People living in Japan under the Status of Forces Agreement owe Japanese hospitals tens of thousands of dollars in unpaid medical bills, medical officials say.

The problem is jeopardizing the relationship between base clinics and Japanese medical facilities and could make it more difficult for them to seek emergency care.

“These host-nation facilities can at some point say, ‘we’re tired of this, we’re not taking any more of these patients,’” said Lt. Col. Ronald T. Stephens, commander of the U.S. Army Medical Department Activity-Japan (Meddac) at Camp Zama.

Debtors most often are people not covered by Tricare, the military’s insurance system. They include people who either don’t have insurance or whose insurance doesn’t cover incidents in Japan, such as Medicare.

Some cases have involved insured Department of Defense civilians who received claim checks from their insurance companies after receiving service, but failed to turn the payments over to the Japanese hospital where the service was provided, Stephens said.

“First and foremost, those are bills that people genuinely owe,” he said.

At Camp Zama — where acute and emergency patients are generally referred to one of four Japanese facilities — more than 20 Americans currently owe more than $110,000.

Some of the cases are more than a year old, Stevens said.

“It sheds a poor light on Meddac, on U.S. Army Japan, the Army and the United States.”

The problem seems limited largely to Japan; in South Korea, for instance, U.S. civilian patients routinely are referred to off-post clinics, particularly for dental care. But in most cases, patients are asked to pay for their services on the spot, reducing the possibility of an unpaid bill.

Military members largely are prohibited from visiting South Korean clinics without approval. Many civilians and contractors, however, prefer to use local facilities because of easier scheduling, modern facilities and often cheaper fees for routine medical services.

As in the United States, medical bills in Japan can be staggering. Payments usually are expected up front or soon after the service.

“It’s like sushi,” said Navy Lt. Rommel Flores, head of Tricare operations at Yokosuka Naval Hospital. “You want sushi, you pay whatever the amount is for it.”

In many cases, Japanese medical facilities are kind enough to bill American patients but they expect the payments quickly.

“I think that servicemembers, their families and civilian workers probably don’t understand the system,” said Kazumi Watanabe, an official at Ebina General Hospital’s general administration division where Zama patients often are seen. “The hospital’s purpose is to provide care but it cannot let payments just slip out, otherwise it will not be able to manage to stay in business.”

He adds that for people visiting Japan, where insurance may not be accepted, the bills can be extremely expensive.

“We want people to be conscious of that,” Watanabe said.

Over the holidays, two family members visiting servicemembers at Yokosuka required medical help off base and now face thousands of dollars in bills, Flores said.

The same has occurred with a dozen people in the past two years.

In many cases, the problem stemmed from older family who would be eligible for Medicare in the States. Medicare doesn’t pay in Japan. “It doesn’t pay overseas,” he said. “Sometimes that’s all they have.”

At Yokosuka, unpaid bills to local hospitals became such a problem several years ago that Navy leaders made it mandatory for anyone not covered by Tricare to purchase health insurance before they can receive command sponsorship. The rule primarily affected extended families and other secondary dependents.

“It’s a headache for us,” Flores said.

His advice to visiting family members is to buy travelers insurance with medical coverage that works in Japan in advance. The insurance can cost a few dollars a day.

“You remember the camera and film, keep insurance in mind too,” he said.

Hana Kusumoto contributed to this report.

Travel tips

Medical commands offer servicemembers a few suggestions to avoid the problem:

Advise visitors to purchase travel insurance that includes medical coverage, for Japan, before they arrive.Keep enough cash available to pay a hospital bill or deductible if they have insurance. Japanese medical facilities may not accept credit cards or checks.Even servicemembers should consider travelers medical insurance when traveling in Asia. In the event of an emergency, Tricare will pay for treatment at the nearest facility, which may not be their home station. Insurance can cover the cost of bringing them home for treatment.Speak to officials at the base Tricare office before seeking service off base when possible so they can help with billing and paperworkAlways pay bills. Tricare offices may be able to help servicemembers work out a payment plan with a hospital, but it’s a favor the hospital offers, not a requirement.— Juliana Gittler

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