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YOKOTA AIR BASE, Japan — At least two Americans have recently racked up — and not yet paid — thousands in medical bills at Japanese hospitals while visiting U.S. personnel at Yokota, prompting a new policy that requires long-term guests to have overseas medical insurance.

Starting Sept. 15, any visitor seeking a base pass for more than 24 hours must show proof of such insurance if not covered by the military’s Tricare insurance plan or a Japanese policy, according to the order issued Tuesday by Col. J. Marcus Hicks, 374th Airlift Wing commander.

"It strains the good relationship we’ve built with the (Japanese) hospitals" where U.S. personnel and their dependents turn for treatment not offered at Yokota, said base spokesman Maj. Christopher Watt.

It’s not a new problem, Watt said, and in most cases visitors who are injured or fall seriously ill while in Japan are unaware their health insurance does not cover them overseas.

The collective effect has chipped away at the medical partnership over the years, he said.

"It may get to the point where we lose service," he said. The base has sent letters to the patients and their hosts urging them to resolve the outstanding bills.

Tricare — which refers thousands of troops and civilians to Japanese facilities for treatment not offered by the military — shares the concern, said Lora Sanders-Vannoy, a Tricare spokeswoman at Yokosuka Naval Base.

Japanese hospitals would not refuse treatment in emergency situations that bases are unequipped to handle, she said. But if the problem continues, they might pull back services now readily available to Americans connected to the military, she said.

"The possibility is that they just won’t make appointments for us when we call," said Sanders-Vannoy, who said she forwarded the Yokota policy to Navy officials for review.

"If we could treat them, we would and then bill them," she said. But once a visitor not covered by Tricare is treated off-base, "we legally can’t fund those bills."

U.S. Army Japan officials, however, said they would likely fund emergency off-base care for uninsured visitors of U.S. military personnel to prevent hospitals from having to assume the financial burden.

"If it’s life, limb or eyesight on the line, the Army pays for it and we worry about payment process later," said USARJ spokesman Maj. James Crawford.

The command has a formal partnership with a dozen hospitals near its headquarters at Camp Zama and sends a liaison team to accompany patients referred to those sites.

"We want to keep a good relationship with these hospitals," Crawford said.

Most Japanese have social or national health care insurance that covers 70 percent of their bills. Unlike U.S. hospitals, Japanese medical facilities require payment in full when patients are discharged.

Disaster Medical Center in Tachikawa, where at least one of the most recent patients from Yokota was transferred, has required Americans who cannot pay in full to sign a "debt acknowledgement statement," hospital administrator Satoshi Koda said Friday.

He said the hospital is in the process of negotiating payments or collecting installments from three American patients who have since returned to the United States. Yokota officials said at least one American associated with Yokota personnel was treated at Disaster Medical Center.

"We are troubled since when they return [to the U.S.], it takes time to track them," Koda said.

U.S. Forces Japan said it has no plans to adopt the new Yokota policy for all installations in Japan, instead leaving it up to individual base commanders.

Stars and Stripes reporter Hana Kusumoto contributed to this story.

Getting insured overseas

1. Overseas health insurance can be bought for as little as $5 per day from a variety of companiesoffering coverage of up to $1 million, according to U.S. officials.

2. Almost no health care providers in Japan accept U.S.-based healthinsurance, according the State Department. Patients must pay their entire bill upon being discharged and then seek reimbursement from their stateside insurers.

3. Most small clinics and some large hospitals do not accept credit cards, and no facility accepts U.S. checks, according to the State Department.

4. Officials urge Americans travelling abroad to check with their health insurance companies about overseas coverage and to buy an additional policy if necessary.

5. A list of overseas health insurance providers can be found by logging on to: http://travel.state.gov/travel/cis_pa_tw/cis/cis_1470.html#companies

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