Equipo Williams

First off, everyone is perfectly fine. Please, nobody begin reading this in a panic. Today, Audrey and I took a trip to the ER in Río de Janeiro and I thought you might like to know how that went. 

Audrey’s right knee has been hurting for three or four weeks now. We can’t recall any specific injury that started it, but it’s just been sore and hasn’t gotten better, despite generally doing the right RICE (rest, ice compression, elevation) things. Well, maybe we didn’t do all of those things very well while hiking around in the jungle last week where ice is scarce and some walking over rough terrain was required just to get to and from the jungle lodge. 

So the past week her pain has been getting a bit worse, and we decided we should see a doctor. We have Geoblue international insurance and they recommend a telehealth consultation initially for pain and injuries, so last Friday from the Manaus airport Audrey and I got on a video call with a doctor. That doctor recommended an in-person exam and suggested an ultrasound or X-ray would probably be advised. 

I then pored through the insurance website and app to get information on recommended providers and what should be covered or not. I called the “in-network” pediatrician listed in the insurance app for Río de Janeiro, who said that we should just go to the emergency room. He recommended one near our hotel. 

I’ll admit, I went through some internal hand-wringing about that. I mean, her knee is sore but she can still walk gently on it, and it definitely doesn’t feel like an emergency at all. My experience with ER visits in the US is that you wait for several hours (particularly for something that isn’t actually urgent), fill out heaps of paperwork, wait again a few hours for scans, then receive a fairly large bill even after insurance pays their share. On the other hand, Marcus convinced me that we’re only in Rio a few more days and after that it may get harder to find doctors that speak English in more remote areas. Plus the local doctor had actually suggested it, so we went. 

We took an Uber 5 minutes down the street to the recommended hospital Copa D’Or, which is private. At the reception desk for the pediatric emergency department, there were a few signs in English, but none of the three ladies at the desk spoke any, so they gestured for us to sit down. We waited maybe 10 minutes, then the receptionist came over with a printout of a few questions that I think she used Google Translate to convert to English, and a pen so I could write my answers. I wrote that Audrey was a new patient, we had insurance, and then I handed her our ID and insurance card. 

Another 10 minute wait, then I signed some papers saying I acknowledged we have no Brazilian insurance and I am willing to pay the full charges if necessary. 

While waiting, I called our insurance and asked about the claims process – did we need or could we get any preauthorization? I was imagining several thousand dollars for the doctors and ultrasounds and X-rays and who knows what else. Eventually I learned we would just need to pay out of pocket and file a claim to be reimbursed. With our insurance plan, there’s a $50 co-pay for ER visits and a $2500 deductible per patient, so at least I felt reassured that we wouldn’t totally go bankrupt in the end. 

We waited only a few more minutes and then a doctor who spoke quite good English interviewed Audrey and got the basic history. She immediately referred us to an orthopedist and of course I was imagining we would have to make an appointment and come back another day for that. Nope. They fetched Audrey a wheelchair because it was “a bit far,” (a few hundred meters down a hall, up an elevator, then another few hundred meters) and wheeled her right up. Within about 5 minutes she was being interviewed again and then examined by the orthopedist. He explained that she was experiencing some inflammation around her iliotibial band, which occurs due to overuse and is more common in slightly older kids. But we should ice it up to 5 times per day and take some anti-inflammatory medicine for five days, plus pain medicine as needed. He had to look up the translation for a few words (like iliotibial band) but spoke fairly good English. Better than our Portuguese for sure! He printed out a slip with the medication info and hailed an orderly to wheel Audrey down to Billing. Eep. 

We waited in the hallway there for maybe 5 minutes and in the meantime a nice lady showed up and said she would help with translation if needed while we paid. Once the Billing staff member arrived, he printed out our bill, which was just over $R500 (about $100 USD). I paid with a credit card and got enough official receipts to submit the claim to insurance (which at least starts counting against the deductible). Seems like a totally reasonable amount after seeing two doctors and being helped by about a dozen people at one point or another. 

After just over an hour, we were in an Uber back to the hotel and stopped at the lobby restaurant for some ice. 

So even without insurance, taking Audrey to the ER cost us just over an hour of our time and about $100 (plus two $3 Uber rides). For that we have the reassurance from a doctor that she just needs anti-inflammatory medicine and continued RICE treatment. Brazilian ER: 5 out of 5 stars, highly recommend, though I hope you never need it!