American Hospitals Can Sue Canadians Travelling Without Insurance

Alert to Snowbirds

Though all American hospitals are required by law to treat your medical emergency, even if you have no health insurance, they are not prevented from demanding payment or sending collectors after you if you don’t pay. And crossing the border will not protect you.
American hospitals are run like businesses, even the non-profit institutions.  They have to be. There are no government bailouts if they run deficits.  If you have travel insurance and you haven’t encountered problems with pre-existing conditions or non-disclosure exclusions you’ll be fine and your bills will be covered—so long as you notified your insurer’s assistance company as you were supposed to and you let them manage your case. That’s what travel insurance is about and that’s why it has become indispensible for any Canadian crossing any border.

If, on the other hand, you’re travelling only with your provincial medicare coverage, you will be responsible for everything government insurance does not cover—which is a lot.  Most provincial plans don’t cover even 10 percent of a U.S. hospital bill.  And many U.S. hospitals simply will not accept your Canadian provincial insurance: they will mark you down as an uninsured patient.

Occasionally, even if you have travel insurance, you may find the hospitals coming after you for payment that your insurer did not cover: perhaps you had a pre-existing condition you insurer didn’t know about, or you didn’t disclose your complete medical history when applying for medically underwritten insurance. This happens rarely, but it does happen.  And if it happens to you it can be calamitous.  Claims for $25,000 to $30,000 for a two-day stay are not unusual.

What do you do if you are faced with such a claim? First of all, don’t panic. You’ll have to come to some kind of settlement just as you would with any other legitimate claim for payment.  When you were in hospital, you or your travelling partner surely signed forms confirming that you were ultimately responsible for payment of services rendered to you—even if you had travel insurance. Everybody signs such forms.  Or you may have signed a credit card deposit. All of these are legitimate commitments and they are designed to cover those contingencies where insurers deny your claim or pay only parts of it, or you are responsible for co-payments, or you have no insurance.

The worst thing to do is write a cheque for the full amount billed and send it off. No hospital expects to be paid full “retail price.” If you do that you will have overpaid. On average, U.S. hospitals collect only about one third of the retail charges they bill with domestic U.S. health insurers, so don’t be afraid to negotiate and start low, be tough, don’t hesitate to put up a “take it or leave it” stance, and before you send away one dollar, get a properly certified letter from a high authority at the hospital that your payment will be considered payment in full, no other collection efforts will be made.  Sending away a cheque marked “payment in full” without having such a letter in hand is worthless. And a letter from a lowly accounting clerk won’t do it.

But before you resort to that, check with your travel insurer if your unpaid bill is due to an unpayable claim. Insurer’s often have provider relations services that can help you negotiate favorable settlements. They don’t like to have unhappy customers.

Your best protection always is to get insurance from a professional who specializes in travel coverage,  take time understanding your policy, fully disclose your health status to your agent or when filling out your medical questionnaire, and check with your doctor if you’re unsure about your medications or the results of any recent tests. The responsibility for accuracy and completeness is yours. You can’t do all of this if you leave the purchase of insurance as the last item on your “to do” list.

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