International students have recalled frightening and stressful experiences of being asked to pay hundreds of dollars up-front before being treated in emergency departments at Queensland public hospitals.
It has prompted advocates to call for a change to hospital policy to bill students' health insurance directly.
International students are ineligible for Medicare, but as part of their student visa, they are required to have health insurance.
Feroza Arshad and her husband came to Australia to study, and after she had completed her studies she began working on a temporary graduate visa.
While her husband's studies continued, their first child, Hashim was born in July 2021.
Hashim was born prematurely, and two days after coming home from the hospital, the newborn had a prolonged crying fit.
"I tried to settle him and then his crying got so worse, and he was all red, and suddenly he went quiet," she said.
"His eyes were closed and I tried to move his limbs but he was unresponsive.
"I was trying to wake him up, he wasn't waking up, so as a new parent, I got freaked, and called an ambulance."
Paramedics checked on Hashim, and took the mum and baby to hospital.
'Once they had the bank card they took us in'
When they arrived Ms Arshad said the triage reception, while her baby was on a stretcher with paramedics standing next to her, asked for her son's name and details.
Ms Arshad said she explained she did not have Medicare, and instead had health insurance. The hospital administration officer then asked for an up-front payment or a bank card.
"I remember I didn't have my wallet with me or anything. So I called my husband [who had followed the ambulance in his car] and I was like, 'where are you? You have to come in'."
Due to COVID-19 restrictions, Ms Arshad said her husband couldn't come in, so the hospital arranged for a staff member to go and collect their bank card.
"All that while Hashim and me were in the reception area. I was very scared, very worried, I was very nervous, crying," she said.
"Once they had the card at the reception, then they took us in."
Ms Arshad said while Hashim was being treated a hospital staff member asked her to sign documents allowing the payment to be processed.
"I remember it was very scary for me — those 10 to 15 minutes — for me, it was the longest time because I was waiting there, and my baby was not taken in," she said.
"I just wanted him to get in and get checked, and make sure that everything is okay. I am a doctor and a part of me inside was telling me: 'oh, every second matters, every minute matters. Why are they not taking him in?'
"I may be overthinking — but if you put yourself in my shoes — I know every parent would be scared."
Ms Arshad said she was later told her baby had colic and that while he was ok, his body had become exhausted.
"They told me that: 'you did the right thing, that you called the ambulance … and brought him in'," she said.
Hashim was discharged after about six hours of observation.
Ms Arshad said given the hospital had been able to charge her health insurance directly when she was admitted for Hashim's birth, she wants the same process to be applied in the emergency room.
"Why can't I charge my insurance directly for when I go to an emergency or when I go through an ambulance?" she said.
"So that means all you have to do is that, make a policy about it, you have the means, you have the resources, you have the systems in place, you just have to make a policy about it."
Pakistan Australian Cultural Association (PACA) president Syed Asghar Naqvi said international students or temporary visa holders face a lot of issues when they go to emergency departments.
He said the financial pressure on international students included tens of thousands of dollars per year for their degrees, while balancing living and accommodation costs, and restrictions on how much they can earn.
"As an Australian, as a Pakistani community member as well, I do think we need to treat people in [a] human way, especially when someone is in an emergency," he said.
"When the students go to hospitals, the policy needs to be changed where hospitals ask for the money up-front."
Mr Naqvi said there were also examples where international students, who develop terminal illnesses while they are studying, do not have the correct level of insurance which will cover the costs of treatment.
PACA helps struggling international students by creating online fundraising call-outs to fund their medical fees and encourages members of the community to provide the students food and other support.
Mr Naqvi said he wants the government, university sector and health insurers to work together to better support international students.
He suggested that universities and health insurers could better tailor health insurance packages that provide international students with top-level cover but at more affordable prices.
"The government should help the students to make it a necessity to have the highest level of cover, because, later on students would suffer when they need support," Mr Naqvi said.
Despite health insurance, Amir was billed $1,500 for a heart attack
In October 2021, Amir Mehmood started getting chest pains. Thinking it wouldn't be serious, he went to a GP to seek treatment. But then later that day the pain became "unbearable".
Just a few minutes' drive from Brisbane's QEII hospital, Mr Mehmood asked his friend to drive him to the emergency department.
Mr Mehmood said he was told that as a Medicare-ineligible patient he would have to pay up-front.
He said he did not have enough money at the time, so asked his friend to help with payment.
When he was taken through to emergency, he was monitored with an ECG, and then transferred to the Princess Alexandra Hospital (PA).
"[The] next morning, they informed me that: you had a heart attack," he said.
After being admitted to the PA Hospital, he was invoiced the full amount for his care — about $1,500.
Mr Mehmood said many international students believed that because they have health insurance, they would not have to pay up-front for emergency department care and then claim on insurance later.
"Emotionally, it was really hard," he said.
"Hospitals should change their policy, that if anybody comes in, in an emergency at least, they shouldn't be charged initially," he said.
In a statement, Metro South Health said it was committed to providing timely emergency healthcare based on clinical need and would explore any opportunities to improve processes and communication in relation to up-front payments by Medicare-ineligible patients.
A Queensland Health spokesperson said anyone who attended a hospital would be seen according to clinical need, not their ability to pay.
"Public hospitals may request payment from Medicare-ineligible patients to recover costs associated with the care provided, however these decisions will not delay the delivery of emergency care," the statement said.
"Decisions on how costs are recovered from Medicare-ineligible patients are at the discretion of the individual Hospital and Health Service.
"Any payment requested from Medicare-ineligible patients must be proportionate to the level of care provided."
Metro South Health acting chief operating officer Adrianne Belchamber said Medicare-ineligible patients requiring emergency care and who do not have insurance or have difficulty paying are not denied care.
"Anyone who requires emergency life or limb-saving healthcare will always be treated, regardless of their Medicare eligibility," she said.
Both Ms Arshad's and Mr Mehmood's medical costs were ultimately reimbursed by their respective health insurance policies, which is why they want hospitals to implement processes to directly bill health insurers rather than requiring students to pay upfront first.
A spokesperson from the Australian Department of Health and Aged Care said overseas student health cover (OSHC) was a mandatory requirement of a student visa.
The spokesperson said base OSHC coverage, which is purchased by most students, includes 100 per cent of the charges raised by a public hospital and ambulance services.
"If there is a contract between the insurer and private hospital, the amounts as specified in the contract (in practice this means 100 per cent of the charges)," a spokesperson said.
"The scope of coverage and premiums for OSHC are intended to ensure that the cost of health insurance does not serve as a disincentive to prospective international students coming to Australia to study, and to ensure that they have access to affordable medical and hospital treatment whilst they are in the country."
