facilities, or prescription drugs.

The co-pay for the hospitalization is Euro 1763, US $2000, per hospital admission. Since February this year, I’ve had three hospital admissions and four surgeries (two leg surgeries in one five-day hospital admission).  

At the time of the first admission, we paid out-of-pocket, the sum of ZAR 80000, US $5348, Euro 4715, for the estimated cost of the first visit to “theatre” for the angiogram including one overnight stay. At the time, the hospital’s billing department was diligently attempting to get our insurance company to pay, to no avail.

During the subsequent surgery, the cardiac bypass, the insurance company hedged for days but finally got their funding subsidiary to pay a portion of the hospital bill excluding all the doctor bills.  

Our insurance company was attempting to claim I had a pre-existing heart condition I hadn’t disclosed at the time of the application in 2012. This is simply not true.  

Sheep grazing on a hillside.

Sure I took a low dose hypertensive drug for a mild case of heredity high blood pressure, but I had disclosed this at the time of the application.  My blood pressure has been totally under control for the past 20 years, usually running around 110/68, certainly not a concern.

Besides, would we be traveling the world, often embarking on strenuous activities, if I had a known heart condition?  Hardly. We had no idea. We’d have taken immediate action rather than risk my having a life-threatening cardiac event had we known.

Then, on March 29, 2019, we visited the cardiothoracic surgeon for a routine post-cardiac bypass surgery exam at which point when he examined the condition of my legs, he immediately arranged an appointment with a plastic surgeon with excellent “wound care” experience.  

Within hours, I was immediately admitted to the hospital, having the first of two leg surgeries a few days apart.  But, before admission, we spent two very stressful hours, trying to get the insurance company to pay the required ZAR 130000, US $8690, Euro 7662. Here again, we had to pay out of pocket when the insurance company wouldn’t come through.

I spent hours on my phone attempting to get the insurance company to pay. Once again, they used all the excuses in the world to avoid paying. They said we should go ahead and pay out of pocket and later file claims, which we’ve done, again to no response.

Since we’d already paid the plastic surgeon’s bill out-of-pocket, in the above ZAR 130000, we had no outstanding bill with her. Plus, we’d paid the ZAR 80000 out-of-pocket for the first hospital admission to the cardiologist.

Two adult Connemara ponies and a youngster.

Remaining have been the bills for the anesthesiologist, surgical technicians, and most importantly, the cardiothoracic surgeon who’d performed the bypass surgery.

Need I say, dealing with the insurance company and their representatives to get these outstanding bills paid has been an outrageously stressful situation. When I was dealing with this, I could feel my heart pounding in dire frustration.

Why didn’t Tom handle this? We all have our specific skills. Negotiating and handling the endless flow of paperwork was simply not Tom’s forte, and it hardly felt like mine during recovery.

I recall being on the phone with the insurance company while I was in ICU for eight days and immediately upon returning to Marloth Park after the surgery when I was in rough shape for many weeks.

So, where are we now? With their refusal to pay they have claimed they are awaiting my medical records for the past 20 years which I have since verified are in their hands.

Now, bit by bit, bill by bill, we are negotiating with doctors requesting they accept a discounted payment from us. This is standard practice in the medical business when companies often deal with reduced fees for services, especially in the US for Medicare and Medicaid and national health insurance (NHS) as provided to citizens of the country of South Africa.

A beautiful sunset from the garden.

We’re almost done paying with one outstanding payment to negotiate, which we’ll hopefully resolve by tomorrow. At that point, we’ll submit a few more claims and wait and wait and wait…to see if the insurance company will ever reimburse us.

In the meantime, we’ve had no choice but to keep the policy in effect, although they doubled the premium after the surgery. No company will insure me other than Medicare in the US which I may have no choice but to re-instate once all of this is resolved.  

It is ill-advised to cancel the policy now until all of the claims are resolved or, we give up hoping to be reimbursed. While in the US in November, we’re considering signing me up for Medicare which doesn’t pay for any medical treatment outside the US but if I need non-emergency treatment, we can always fly back to the US for such treatment. If it’s an emergency outside the US…we’re in big trouble.

Many may say, “stop traveling and return to live in the US.” We have no interest in doing this. We have a lot of the world left to see and are not forfeiting the joy and happiness we continue to experience in our travels.  

If and when the time comes, we can no longer travel due to medical issues, we’ll decide at that time.  We now realize the delicate balance of life itself, more than ever, and how and why we should live it to the fullest.  

Many don’t get this decision but, we do, and in the long run, that’s all that matters. We’ll continue to update the progress on this frustrating situation as we continue. Right now, our focus is on healing, recovery, and putting all this stress behind us.

Have a pleasant day and evening wherever you may be.

Photo from one year ago today, June 9, 2018:

Water spouted out of his mouth after he took a big gulp of water. For more photos, please click here.

Celebrations aren’t the same right now…We aren’t missing a thing when we have so much to celebrate!…

Check out these mature horns on this Big Daddy kudu!

“Sighting of the Day in the Bush”

Mongoose, who are carnivores, don’t bother with the marulas currently dropping from the trees.

Today, March 7th, is our 24th wedding anniversary. This will be the first year we won’t be making a fuss or dining out to commemorate this special day.  

My goodness, I’m alive! This is cause for celebration! I was in the ICU in hospital on Valentine’s Day, still in ICU on my birthday on the 20th and now recuperating at our holiday home in Marloth Park on our anniversary. Instead, today, we’ll stay in as I continue in my recovery, celebrating Life itself.

Kudus by the veranda steps.

None of this bothers me or makes me feel sad. None of those special dates would have any meaning if my dreadful heart condition hadn’t be discovered by the best doctor on the planet, Dr. Theo Stronkhorst, in Komtipoort, who essentially saved my life.

In hospital, the cardiac, thoracic surgeon, and the cardiologist explained that when I would have had a heart attack which was inevitable at any time, there would be no resuscitating me. With only one working artery, death would have been imminent.  

Kudus were enjoying pellets.

Instead, I’ve been given another shot at life, and today, on our 24th wedding anniversary, I celebrate this second chance with the man of my dreams, my partner, my lover, my best friend, and now my diligent, hard-working, and devoted caregiver. I don’t need a fancy meal or the ambiance of an upscale restaurant to make me feel loved.  

All I need is to be with Tom today, reveling in the gift we’ve been given…more time to be together…more time to travel the world…more time to embrace the wonders of the world around us. For this, we celebrate with indescribable joy.

A Big Daddy was checking out the snacks being offered.

Last night, at happy hour, Kathy, Don Linda, and Ken stopped by for sundowners and celebrated Life with us before they headed out to dinner. It was beautiful to see them all, although I excluded myself from a glass of wine. 

At this point, the thought of a glass of wine or other cocktails makes me feel queasy. I’m sure; once I’m off some of these medications, I’ll be able to enjoy one or two glasses of red wine, now and then. For now, hot or cold tea and diet orange soda are all I can manage to get down.

Three Big Daddies stopped by together.

The conversation was lively and animated as we sat at the big table on the veranda after dark. It seemed like so long ago that we all were together when in fact, it was only on Saturday night, February 9th, that we had dinner together at Jabula to celebrate a good outcome for my upcoming triple bypass surgery. At that point, only three days away.

I easily recall how frightened I was at that time, but I was also comforted by their encouragement, friendship, and love. It was a fun night. We’re planning to replicate that good time, after the fact, next Friday on March 15th, when I plan to attend another dinner at Jabula. This will be my first time out to dinner since the surgery.  I’m so grateful. (Bear with me, I can’t stop saying this).

This morning’s mongoose frenzy.

The four of them took off early this morning for an educational safari adventure studying birds of prey in Kruger National Park. It will feel as if we’re right there with them! I’m hoping to share some of their photos and a little information about these fantastic birds once they start posting photos.

I won’t extol the virtues of my fine husband Tom and bore our readers “ad nauseam” with why I feel so lucky to have been married to him for the past 24 years and together for almost 28 years. Those who’ve been reading our posts over the past seven years (our first post was March 15, 2012) already get it from snippets I’ve included here and there.

Once they devoured the eggs, Tom mixed up. They wait in hopes of more.

Instead, I’ll say, “Happy anniversary, my love. Now we have many more years to enjoy life together.” What more could I ask for? Healing? It’s coming. I feel a tiny bit better each day. Last night my feet didn’t burn during the night. And although I awoke a few times feeling pain and stiffness, I could tell I was on the mend.

Coronary bypass surgery is a big operation.  I have four significant incisions in my body, a broken sternum, and various sites healing after the insertion of tubes.  The three over-foot-long incisions in my legs are painful, making moving and walking as required difficult. The incision in my chest from my collarbone down to my stomach burns, itches, and aches. The inside of my chest, which was wired back together, is painful as it stretches and strives to heal. The pulled muscle in my right chest will take months to heal. 

But…I am alive to celebrate this outstanding marriage and continue our fantastic world journey for as long as possible. 

May good health come your way!

Photo from one year ago today, March 7, 2018:

One year ago: This morning’s first-time visitor to the yard, a wildebeest.  Never once did he look at us or pick up his head for a face photo. But, we were happy to see him anyway! Later, we named him Wildebeest Willie, and he’s been a regular since a year ago. Now he looks into our eyes before eating any pellets. For more, please click here.

Good news…Uplifting with peace of mind…Safari luck prevails…Gratefulness…

Little came looking for me, wondering why I haven’t been sitting outdoors as usual. Oh, Little, you put such a smile on my face.

“Sighting of the Day in the Bush”

These species get along well, especially when there are plenty of pellets to share.

It wasn’t as simple as returning to our bush house and working on my recovery.  There are so many things to handle besides the credits and refunds we’ve been hoping to receive, in part, if at all.

A few items easily fell into place (some of which we mentioned in an earlier post), which includes:

  • The extension of the car rental for another three months until we leave on May 11th: The rental company, a subsidiary of Hertz, agreed to continue the rental until we leave for the same excellent price
  • The coincidental cancellation of a flight by Ethiopian Air for the flight from Nairobi to Santiago Chile resulted in a refund for ZAR 31587, US $2,150. This was a stroke of safari luck for sure. (We’ve yet to receive the refund but are working with Expedia to get this done).
  • A partial refund from Greg Harvey Tours for the photography tour to Kenya for $5000. (We lost over ZAR 142265, US $10,000 on this one)
  • Partial refunds from two cruises we had to cancel.
  • Cancellation without penalty of two hotel stays we’d booked, one for one night, another for seven nights.
No sooner than Tom opened the big doors this morning, these two zebras were waiting to see if there were pellets on the menu.

As time marches on, we see other ways we can save a few dollars here and there.  But, the biggest relief of all came today when the top billing administrator from Mediclinic Nelspruit informed us that our insurance company would pay the claim for approximately ZAR 700000, US $49,204 minus a ZAR 28453, US $2,000, deductible for the cardiac bypass surgery.

Once that’s paid in the next week, then we’ll file the claim for reimbursement to our insurance company for the ZAR 80000, US $5628 for the angiogram and other tests before the surgery, an entirely separate bill, again requiring a ZAR 28453, US $2,000 deductible which we’re happy to pay.  

Suddenly, there were more when the word got out.
The alternative would have been for us to pay, out of pocket, ZAR 842267, US $59,2014, a substantial chunk out of our budget that would have severely impacted plans for the future while we recovered from the unexpected loss of such a huge sum.  
Since we needed to prepare for the eventuality of the insurance company refusing to pay, we had to liquidate some assets (sadly) at their lowest value to put the funds into our checking account to be prepared for the hospital requiring immediate payment.  
A moment later, we had kudus in the garden as well.
We’ll have to bear US tax consequences for taking out this sum and working with our accountant in Nevada to see how this will roll out for the 2019 tax year.  There’s no free ride.
However, we feel the peace of mind and relief that the insurance company will pay the very reasonable hospital bill of ZAR 700000, US $49,204. In the US, the cost of this surgery could have been eight or nine times more than the cost here in South Africa.
Then, of course, Little appeared.
The insurance we have doesn’t provide coverage while we’re in the US.  Had this situation transpired and with the limited coverage offered by Part A Medicare, we could easily have had to pay well over ZAR 1422653, US $100,000.  
The cost per day for the ICU unit in the US typically runs from ZAR 99586, US $7,000, to ZAR 142265, US $10,000 per day.  I spent eight days in ICU in Nelspruit.
The identical five zebras visited off and on all morning.

Need I say, we are relieved beyond words. Not only was my life spared by this horrible situation being discovered during our last few weeks while in South Africa, but we’ve been spared some tough-to-swallow expenses had we been anywhere else in the world.  

This, above all other safari luck experiences, has genuinely been the best of them all.  Sure, I’m still in lots of pain and expect to be so for at least several more weeks, but my spirit is uplifted and hopeful for the future.  

The zebras often get into little scuffles amongst themselves over the pellets.

I do not doubt that I’ll be sufficiently recovered for our May 11th flight to Dublin and the long drive to Connemara, Ireland, where we’ll settle for almost three whole months, picking up where we left off in our worldwide journey, as we continue to share this blissful experience with YOU…all of our worldwide readers.

A few readers have written and asked this question in one form or another: “Did you, at any point during this medical crisis, fear your travel days were over?”

Little likes to eat Frank and the Mrs. birdseed, which we often toss into this area.

The answer from me is straightforward…once I realized I’d survived the surgery, my hopes have escalated each day. On the other hand, Tom, the worrier, has continued to be concerned even as recently as this morning.  

But, with the insurance company paying the bill and these other refunds coming through, soon his mind will be at ease, especially as he sees me improving a little each day.

Kudu and zebras.

Thank God. Thank the Universe. Thank the South African doctors for their expertise. Thank Dr. Theo in the little town of Komatipoort for discovering my condition by going on gut instinct and his deep compassion for his patients.  

In essence, this experience, however painful and frightening, may prove to be the best thing that ever happened to me.

Safari luck and gratefulness, a winning combination.

Photo from one year ago today, March 6, 2018:

This was a “tower” or “journey” of the eight giraffes who made their way to the only paved road in Marloth. Note the eighth giraffe is to the far right in this photo. For more photos, please click here.