Perhaps. But they seem to be causing a great deal of anxiety to their client. Which, I guess brings me back to my original statement: 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.
No, this is utterly unrealistic. Do you know how much work is involved in negotiating rates with even one provider?
Even for regular U.S. health insurance with massively greater economies of scale and geographic focus, many hospitals in your home state will be out of network.
Expect away. Please explain exactly how you expect a Canadian travel insurer to do that with respect the the U.S. healthcare system. The U.S. healthcare system does not have a good system for addressing the cost of emergency claims for its own citizens.
Nobody can ever ensure in-network access for emergency treatment. U.S. insurers cannot do that even when patients are taken to hospital in their own state.
The U.S. healthcare system notoriously causes a great deal of anxiety for all patients. I have no knowledge of whether this specific insurer Candaian is ethical, but even an insurer with the best intentions is going to have great difficulty with this. Your anger here is misdirected. The fundamental problem is with the U.S. healthcare system.
I have no anger at all. And I don’t actually believe for a moment that the Canadian insurance company is engaging in the tactic that you’re suggesting.
But they sell a product that is specifically aimed at covering out-of-network emergency treatment for non-resident patients (and, I gather from the website, this is a potential issue if you travel domestically between provinces as well). If they can’t actually cover that loss, then I would think that’s a problem. A type of fraud, in fact.
I will not argue that the fundamental problem isn’t with the US healthcare system - but my US based insurance has network providers all over the world. That’s probably because I have access to Blue Cross Global Core, and I guess there is some sort of deal where Blue Cross of A doesn’t have to negotiate with hospitals in B because some other insurance company did and BC of A just adopts that network. Or maybe not - maybe Blue Cross Global negotiated with providers in over 200 countries on its own But I don’t think the Canadian company is using this denial of benefits as leverage against the hospital. Because the policy specifies how much the Canadian company will pay. Maybe not in dollars, but there’s some formula and they could certainly pay the X % of the “reasonable and customary charges” defined by them and let the hospital deal with the patient for the rest without saying they are denying coverage altogether.
This is irrelevant. You just keep ignoring the fact that the problem here is with emergency treatment, which will often inevitably be out of network in the U.S.
I’m not ignoring that - I’m disagreeing with you about how inevitable it is. It is entirely dependent on your insurance company and its network - and also whether your insurance pays for out-of-network care ( which some still do ). My insurance has 100 participating general acute care hospitals within 20 miles of my home - I’m pretty sure that’s every hospital within 20 miles. And the reason I mentioned that my plan has network providers all over the world is because I think it is very unlikely that my particular plan individually negotiated each of them rather than some larger entity negotiating on behalf of all US Blue Cross/Blue Shield plans.
This also seems to suggest that since my doctor recommended the standard once every 2 years Cologard type test, I now have to wait 60 days to travel after that doctor visit.
Doctors always seem to frequently fiddle with medication levels. “adjustment or change” even though there is no exhibited risk, it’s just a precaution.
The wording seems extremely weaselly.
Blue Cross is one of the dominant medical insurance organizations in Canada. My wife’s employment benefits are through the local Blue Cross. They are no amateurs in this game.
Louis was on a 10-milligram pill in Saskatchewan, which was increased to a 20-milligram dosage in July, three months before he left for the U.S.
Not sure how “three months before he left for the US” (Plus presumably a duration in the USA, since he probably left Canada well before February) translates into a violation of the 60-day rule, unless he bought his insurance a month early, which seems even more of a weasel move by Blue Cross reeking of pre-ACA tactics in the USA. Possibly BC subcontracts to a US firm for this coverage?
I have a friend who told the story of his uncle, also a snowbird in Arizona. A neighbour found him lying in his bed after a stroke; his brother took the back seat out of his SUV and drove him non-stop to the Canadian border, since the guy had no medical insurance.
I’m trying to imagine an insurance company saying “you house insurance won’t cover the kitchen electrical fire because your back deck was not up to code.” And getting away with it.
The sixty day rule quoted was from a travel policy I used - like I said
Not if it was negative - it wouldn’t involve “an illness, disease, or other condition” in that case.
The quote says “received a recommendation for a test” not that it was for treating a condition. Plenty of room to weasel, although I suspect they’d lose in court.
The quote starts out
Pre-Existing Condition means an illness, disease, or other condition during the sixty (60) day period
Insurance companies exist because the vast majority of insured people don’t make claims. They employ skilled actuaries who, with the aid of computer statistics can assess the likely claim rates, and therefore costs, for any risk.
Most people in the UK do not have health insurance of any kind because we have the NHS. When we go abroad, we are strongly advised to buy cover, and the cost of that cover will be determined by a number of factors:
The countries you are visiting
Your current state of health
Your age
What you intend to do (skiing, water sports, motorcycling etc)
A young, fit person can buy cover for a European holiday for less than £50, whereas an old fogey like me may pay ten times that. Thousands of Brits travel to Disney World in Florida every year and I would make a WAG that at least 10% have no insurance at all. They are the ones who get reported in the news because they are faced with a huge bill after an accidental injury.
The have worked in many emergency departments, some close to the American border. One problem in Canada is there are only so many neurosurgeons. They can only do so many operations. Sometimes there is no availability.
There arise occasions when a young, healthy patient needs a critical operation and the best available alternative is an American hospital. Provincial governments have to approve emergency expenses including American ambulance transfer, operation, hospital care and repatriation when stable. Even when this is approved, the families often have issues with payment coverage.
A surgeon operating for appendicitis in Canada might be paid four hundred dollars, plus hospital visits and extras.
As I understand, if the provincial health authority sends a person from Canada to the USA for special treatment (i.e. due to backlogs, shortage of specialists, urgency) as has happened AFAIK in some of the prairie provinces, then the provincial health authority will cover the entire bill.
If a patient chooses on their own to get treatment in the USA - deep pockets, excessive local wait times, or as the OP suggests, because they are in the USA - then it’s on the patient to fund the treatment. I don’t recall the case, I’ve never had to deal with it - but I vaguely recall hearing that the provincial health will reimburse the patient for the treatment to the amount that would have been paid locally. (The provincial fee schedule) The problem is the disparity between reasonable, local amounts and what the US medical system charges.
The Canadian system is not all sweetness and light. Governments vacillate between cutting costs and then trying to solve the problems with backlogs and shortages it creates. The health system consumes a large portion of provincial budgets, even with financial assistance from Ottawa. COVID has remarkably aggravated this problem, since doctor and particularly nurse shortages are aggravated by the burnout rate the crisis created. However, our system is strongly defended by Canadians as infinitely preferable, warts and all, to the American or even the British system. Everyone is in the same line-up. Nobody gets a bill.
In an emergency the approvals need to happen quickly. To administration’s credit, they do. I know of one case where a family was approved but charged for much of the air ambulance bill, but not the life-saving operation or medical treatment. It still would have cost them $50,000. Our emergency group and our hospital generously reimbursed them, however.
The Canadian system has many, many flaws. I am willing to defend it - warts and all. The problem is the problems are well known, but poorly studied. Data is often lacking, as is sometimes the will to make things better or seriously address them. Improvements are slow, and reasonable discussion of some things hard to accomplish politically.
This is the key point that makes these kind of thing so insane, even by the standards of US healthcare (which is inherently bonkers and nonsensical). At least in the Canadian case the systems are similar enough that the Canadian insurer can provide health insurance that is recognized in the US. Travellers from other countries don’t even have that that generally, they considered uninsured from the US point of view, then have to pay the rack rate and then claim it back from their insurance company.