~ More than 5 hours of waiting for 4 stitches and a bill of US $877.50 (EUR 830.00)! ~
On March 14, 2023, we reported to the Emergency Department of the Sint Maarten Medical Center (SMMC) at 10:00am, because my wife had suffered a flesh wound in her leg, which needed to be stitched up.
Soon she was seen by a triage doctor who determined that the wound needed to be sutured. No fracture was detected. Whether we were insured was the question. Yes, at Menzis and we showed the Menzis health insurance card . No, you are not insured, because you do not have local insurance, we were told. Despite the fact that Sint Maarten belongs to the Kingdom of the Netherlands, a Dutch health insurance card is however not accepted. And which tourist has local insurance? No one, right? At a later stage – after filing a complaint – we were told that the SMMC did not conclude a care contract with Menzis and therefore we were not insured. This explanation is acceptable. In practice, uninsured meant that the SMMC could charge what they want, more about that later.
After the triage doctor, we were referred to the waiting room. Only after 5 hours (!) of waiting we were helped further. We could not entirely avoid the impression that the local population was favoured, but of course that cannot be substantiated. The doctor who applied the stitches was friendly and knowledgeable. Now quickly checkout and away. No, first an X-Ray had to be made to rule out that the bone had not been hit. The attending physician didn’t know why either, but the chief physician had determined that. Of course, the X-Ray should have been made before the stitches were applied. If they had found something – which fortunately wasn’t the case – should the stitches have been removed?
During the complaints procedure, the SMMC stated that we had agreed with the X-ray. This was a bit more nuanced. We indicated at two doctors that we did not see the point of an X-ray after applying the stitches, but the head of the department insisted that an X-ray be made, to rule out that the bone had not been hit. There was only a flesh wound, which was also determined by the Dutch triage doctor. He also did not understand why an X-ray had to be made, but because he had only been working in the SMMC for 2 days, he was overruled by the Head of Department. There was no point in protesting further and we only agreed because we wanted to leave as soon as possible.
Given that we were not insured according to the hospital, we had to pay the bill ourselves. That amounted to a whopping US $877.50. For 4 sutures plus a tetanus injection and an X-ray. Because you only want to leave after almost 6 hours in the hospital, you pay and do not enter into the discussion about the height at that moment.
The next day I filed a complaint with Mrs. Bonnie Dekker, a board member of the SMMC. I indicated to her that in the past I was Managing Director of the Amersfoortse Antilles (now Ennia), at the time the largest health insurer in the Antilles and that the staff of the SMMC was insured with me at that time. And that I knew something about rates. The bill of US $877.50 was excessive in my eyes (not to mention the long waiting time).
Her response was as follows: “As far as the amounts are concerned, I understand that there is no insurance. The cost of treatment including care for a wound may be higher if this was done in an emergency room, because an amount must already be paid for the consultation itself. Of course, I don’t know what the care situation was and why the doctor decided to take an X-ray. I have asked our complaints officer to send me a digital form. Once I have that, I’ll send it via WhatsApp”
We completed the complaint form and sent it with the request to provide a breakdown of the costs. Despite multiple requests to do so, still nothing received. We received a copy of the bill we already got when we left the hospital. The specification on the bill read:
1. ER Treatment Group 3 : NAf. 1,270.00
2. Lower leg right: NAf. 309.50
Total: NAf. 1,579.50 (= US $877.50)
I made it very clear that I wanted to receive a full breakdown of the costs: use of the Emergency Unit, costs of the triage doctor, costs of the attending physician who placed the stitches, costs of the head doctor, costs of tetanus injection, etc. Only on the basis of this, it can be assessed whether excessive charges have been made. Again, US $877.50 (EUR 830.00) for 4 stitches seems to be on the high side, to put it euphemistically. You also might think that the SMMC is trying to cover the costs of the new hospital in this way. But as said, the hospital refuses to give a full insight of their costs. As a result, they can charge what they want.
Sint Maarten is and remains a beautiful tourist destination. But, try – as far as possible – to avoid the SMMC. Go to a local doctor or to the hospital on the French part.
Finally, another point of attention for tourists. When renting a car, please note the following: In accordance with the LAM (National Ordinance on Motor Vehicle Liability Insurance), the coverage for civil liability is limited to NAf. 90,000 (approximately EUR 50,000). This means that in the event of an accident, for which you are liable, you only have a cover of EUR 50,000 and you personally pay for the excess. Especially if the other party has an injury, this can involve considerable amounts. Fortunately, most car rental companies nowadays offer a standard coverage of 1 million, but it is still wise to check this carefully (NB: the same applies to Curaçao, Aruba and Bonaire).
Peter van der Pligt