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CAMP FOSTER, Okinawa — When it comes to getting health care outside the military medical system, money matters. But so does location.

While most hospitals in Japan require payment in full at time of discharge, 21 South Korean hospitals have signed agreements with the military that allow American patients to work through their Tricare, Aetna or other American insurers.

In Japan, some Americans have found themselves having to come up with thousands of dollars.

When Shirley Tyler’s husband Greg, a reporter for Stars and Stripes, died in April 2006, she found herself $20,000 in debt after four days of intensive care treatment for her husband at a Sasebo, Japan, hospital.

“I had to take out a loan from Navy Federal,” she said. “I couldn’t return to the States to bury Greg without paying the hospital bill.”

Her insurer, Aetna, later covered the cost.

Her story is not unusual.

Chip Steitz, the public affairs officer for DODDS-Pacific and DODEA-Guam, had been warned about the insurance problem before he had an operation to repair a blocked carotid artery in his neck.

“I arranged for my credit card company to increase the limit on my card to cover the cost,” Steitz said. “After that, I had no problem filing the claim with Blue Cross/Blue Shield and getting reimbursed. They didn’t even require me to have the bill translated. It turned out they had translators there who deal with foreign claims all the time.”

His hospital bill was about $30,000, Steitz said. He was reimbursed within 30 days.

Patients are urged to consult their health plan representatives for information on receiving care — and coverage — in their areas. Arrangements can differ greatly depending on the country and city.

In South Korea, the U.S. Army’s 18th Medical Command has memorandums of understanding with 21 South Korean hospitals.

Most hospitals and doctors in the country expect full payment immediately, before insurance companies get involved.

However, hospitals that have signed such agreements will provide patients with paperwork to make insurance claims.

In Japan, Aetna Global Benefits, which covers most civilian Defense Department employees, warns its clients that “payments in cash are expected, but more facilities are starting to accept credit cards (commonly accepted are Visa or MasterCard). The balance must be paid upfront at the time of service or prior to discharge. Direct billing to a private or company insurance is uncommon.”

Stars and Stripes reporter Tim Flack contributed to this report.

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