This entry is dedicated to those who may be coming to Italy soon for an extended stay. You might find this story eye-opening.
Before I had a Permit of Stay as a worker in Italy, I was not covered under the Italian healthcare system. Instead I paid for an international policy through Lloyds of London that would cover any hospital stays, ambulance services and any recovery therapy. It was not exactly cheap. It almost cost typical individual insurance rates in the US at the time, which was the years 2001-2002.
Unfortunately I had to use the policy one day when I went to the emergency room for stitches in my inner ear, a series of facial x-rays and an overnight in the hospital.
Firstly I was surprised by how lazy the service was in the hospital in Venice, where I was living. The doctor checked on me for 2 minutes at 7 a.m., after I had checked into the hospital the night before, and I basically never saw him again. I felt I was wasting my time with only an ear injury and some bruises. The hospital had given me a glorified bed to rest in. I had to beg the staff to properly schedule my x-rays, which were the main reason I was staying checked in at the hospital. I left as soon as the images were made because I knew I was being billed privately for their services.
In fact, I found out 3 months later that they had billed me "royally". For the services mentioned above, the grand total was Euro 3900, with no billing details provided to understand how they arrived at that number. Then I discovered that Lloyds would only pay for Euro 1000, not even half the sum. I was shocked and horrified.
I started to ask for more information from the hospital billing administration, but their attitude was that I was an American and should expect hefty bills from a hospital. They were under no obligation by law to provide me with any further details. I simply needed to pay up.
After complaining to many Italians who had no idea that I would be billed so much, I was told by a nurse that I should not have given any insurance information. In that case, the costs would have been absorbed differently by the hospital. But I had wanted to use the policy I had been paying for. Also, it seemed devious to force the hospital to absorb my costs. I feel that I was over-billed in the end since they knew I was American and supposedly was used to high fees.
Now I know that I should bought insurance directly through the Italian ULSS system that would have cost less and guaranteed better coverage while in Italy.
Since I changed my Permit of Stay for work status, I have been put into the national system automatically so these problems no longer apply. At this point, I just pay a "ticket" which is a "co-pay", according to the American insurance system. I am finally enjoying socialized medecine, although it's even better in other European countries, with even fewer fees or even none at all.
For an American looking to come here to settle or finding yourself a tourist in Italy for more than 90 days, you should first get a Tourist Permit of Stay. That permit requires private insurance coverage. The basic permit requirements are listed on the website for the Polizia di Stato (in italiano). For English-speakers, The Informer is a great resource to get details about all permits and requirements.
Other useful links (in italiano):
explanation of health coverage situations and policies for foreigners in Italy: stranieriinitalia
information about buying the national healthcare card (tessera sanitaria): ministero della salute