I don’t think that Saskatchewan Blue Cross ( the insurance mentioned in the article ) is a US company.
It varies; there can be subsidiaries; a Canadian company may itself be buying the policy from an American insurance company; and there can be clauses in the policy that say the governing law is not the law of the place where it’s sold.
(I have read my health insurance policies before travelling to the US, and the actual insurer is often not the Canadian company that sold the policy.)
It appears that they are, indeed, a local, not-for-profit insurance company. (For what it’s worth, that is also true of many of the Blue Cross and Blue Shield plans in the U.S.)
This may certainly be the case, as well. Saskatchewan Blue Cross’s website for their travel insurance doesn’t make this clear, one way or the other.
The article seems to emphasize that the denial was based on the failure to disclose the change in medication rather than the change itself. I suspect there was some sort of wavier of the pre-existing condition exception that required accurate information to be provided (and either required it to be continuously updated or he filled out the forms after the change).
I suspect that some sort of material misrepresentation would invalidate the whole policy, so you don’t have to address whether the stroke was caused by the pre-existing condition.
We have just taken out travel insurance (Not including the USA which would have doubled the premium) and, although they did ask, for example, how many different medications were prescribed, they did not want to know specifics - dosage or brand.
The NHS encourages GPs to prescribe by generic names, rather than brand names. This allows pharmacists to use whichever brand they have available. If the GP prescribes a brand, the pharmacist is obliged to issue that brand.
I guess the question then is - what did the questionnaire say? I’ve had the doctor adjust my blood pressure medication a few times, including one time when a medication was recalled for some reason and a substitute made, another time when a two-part medication was discontinued and now I take the two parts as separate medications… I’m not sure this would come to mind as a significant change for that questionnaire. Plus - my prescription change once was because the numbers were creeping up, even though it was still considered “treated or controlled”.
The other point I would wonder about is materiality - does cholesterol medication have a stroke risk? I can see that being an applicable risk for blood pressure issues, but cholesterol medication? I got a cream prescription for a serious foot rash - would that exclude me from insurability with a stroke?
As I understand it, provincial rules and my prescription coverage from work both require the pharmacist to substitute a cheaper generic where available.
When we lived in Florida, a lot of the 6 month snowbirds were from Canada. They told me that they HAD to return in 6 months or they lost their health insurance coverage. Needless to say, not one of them ever stayed beyond 6 months, and their emergency plan was always the same plan. If they got sick or injured, they would go back to Canada instantly rather than go to a US hospital.
If only the Quebecois had the same policy. Boy, were they different than the Canadians!
A. Quebecers are Canadians.
B. Quebec health care has the same eligibility rule:
If you are returning to live in Québec after having settled abroad or in another Canadian province, you have to re-register for Québec health insurance even though you were registered in the past. To remain eligible for health insurance, you must not be absent from Québec 183 days or more, consecutive or not, in a given calendar year (January 1 to December 31).
C. Please don’t make ethnic slurs against my fellow Canadians.
I have an idea what may be happening here. The insurance company may not be trying to screw the patient. This may be essentially a negotiating position with the hospital.
The problem is that the hospital is going to produce a bill at the ridiculously inflated “rack rates” that they use that are 5 times normal pre-negotiated contracted rates for in-network treatment. For out-ot-network emergency treatment where both provider and insurer are in the U.S., I know there are internal methods within the U.S. healthcare industry that have been set up to determine fair rates in this situation. But the Canadian insurer may not be part of this arrangement, so they are essentially negotiating from scratch with the hospital about what they will pay.
If the Canadian insurer has a possible technical “out” on the coverage, they may be using this as leverage against the hospital. Send us a sensible fair bill and we’ll pay it, otherwise we invoke this technicality, then you are going after the patient and you will probably get nothing.
It’s tough on the patient caught in the crossfire, but this may be what’s happening, and it’s not really the fault of the Canadian insurer that the system is so fucked up. The hospital will probably send out a bill for $500,000, when the in-network rate would be $100,000.
I don’t know if this is “once upon a time”. As I understand, that problem no longer exists for those over 65. (At least for most provinces) Indeed, we were going to move my dad back to Canada from the USA after he’d lived there for 30 years, and his eligibility would start the moment he crossed the border. Mind you, he’d been paying Canadian taxes on his substantial pension all that time, so in a way the Canadian government had been getting the better end of the bargain.
Under 65, you’re SOL if out of the country 6 months. Wait 3 months to get reinstated…
The other issue is that if you stay more than 6 months (180 days) in a year, you need a special arrangement with the US Immigration people. Worse yet, cumulative visitor time affects your status with the IRS.
This is interesting analysis and could well be right, but there is this point:
As I mentioned upthread, when I’ve bought medical insurance to go to the US, the actual insurer is not necessarily Canadian. Reading the fine print of the policy normally reveals that the insurance is provided by a multinational insurance company of some sort. That’s who would be making the decisions.
Indeed. But, reading between the lines of the article, I conclude that the information should have been disclosed and there’s no dispute over it. The quotes from the family, etc., are all about how it wasn’t intentional, it wasn’t fraud, maybe he didn’t know, etc.
That’s where the falsification becomes relevant. If the issue is pre-existing condition (or some other exclusion), then they would have to show that the condition caused the event. (Although, I always understood that high cholesterol is associated with increased stroke risk).
But if the issue is voiding the policy because the application was inaccurate, I would assume that the policy would permit that independent of the nature of the claim (or if there had even been a claim).
I would expect that a company in the business of selling insurance for foreign travel would have a better system for addressing the costs of claims in foreign countries.
You think a foreign travel insurance company can somehow fix the clusterfuck of the U.S. healthcare system?
If an uninsured or out-of-network U.S. citizen gets treated here, they face exactly the same problem. They will be given a bill for $500,000 when the fair price (the price that insurance companies pay on a prenegotiated contract) is $100,000. And the U.S. government cannot manage to fix this for their own citizens.
I think that a company that is in the business of selling insurance to cover events that take place in foreign countries would be aware of (and factor in) the price of those claims. Whether that’s adjusting premiums or negotiating rates or something else, it’s not like it’s an unforeseeable development.
Selling medical coverage for travelers is knowingly offering to insure an “uninsured or out-of-network” individual (I think that’s not just true in the United States, but also true is many or most foreign countries). And the insurance company is aware that those prices are higher than for covered individuals (and, in the United States, can be very high). That’s the insurance product that you are selling (and, likely, that’s why the customer is buying it).
The fact that there are “foreseeable” problems with the fucked up U.S. healthcare system does not mean that there is any sensible solution for anyone who has to interact with it. You expect them to pre-negotiate rates with every possible emergency service provider in the U.S.? Even major U.S. insurance companies cannot possibly do this.
And the fucked up U.S. system is that if a patient is out of network, the provider will just send out a massively inflated bill, and if you have assets you have little leverage to negotiate and they will come after you. This is just the system. Nobody in the U.S. has fixed this for U.S. citizens, how do you expect a Canadian travel insurer fix it?
Do you think it would be better for the travel insurance company to just pay the outrageous first bill that a U.S. provider will always send them, a bill that is inflated fivefold? This would require that they increase the cost of travel insurance fivefold.
No, they can’t. But my US insurance has network arrangements with doctors/hospitals/clinics in many countries and if a Canadian company is selling insurance to snowbirds, it wouldn’t require agreements with every service provider in the US. Snowbirds tend to go to certain areas, and insurance companies needn’t make arrangements with every doctor and hospital - I’m pretty sure there are more providers in Rome than the 26 my insurance has agreements with.
You can have a network for someone who requires routine treatment, just like a domestic insurance company has a network.
But this was emergency treatment, which will usually be out of network.
This problem is not peculiar to travel insurance. It is a huge problem for U.S. citizens who require emergency treatment at out-of-network hospitals. The hospital will send a massively inflated bill, and if you have assets they will come after you. It’s pot luck whether you happen to live in a state that gives you any legal protection against this.
That’s actually changed a bit for US citizens in the past couple of years.
I was talking about emergency treatment. No , a Canadian insurance provider couldn’t possibly make agreements with every emergency room in the US. But if there are 30 emergency rooms in Phoenix under 10 different hospital systems, they certainly could make agreements with those 10 systems if many snowbirds spend winters in the Phoenix area without making arrangements in places where few policyholders spend winters.
An individual is concerned about a potential event that would result in substantial financial consequences. So he buys an insurance policy – specifically for this type of loss – from a company that offers policies specifically targeted for people in his situation who are concerned about this type of loss. The event occurs; the claim is submitted. The insurance company announces that the substantial financial consequence is “fucked up” and the system is to blame and it won’t pay the bill. And you can’t expect it to because “fucked up” and the government didn’t fix it. Yet, of course, this is exactly the reason that that policy was offered and what the insurance company promised to help mitigate and why the consumer bought it. It’s strange that that could be viewed as reasonable.
Now, as a practical matter, the policy appears to have been sold through Blue Cross of Canada – which markets medical policies to travelers because “[o]ut-of-province emergency medical expenses are not generally covered by your provincial medical plan and these expenses can be financially overwhelming” – and emphasizes that it “is a member of a trusted global network, including the American Blue Cross & Blue Shield Association”. So, like the US BCBS entities, I imagine it could take steps to ensure in-network access across the US and, in fact, there appears a BCBS Global program (although I don’t know the details of the coverage).
But fundamentally my point is that you have a company that is marketing plans specially to “[l]et Blue Cross travel coverage take care of any unexpected medical emergency costs so you can make the most of your trip.” I think it’s dubious in that context for the company to sell the policy, collect the premium, receive the claim, and then just throw up its hands and say: it’s fucked up that out-of-province medical emergencies can result in financially overwhelming costs and the US government hasn’t fixed it, so why should we pay the bill.
This whole conversation was premised on me saying that a possible explanation here is that the insurer is not trying to stiff their customer, they are using the technicality as leverage on the provider.