Can an American Hospital Sue a Canadian Patient?

The hospital bill for an emergency appendectomy in St. Petersburg, Florida, arrives at your home in Canada shortly after you return from your vacation: four days, $80,000 USD. Please Pay Now. What do you do?

If you had travel insurance, that likely would not happen—although there are exceptions.

But if you had no travel insurance, you have to deal with it. This is not a situation you can ignore. You don’t want the hospital to bounce the bill over to an international collection agency—that happens a lot, and it can make your life anywhere from uncomfortable to miserable.

Increasingly, U.S. hospitals are diverting all bills for non-US residents to a growing throng of international companies who specialize in cross-border collections so they—the hospitals—don’t have to deal with the complexities of foreign collections, or travel to your province to sue you.

But you are not defenseless.

Hospitals don’t like to sue patients; it’s bad for their public relations. But if they have to, they will—and don’t think that just because you live in a country other than the US you can’t be sued or have your credit impaired.


Check out your provincial protections

In Canada there are considerable protections against unfair collections methods that differ from province to province and in general they are more protective of consumers than are American laws.

You can visit this website to see what protections you have in your own province.

What’s also in your favour is that many states have passed laws requiring hospitals to offer uninsured patients (into which category you would likely fall) the same discounts off charged fees they offer to insurers, and they also require them to reveal to patients the range of free, charitable, or reduced-payment options they offer to low-income or uninsured patients.


Negotiate: It’s expected

This gives you great leverage in negotiating a fair payment that you might be able to manage—especially if you can amortize it over a reasonable period of time. But you must be reasonable. Most hospitals in the US (about 80 percent) are non-profit institutions and routinely provide substantial amounts of free (charity) care to the needy in their communities. They need to make ends meet, and unlike hospitals in Canada, there is no government bailout at the end of the budget year.

It is also true that virtually all public or privately owned hospitals must provide emergency medical services whether you have insurance or not. That’s the law. But that doesn’t mean the services are free. You will be charged.

Hospitals also have the right to request a deposit (in cash, credit card, or promissory note) for any services they provide (something that is usually waived if you can provide proof of supplementary private insurance). Caution: your provincial health insurance card will not do. That’s one reason why those who purchase travel insurance are told to carry their full policy papers with them—so hospital admissions personnel can verify the extent of coverage provided.

So when dealing directly with a hospital demanding payment, be reasonable, but don’t be afraid to start your bargaining position relatively low. You can always raise your bid. You can never lower it. I have seen many cases where a patient, or his or her counsel, have been timid about negotiating and declared victory when they have achieved only a 10 or 15 percent reduction. This is not the time to be timid.

And if you do arrive at a fair repayment plan, make sure you get a signed agreement authorized by a senior hospital officer, not a low-level billing clerk.

If you can settle with the hospital, do so. It’s worth avoiding the hassle of dealing with collectors.


Planning to head abroad? The easiest way to avoid foreign hospital bills is to come prepared with travel insurance.

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