If a Canadian goes to an American hospital?

Question

If a Canadian is on vacation or business etc in the U.S. and becomes ill or injured and has to go to an American hospital, does the Universal Coverage from Canada pay for his bills or is he responsible for them? I know that in Canada everything is covered, just wondered if that holds true even if you're out of the country? Also, would you pay the bill upfront and get reimbursed, or would the hospital just bill the Canadian healthcare?

Answer 1

My son got hurt while we were on vacation in the U.S.  As we were driving through Chicago it became obvious that he needed medical attention (he had scratched his eyeball and it had become infected).  We went to the first hospital we found.  We did have travel insurance but the hospital asked if he had an Ontario health card, I said yes and gave it to them.  He was treated, and we didn't pay a cent.  Never received a bill after we got home either (this was 2 years ago).

Because of all of the different answers you are getting, I'm really not sure what the "official" rules are.

Answer 2

I am covered in the states through my companies extra insurance

Even if I was an American and was sick, I would head for Canada

If I break my leg in the states, I will get a taxi home no matter what it costs.

I hurt my foot on vacation in the UK, went to the hospital, never did give me a bill, and I was willing to pay.

Answer 3

You must have extra travel health insurance, or you will be on the hook for a gigantic bill.  If you have travel health insurance, you're pretty much covered.

Answer 4

No... it doesn't even apply from province to province.  Healthcare in Canada is paid for provincially.

Unless you have benefits that cover your healthcare while travelling you have to pay for any hospital or doctor visits while in the states.

I think if you go to another province you can easily apply for a medicare card but if in another country you won't be covered by the government.

Answer 5

No our government doesn't pay for medical care when you're out of the country. You should purchase travel medical insurance. When I am planning to travel, I get the insurance for 30 days from the BC automobile association. I'm sure there's the equivalent in other provinces. The cost is quite reasonable, and it gives you peace of mind.

Answer 6

Ok lets break this down.

1) Canadian sick in US WILL get billed by the US hospital or will be asked to pay up front.  Honouring the bill is another matter that would be up to the courts in Canada to decide.

2) The Canadian may submit the bills to their provincial plan but they will NOT be reimbursed for the full amount only the amount that the plan would cover in Canada.  This may vary province to province.

3) Not everything is covered there are many procedures that are not covered by the provincial plans and if that procedure was done in the states and not covered in Canada your boned.

4) see note 1

All this being said one should check what benifits that they may have through their employer (mine has out of country coverage) and their credit cards.  To paraphrase the Amex commercials, Out of Country health coverage, don't leave home without it.

Answer 7

each province has different rules,Ontario ohip will pay or emergency treatment but only up to what it would cost to be treated in Canada,as the cost is more expensive in the US you would have to pay the difference yourself

Answer 8

Absolutely DO NOT TRAVEL OUTSIDE CANADA WITHOUT EXTRA INSURANCE.  If you don't get the special insurance to cover you outside Canada, you are totally responsible for all medical expenses you incur.   You can put in claims when you return to Canada but there is no guarantee that you will be reimbursed for even $1.00 of your costs!  Even if you do get money from Cda, you must pay the US immediately.   My nephew just experienced this couple months ago---broke his leg and needed surgery--was in US hospital for less than a week---first bill they recd was from hospital for approx $18,000 - this is the first bill--they still have to receive bill from surgeon, bill from anesthetist, final bill from hospital, etc, etc.   They are estimating somewhere around $30-40 thousand before they are finished and this was "only" a broken leg---can you imagine something that might require weeks in the hospital, or multiple surgeries or extensive care wards?   You could pay for the rest of your life for this one illness and this doesn't cover costs of family coming to get you or be with you--nor the cost of getting you home if you have to come back by ambulance or medical flight, etc.   This was the first time my nephew had not bought the extra insurance and that few extra bucks will cost them thousands and thousands of dollars---even if OHIP reimburses some of the costs, it won't be anywhere near even half of the costs.

Answer 9

As the first person said, you should always buy extra travel insurance when you step outside your province, and your country.  (between provinces you should be okay-but not for ambulance costs which can vary)

Your home province may cover medical expenses incurred in the USA, but only to the amount that would have been covered in your home province.  eg If an emergency room visit here would cost $50, and in the USA it costs you $5000...you are going to be responsible for the difference of $4550.  Most medical things that MAY be covered by your provincial health plan elsewhere are medical emergencies or if you have preapproval.  (BEFORE you are out of country and it takes at least 8 weeks)  If you go to a doctor in the USA for a cold, you may not be covered.

What private insurance does is helps you in the case where the hospital wants to make sure they get paid.  You show them your claim and they may want to talk to the person, or get some stuff faxed.  You still will get a bill, but it helps with the level of care you may receive initially.  (carry your wallet card with you ALWAYS)

When you back to Canada it is time to jump the hoops though.  Your private insurance company is only going to pay the American hospital what your provincial plan will not.  That means, you need to fill out the "Out of Country" forms to your provincial health plan with the receipts-and get approved for whatever costs or denied.  Even when you know and the insurance company knows you will be denied....they still insist on that denial letter.  Then you submit the denial letter and receipts to your private insurance plan to see what they say.  Some plans with private insurance will only cover to a certain amount.  It takes a LONG time for these things to get all done.  Usually about the time you think you are going to have another heart attack or go break someone else's legs is when you get word of what is covered and not.  (but at least you are at home this time for the heart attack) ;)

The American hospitals do not bill Canadian ones at all.  Receipts, receipts and billing companies.

Btw, everything in Canada is not covered.  If you are from Ontario and you go skiiing on BC and break a leg on a mountain and need to be airlifted...be prepared for a NASTY bill that Ontario likely will not cover.  Ambulance services are NOT a covered benefit outside of your home province, and even within they are not totally free.  (a lot is, but not all)  That is a common thing for the younger people who ski or snowboard and think they are invincible.  They may be, but their wallet (or Mom & Dad's) is not.  Eyeglasses, dental, chiropractor etc...many of these things are not covered in some provinces, or for some age groups.

If you find you are going to be a missionary, away to school fulltime or travelling for over 6 months out of country, there are certain situations where your home province will not deem you ineligible.  Those are special situations and people need to speak to their home province health card providers.

Even when you are the most careful person in the world, you never know when a drunk driver will come along, someone talking on a cell phone will run a red or you will trip on a sidewalk.....and that is when you find out that $2 a day you would have paid for travel insurance would have been worth it.  (and dont even think about saying "I'll just sue in the USA"..years and years is a lot of interest waiting to be paid.

Check with your employer or bank or credit card company to see if you are covered too.