International students asked to pay up-front before emergency treatment in Queensland hospitals

International students have recalled frightening and distressing incidents of being asked to pay hundreds of dollars upfront before being treated in emergency departments at Queensland public hospitals.

It has prompted advocates to call for a change in hospital policy to pay for students’ health insurance directly.

International students are not eligible for Medicare, but as part of their student visa, they are required to have health insurance.

Feroza Arshad and her husband came to Australia to study, and after completing her studies she started working on a temporary graduate visa.

While her husband’s studies continued, their first child, Hashim was born in July 2021.

Hashim was born prematurely, and two days after returning from the hospital, the baby cried for a long time.

A small baby boy is in his bed, sleeping
Hashim Arshad New Born 2021.(Provided by: Feroza Arshad)

“I tried to calm him down and he started to cry a lot, then he turned red, he just kept quiet,” he said.

“His eyes were closed and I tried to move his limbs but to no avail.

“I was trying to wake him up, he wouldn’t wake up, so as a new parent, I freaked out, I called an ambulance.”

Paramedics examined Hashim, then took the mother and baby to the hospital.

‘When they had the bank card they let us in’

When they arrived Ms. Arshad said that the triage reception, her child was still in bed and the paramedics were standing next to him, she asked for her son’s name and details.

Ms. Arshad explained that she does not have Medicare, rather she has health insurance. The hospital official then asked for the initial payment or a bank card.

“I remember I didn’t have my wallet or anything. So I called my husband [who had followed the ambulance in his car] and I said, ‘Where are you? You have to come in.”

Due to the COVID-19 restrictions, Ms Arshad said her husband was unable to enter, so the hospital arranged for a staff member to go and collect their bank card.

“The whole time Hashim and I are in the reception area. I was very scared, very worried, very nervous, crying,” he said.

“They said they had the card at the reception, and they let us in.”

A baby boy is lying on his mother's chest.
Feroza and Hashim Arshad after returning from the hospital after the child’s seizure.(Provided by: Feroza Arshad)

Ms. Arshad said that when Hashim was being treated, a hospital employee asked him to sign the documents that allowed the payment to be processed.

“I remember it was very scary for me – those 10 to 15 minutes – it was a very long time because I was waiting, and my child was not picked up,” she said.

“I just wanted him to come in and be checked, and make sure everything was fine. I’m a doctor and part of me inside was telling me: ‘Oh, every second counts, every minute counts. Why are they neutral. Him in?’

“Maybe I’m overthinking – but if you put yourself in my shoes – I know every parent would be scared.”

Ms. Arshad said that later she was told that her child has arthritis and that while he is healthy, his body is tired.

“They told me: ‘you did well, you called an ambulance … they brought him in’,” she said.

Hashim was released after six hours of observation.

Feroza is holding her young son, looking at the camera
Feroza Arshad came to Australia with her husband and son.(ABC News: Cameron Lang)

Ms. Arshad said that since the hospital was able to bill her health insurance directly when she was admitted when Hashim was born, she wants the same procedure to be used in the emergency room.

“Why can’t I bill my insurance directly when I go to an emergency or when I go by ambulance?” he said.

“So that means that what you have to do is, make a policy about it, you have the means, you have resources, you have effective plans, you have to make a policy about it.”

Pakistan Australian Cultural Association (PACA) president Syed Asghar Naqvi said international students or people with temporary visas face many problems when they go to emergency departments.

A man stands in front of a mural made of cultural references in Pakistan.
Pakistani Australian Cultural Association (PACA) president Syed Asghar Naqvi.(ABC Radio Brisbane: Edwina Seselja)

He said the financial pressures on international students include tens of thousands of dollars a year to get their degrees, while weighing living and accommodation costs, as well as limits on how much they can earn.

“As an Australian, as a member of the Pakistani community, I think we need to manage people [a] in a human way, especially when a person is in an emergency,” he said.

“If students go to hospitals, the policy needs to be changed when hospitals ask for money in advance.”

Mr. Naqvi said that there are examples where students from other countries, who develop chronic diseases while studying, do not have the appropriate level of insurance to cover the medical expenses.

PACA helps struggling international students by creating online fundraising appeals to pay for their medical expenses and encourages community members to provide food and other support to students.

Mr Naqvi said he wants the government, the university sector and health insurance companies to work together to better support international students.

He suggested that universities and health insurance companies could better prepare health insurance packages that provide international students with high-quality coverage but at affordable prices.

“The government should help students to make it a necessity to have a very high cover, because in the long run students will suffer if they need support,” said Mr. Naqvi.

Despite having health insurance, Amir was billed $1,500 for a heart attack

In October 2021, Amir Mehmood started experiencing chest pains. Thinking that it could not be serious, he went to the doctor to seek treatment. But later that day the pain became “unbearable”.

Just minutes after driving from Brisbane’s QEII Hospital, Mr Mehmood asked a friend to drive him to the emergency department.

Mr Mehmood said he was told that as a Medicare ineligible patient he would have to pay early.

He said he didn’t have enough money at the time, so he asked his friend to help him pay.

When he was taken to the emergency department, he was monitored with an ECG, and then transferred to Princess Alexandra Hospital (PA).

Sign and Princess Alexandra Hospital main road in Brisbane
Princess Alexandra Hospital billed Amir Mehmood $1,500 to care for him when he suffered a heart attack.(ABC News: Liz Pickering)

“[The] The next morning, they informed me: he has a heart attack,” he said.

After being admitted to the PA hospital, she was billed the full cost of her care – about $1,500.

Mr Mehmood said many international students believe that because they have health insurance, they will not have to pay first for emergency care and apply for insurance later.

“Emotionally, it was really hard,” he said.

“Hospitals should change their policy, that if someone comes in, in an emergency at least, they can be charged from the beginning,” he said.

In a statement, Metro South Health said it is committed to providing timely emergency health care based on clinical needs and will explore any opportunities to improve processes and communication regarding payments to Medicare ineligible patients.

A spokesperson for the Queensland Department of Health said anyone who goes to hospital will be seen based on clinical needs, not their ability to pay.

“Government hospitals may request payment from patients who are not eligible for Medicare to recover the costs associated with the care provided, however these decisions will not delay the delivery of emergency care,” said the statement.

“Decisions on how costs are recovered for Medicare ineligible patients are controlled by each Hospital and Health Service.

“Any payment requested from patients who are not eligible for Medicare must be commensurate with the quality of care provided.”

Metro South Health acting CEO Adrianne Belchamber said patients who are not eligible for Medicare who need emergency care and are uninsured or have difficulty paying are not denied care.

“Anyone who needs emergency life or limb-saving health care will always be treated, regardless of whether they are eligible for Medicare,” she said.


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