Though Obamacare Wanes: Insured Visitors Experiencing Medical Emergencies in the US Need Not Worry

The dismantling of the Affordable Care Act (also known as Obamacare) by the Trump Administration is going to be attracting a lot of media attention in the coming months and some of the media coverage may stir up unease among Canadians planning long term visits to the U.S.

According to most polls, the majority of Americans have been disappointed with the ACA because of its high premiums, deductibles, and loss of familiar provider networks. But for visitors to the US who need emergency hospital care and have supplemental private health insurance, it will remain business as usual—at least for the immediate future—with very little difference in the high quality of care or the unlimited availability of hospitals or doctors. Travel insurers in Canada all work through assistance companies that have arrangements with networks of health care providers (hospitals, doctors’ groups, urgent care clinics, etc.) that give them preferential rates, and that translates to more affordable premiums for you. That’s a good thing. But if you’re counting only on your provincial government health insurance plan for protection, you need to change yours ways before you leave the country.

Hospitals in the US—be they private/for-profit institutions or non-profits (in the US only 20 percent are for-profit)—they must be run like businesses. They need to make ends meet as there is no government handout if they end up in the debt at the end of the fiscal year. And many do. They will demand payment—even though by law they must treat you for any emergency, whether you are insured or not.

But sooner or later they will demand payment and they know that your Canadian government insurance pays only a small portion of billed charges and is no substitute for real coverage.

 

Get travel insurance and know what you’re getting

Buying a policy at the last minute and leaving it in a drawer at home while you head for a southern beach is reckless.  Unless you know what’s in your policy, how coverage works, what it does not cover as well as what it does, and what your responsibilities are when applying for insurance as well as in case of a medical emergency, you’re at great risk.

 

Every policy sold comes with conditions. It must, otherwise your premium costs would be unmanageable. Knowing these conditions: like being extra careful to read the medical eligibility rules, completing health questions accurately and completely, and knowing what you’re required to do in case of medical emergency can mean the difference between having your claim totally covered, or denied.

And remember that when you sign a hospital admission form in an American hospital, you agree that if your insurer does not pay your bill, for whatever reason, it comes back to you for full payment. It’s right there, in the fine print. It’s not trickery, it’s just business.

 

Take your policy (not just your wallet ID card) with you.

And even after you have already purchased your policy, read it. Did you have any changes in your health after you bought your plan that you didn’t tell your insurer about: like a new medication, a visit to a specialist, or a prescribed lab test? Your policy requires you to do so.

 

Do you understand that if you need a major procedure like a catheterization or an intestinal scoping your insurer’s medical consultants must first approve it—unless delaying it threatens your life or health.

 

And just because the insurer gives your hospital approval to have procedures done or to treat you as they best determine, it is no guarantee of payment.  That happens only after your insurer’s assistance service determines that your application for coverage accurately reflects your true medical history.

 

 

Know your policy. If you don’t understand it—demand clear answers from the agent selling it to you.

If you aren’t sure about how to answer a medical question on your application, ask your doctor.

You pay for coverage. Know what you’re paying for.

 

Get in touch with us today.

 

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