International Medical emergency story [travel to Canada, no insurance]

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Thevillianinbrown
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International Medical emergency story [travel to Canada, no insurance]

Post by Thevillianinbrown »

Hello Bogleheads,
I just wanted to share this story with the community. My neighbor and her brother just went up to Toronto on vacation. Once they arrived in Toronto, her brother had a heart attack and medical staff had to perform CPR. He was sent to the airport next to the hospital because they are contracted with them. They had a cardiologist at the hospital, but they couldn’t do any surgical procedure to correct the issue at this hospital. Before they would do an angiogram, they wanted to be paid upfront. Angiogram $8000.00 out of pocket (the patient on Medicare and just retired, I think). They found out that he will need triple bypass surgery after being transferred to a hospital that can do the heart surgery. His wife had to travel back to US to get the checkbook before they would do any kind of work period. This sounds like the worst-case scenario that can happen aboard. I usually get travelers insurance but will always keep this story in mind when I travel outside the US. I was shocked that the doctors are independent contract workers in Canada, and this is the way they behave unfortunately, I guess it comes down to the system. They wouldn’t perform any medical procedure unless they were 100% sure they were going to get paid.

T.V.I.B
sonosoldi3112
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Re: International Medical emergency story

Post by sonosoldi3112 »

Sorry to hear this.

Do you know if he had travel insurance? or was he relying on the medicare emergency medigap provision which I realize is not a large amount in monetary value.

Indeed a cautionary tale ... thank you for posting as is important to know. James
sawhorse
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Re: International Medical emergency story

Post by sawhorse »

Yes, doctors in Canada are independent contractors. I'm surprised you didn't know. The majority of ER doctors in the United States are independent contractors too.

It's important to have travel insurance for this reason.

Canada's health system is free at point of service for Canadians, but they do a bit of gouging for international patients.

The good news is that the bill will probably be a lot less than if he were uninsured or out of network in the United States. It will still be a lot, but not the high hundreds of thousands it would have been in the United States.
sonosoldi3112
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Re: International Medical emergency story

Post by sonosoldi3112 »

So solution is always to have reputable travel insurance to cover all eventualities?

Do most policies suffice in this regard as it is so important.
Thank you
strafe
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Re: International Medical emergency story

Post by strafe »

Sorry to hear that. I think it's important to take a step back and realize this is not a worst case scenario.

Worst case scenario would have been that he died or that he did not receive emergency medical care.

They resuscitated and stabilized him without payment.

Requiring upfront payment from a foreigner for elective medical procedures seems reasonable to me.
codedude
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Re: International Medical emergency story

Post by codedude »

Would the docs/hospitals not accept credit cards? Or did the spouse not have them that she had to travel back to the US to get them?
camden
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Re: International Medical emergency story

Post by camden »

I find this story stunning, and difficult to believe as presented. A coronary angiogram in a patient with acute myocardial ischemia is not an elective procedure; it is a medical emergency which needs to be done as soon as possible to determine the best course of therapy (stunting or surgical bypass) in order to avoid irreversible heart tissue damage, and time is of the essence. It is hard to imagine in this scenario that any cardiologist would sit on his or her hands until they were paid in advance, whether the patient was a foreigner or not. That would seem to me to be ethically/morally totally unjustifiable.

Perhaps Canadian physicians on the forum who are directly familiar (as I am not) with the health care system there will weigh in on this one.

Regardless, not a bad idea to have travel insurance for unexpected problems in any case....
.
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ram
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Re: International Medical emergency story

Post by ram »

Thevillianinbrown wrote: Tue Sep 17, 2019 4:36 pm Hello Bogleheads,
I was shocked that the doctors are independent contract workers in Canada, and this is the way they behave unfortunately, They wouldn’t perform any medical procedure unless they were 100% sure they were going to get paid.
T.V.I.B
1) A foreigner got prompt appropriate emergency heath care without any proof of ability to pay.
2) A foreigner got appropriate advanced non emergency healthcare after demonstrating ability to pay for the service.

I would be appreciative of any country that would do the above. I would venture to say that the majority of countries in the world would be unable to do so.
Ram
drawpoker
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Re: International Medical emergency story

Post by drawpoker »

Actually, in a case like this, the key would have been to purchase a separate specific type of travel policy called medevac coverage.

This pays for the patient, once stabilized, to be flown out and back to a U.S. hospital that can do whatever the needed surgery/procedures required. Some travel insurance policies and the Medigap policies that provide for foreign emergency care do not provide the medevac benefit. It can be purchased as a stand-alone, however.

The coverages afforded by both Medigap and private travel insurance are really intended for the type of emergency medical care needed for accidental injury. Or the sudden onset of a serious, infectious type illness.

Not for cardiac or stroke events. That is also why these travel insurance plans also restrict benefits and coverages for folks age 70 or older.

OP, is this neighbor you write about from Buffalo, Niagara Falls, or somesuch along Lake Ontario? The strangest thing about the story is that the wife had to return home to get the checkbook.

Even if it was a drive of less than two and a half hours, seems very odd in the 21st century for someone to do this. When there are so many ways to transfer money quickly. :?: :?:
9liner
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Re: International Medical emergency story

Post by 9liner »

I am fortunate enough that my insurance company has very generous coverage for international travel. A quick phone call to their International SOS line and they will arrange payment for services rendered. That being said, there may still exist certain instances where we would have to pay out-of-pocket then seek reimbursement.
drawpoker
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Re: International Medical emergency story

Post by drawpoker »

camden wrote: Tue Sep 17, 2019 6:26 pm ...difficult to believe as presented. A coronary angiogram in a patient with acute myocardial ischemia is not an elective procedure; it is a medical emergency which needs to be done as soon as possible to determine the best course of therapy (stunting or surgical bypass) in order to avoid irreversible heart tissue damage, and time is of the essence. It is hard to imagine in this scenario that any cardiologist would sit on his or her hands until they were paid in advance, whether the patient was a foreigner or not........
No doc here, but kinda wondered the same thing myself.

Of course, if this is the hospital in question (1st responder for Toronto airport) they also claim to be seeing eighty-five million patients a year in their ER. Remarkable, Must be a real model of efficiency, eh.

http://www.williamoslerhs.ca/about-osle ... l-hospital
Trader Joe
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Re: International Medical emergency story [travel to Canada, no insurance]

Post by Trader Joe »

Thevillianinbrown wrote: Tue Sep 17, 2019 4:36 pm Hello Bogleheads,
I just wanted to share this story with the community. My neighbor and her brother just went up to Toronto on vacation. Once they arrived in Toronto, her brother had a heart attack and medical staff had to perform CPR. He was sent to the airport next to the hospital because they are contracted with them. They had a cardiologist at the hospital, but they couldn’t do any surgical procedure to correct the issue at this hospital. Before they would do an angiogram, they wanted to be paid upfront. Angiogram $8000.00 out of pocket (the patient on Medicare and just retired, I think). They found out that he will need triple bypass surgery after being transferred to a hospital that can do the heart surgery. His wife had to travel back to US to get the checkbook before they would do any kind of work period. This sounds like the worst-case scenario that can happen aboard. I usually get travelers insurance but will always keep this story in mind when I travel outside the US. I was shocked that the doctors are independent contract workers in Canada, and this is the way they behave unfortunately, I guess it comes down to the system. They wouldn’t perform any medical procedure unless they were 100% sure they were going to get paid.

T.V.I.B
How old was her brother?
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southerndoc
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Re: International Medical emergency story [travel to Canada, no insurance]

Post by southerndoc »

I'm assuming Canada does not have something similar to US EMTALA laws.
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bluquark
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Re: International Medical emergency story

Post by bluquark »

drawpoker wrote: Tue Sep 17, 2019 6:36 pm OP, is this neighbor you write about from Buffalo, Niagara Falls, or somesuch along Lake Ontario? The strangest thing about the story is that the wife had to return home to get the checkbook.

Even if it was a drive of less than two and a half hours, seems very odd in the 21st century for someone to do this. When there are so many ways to transfer money quickly. :?: :?:
Canadian medical offices rarely handle patient payments so they don't have an established process for every payment modality, and they default to recommending one option they have used in the past. I've encountered this during a minor medical visit while visiting Canada.
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drawpoker
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Huge Change In This Now

Post by drawpoker »

The OP has just amended the title of the thread to say the patient here had no insurance, anyone notice?

This represents a HUGE difference, puts a whole new complexion on it.

(OP, really should go back in and correct the reference to Medicare as well in the start of thread)
toofache32
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Re: International Medical emergency story [travel to Canada, no insurance]

Post by toofache32 »

southerndoc wrote: Tue Sep 17, 2019 7:12 pm I'm assuming Canada does not have something similar to US EMTALA laws.
I was thinking the same thing. I guess, unlike US docs, they are not required by law to work for free when these scenarios arise?
toofache32
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Re: Huge Change In This Now

Post by toofache32 »

drawpoker wrote: Tue Sep 17, 2019 7:32 pm The OP has just amended the title of the thread to say the patient here had no insurance, anyone notice?

This represents a HUGE difference, puts a whole new complexion on it.

(OP, really should go back in and correct the reference to Medicare as well in the start of thread)
I too was wondering how Medicare status is relevant to healthcare received in another country.
student
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Re: International Medical emergency story [travel to Canada, no insurance]

Post by student »

Will international travel medical insurance such as https://www.geobluetravelinsurance.com/ ... erview.cfm be useful in situation like this? This is what I use.
drawpoker
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Re: Huge Change In This Now

Post by drawpoker »

toofache32 wrote: Tue Sep 17, 2019 7:35 pm

I too was wondering how Medicare status is relevant to healthcare received in another country.
In the original posting the OP stated he thought the guy was on Medicare. Now we know that was incorrect.

IF he had been on Medicare and carrying the appropriate Medigap policy, it would have paid 80% of emergency care in a foreign country. With a lifetime cap of $50,000. No benefits at all for medical evacuation costs, however, hence, the mention of the importance of purchasing travel insurance with medevac rider.
biscuits
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Re: International Medical emergency story [travel to Canada, no insurance]

Post by biscuits »

True story of medical emergency in Canada, with more detail and action items:

My husband had a medical emergency recently while visiting Canada from the US. He received excellent emergency care from the EMT's, quick ambulance transportation to a rural hospital, CT scans and excellent emergency care in the hospital, and admission for three nights. We were not asked for payment upfront, but rather were asked to pay the hospital bill ($11,488 CAD) upon discharge, and we paid with a credit card. A bill for the ambulance ($1000 CAD) was mailed later, and we paid this by credit card. He was referred to a larger hospital for EEG and a consultation, and we paid $250 CAD (cash--our choice) for the specialist physician fees, and $550 for the EEG (credit card). He needed an MRI and got one very quickly, with quick radiology report, at a "private pay" facility for $1,250 CAD (paid by credit card). An MRI for an out-of-country patient through the government health care system would have cost $2,250, and might not have happened so quickly.

We are now in the process of seeking reimbursement from our insurance company. We thought we had covered all the bases before leaving the US for this trip: my husband is on Medicare, and has a supplemental policy that reimburses up to $50,000 for out-of-country emergency medical care on trips not exceeding 60 days. We also purchased a large policy for medical evacuation and emergency medical coverage (he did not need emergency evacuation).

Here is the one thing we did not anticipate: my husband's insurer, USAA, requires proof of the exact dates on which we entered and departed Canada. The only proof they accept are airline tickets, airline itineraries, and passport stamps. We drove, and the border crossings we used no longer stamp passports--they scan them. Hotel receipts and gasoline receipts are not acceptable, and so, to obtain electronic copies of our travel records from the US and Canadian border agencies, we have had to file the equivalent of Freedom of Information Act requests with both governments. We filed those weeks ago, and were told it can take 30 days or longer to get a response. We are still waiting. Good thing we were able to pay those credit card bills, and that USAA tells us we have 15 months to file the claim.

Next time we cross the US-Canada border, we will ask again for passport stamps--we were told we'd have to submit to time-consuming interviews to get them, even though we are NEXUS cardholders. We would have opted for the interviews had we known how difficult it was to get the electronic records of our border crossings after the fact.

If anyone has any suggestions on how to get these border crossing records more quickly, I would love to hear them.
Last edited by biscuits on Tue Sep 17, 2019 8:08 pm, edited 1 time in total.
student
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Re: International Medical emergency story [travel to Canada, no insurance]

Post by student »

biscuits wrote: Tue Sep 17, 2019 7:59 pm True story of medical emergency in Canada, with more detail and action items:

My husband had a medical emergency recently while visiting Canada from the US. He received excellent emergency care from the EMT's, quick ambulance transportation to a rural hospital, CT scans and excellent emergency care in the hospital, and admission for three nights. We were not asked for payment upfront, but rather were asked to pay the hospital bill ($11,488 CAD) upon discharge, and we paid with a credit card. A bill for the ambulance ($1000 CAD) was mailed later, and we paid this by credit card. He was referred to a larger hospital for EEG and a consultation, and we paid $250 CAD (cash--our choice) for the specialist physician fees, and $550 for the EEG (credit card). He needed an MRI and got one very quickly, with quick radiology report, at a "private pay" facility for $1,250 CAD (paid by credit card). An MRI for an out-of-country patient through the government health care system would have cost $2,250, and might not have happened so quickly.

We are now in the process of seeking reimbursement from our insurance company. We thought we had covered all the bases before leaving the US for this trip: my husband is on Medicare, and has a supplemental policy that reimburses up to $50,000 for out-of-country medical care on trips not exceeding 60 days. We also purchased a large policy for medical evacuation and emergency medical coverage (he did not need emergency evacuation).

Here is the one thing we did not anticipate: my husband's insurer, USAA, requires proof of the exact dates on which we entered and departed Canada. The only proof they accept are airline tickets, airline itineraries, and passport stamps. We drove, and the border crossings we used no longer stamp passports--they scan them. Hotel receipts and gasoline receipts are not acceptable, and so, to obtain electronic copies of our travel records from the US and Canadian border agencies, we have had to file the equivalent of Freedom of Information Act requests with both governments. We filed those weeks ago, and were told it can take 30 days or longer to get a response. We are still waiting. Good thing we were able to pay those credit card bills, and that USAA tells us we have 15 months to file the claim.

Next time we cross the US-Canada border, we will ask again for passport stamps--we were told we'd have to submit to time-consuming interviews to get them, even though we are NEXUS cardholders. We would have opted for the interviews had we known how difficult it was to get the electronic records of our border crossings after the fact.
Thank you for the story. USAA position is understandable. What I don't understand is why so difficult to get a passport stamp.
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Re: International Medical emergency story [travel to Canada, no insurance]

Post by biscuits »

When we were crossing the border into Canada (at Calais, Maine), we asked for passport stamps, and were told by the border agent: "We don't just hand those out the way we used to. You would have to go into the office and have an interview and a criminal background check. I see you are NEXUS members, so that may speed things up, but it could take a while."

I explained that we needed a record of the border crossing for insurance purposes, and the agent said, "Oh, you can just go online and request that." She made it sound easy and automatic, and I pictured just going online and downloading a record. But then I found out that it is not easy--just figuring out how where and how to file the request takes a while. I have no idea why they don't just stamp your passport anymore. I will try to find out next time we cross the border (we travel to Canada frequently).
Yooper16
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Re: International Medical emergency story [travel to Canada, no insurance]

Post by Yooper16 »

biscuits wrote: Tue Sep 17, 2019 8:15 pm When we were crossing the border into Canada (at Calais, Maine), we asked for passport stamps, and were told by the border agent: "We don't just hand those out the way we used to. You would have to go into the office and have an interview and a criminal background check. I see you are NEXUS members, so that may speed things up, but it could take a while."

I explained that we needed a record of the border crossing for insurance purposes, and the agent said, "Oh, you can just go online and request that." She made it sound easy and automatic, and I pictured just going online and downloading a record. But then I found out that it is not easy--just figuring out how where and how to file the request takes a while. I have no idea why they don't just stamp your passport anymore. I will try to find out next time we cross the border (we travel to Canada frequently).
No passport needed--just our "enhanced" state drivers license. I'm am guessing that a Nexus card is the same as our license. Nothing to stamp. We go to Canada periodically-- live a mile from the bridge crossing.
drawpoker
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Re: International Medical emergency story [travel to Canada, no insurance]

Post by drawpoker »

biscuits wrote: Tue Sep 17, 2019 7:59 pm .....husband is on Medicare, and has a supplemental policy that reimburses up to $50,000 for out-of-country emergency medical care on trips not exceeding 60 days. .......
Just to clarify, isn't this supplemental policy from USAA either Medigap Plan C, F, G, M or N, and that it pays 80% of the costs of out-of-country emergency care, with a lifetime cap on those benefits of $50,000?

That is the boilerplate language on these type Medigap, are you saying his USAA is not Medigap, something else that actually reimburses "up to $50,000"

:?:
biscuits
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Re: International Medical emergency story [travel to Canada, no insurance]

Post by biscuits »

The NEXUS card is a "trusted traveller card." From the Canadian Border Patrol website:
The NEXUS program allows pre-screened travelers expedited processing when entering the United States and Canada. Program members use dedicated processing lanes at designated northern border ports of entry, NEXUS kiosks when entering Canada by air and Global Entry kiosks when entering the United States via Canadian Preclearance airports. NEXUS members also receive expedited processing at marine reporting locations.

We presented our passports at the border and requested stamps, but did not get them.
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Re: International Medical emergency story [travel to Canada, no insurance]

Post by biscuits »

drawpoker wrote: Tue Sep 17, 2019 8:24 pm
biscuits wrote: Tue Sep 17, 2019 7:59 pm .....husband is on Medicare, and has a supplemental policy that reimburses up to $50,000 for out-of-country emergency medical care on trips not exceeding 60 days. .......
Just to clarify, isn't this supplemental policy from USAA either Medigap Plan C, F, G, M or N, and that it pays 80% of the costs of out-of-country emergency care, with a lifetime cap on those benefits of $50,000?

That is the boilerplate language on these type Medigap, are you saying his USAA is not Medigap, something else that actually reimburses "up to $50,000"

:?:
You are correct. His USAA policy is a Medigap plan. I'm not sure what percentage of the costs of out-of-country emergency care it pays, but I do know that there is a lifetime cap of $50,000 on those benefits. (You are probably right about the 80%. I just don't have it in front of me right now.)
student
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Re: International Medical emergency story [travel to Canada, no insurance]

Post by student »

biscuits wrote: Tue Sep 17, 2019 8:15 pm When we were crossing the border into Canada (at Calais, Maine), we asked for passport stamps, and were told by the border agent: "We don't just hand those out the way we used to. You would have to go into the office and have an interview and a criminal background check. I see you are NEXUS members, so that may speed things up, but it could take a while."

I explained that we needed a record of the border crossing for insurance purposes, and the agent said, "Oh, you can just go online and request that." She made it sound easy and automatic, and I pictured just going online and downloading a record. But then I found out that it is not easy--just figuring out how where and how to file the request takes a while. I have no idea why they don't just stamp your passport anymore. I will try to find out next time we cross the border (we travel to Canada frequently).
Thanks for the reply. Very strange. I thought the passport stamp is simply a record of you entering the country. Found this https://www.gands.com/knowledge-centre/ ... ts-anymore Interesting.
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ResearchMed
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Re: International Medical emergency story [travel to Canada, no insurance]

Post by ResearchMed »

We ALWAYS have travel insurance.'

We use a broker, www.TripInsuranceStore.com -which we learned about on cruise critic, although most of the travel insurance issue are not cruise specific at all.

There are quite a few different types of policies, and choices depend upon a variety of specific issues, so TALK to them.

We've purchased policies from Travel Insured, and have had several claims, including a few large ones.
We have always been paid promptly.

RM
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drawpoker
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Re: International Medical emergency story [travel to Canada, no insurance]

Post by drawpoker »

biscuits wrote: Tue Sep 17, 2019 8:31 pm
.....not sure what percentage of the costs of out-of-country emergency care it pays, but I do know that there is a lifetime cap of $50,000 on those benefits. (You are probably right about the 80%. I just don't have it in front of me right now.)
Thanks for the clarification. Don't mean to scare you, but be prepared that when USAA eventually settles up - he still could be facing a big, unpleasant bill.

"With a Medigap plan that covers foreign travel emergencies, the patient pays a $250 deductible plus 20 percent coinsurance, and there’s a lifetime benefit maximum of $50,000."


That 20% co-insurance (that we never think about because our Medigap policies pay it in the U.S.) could amount to alot if charges he rung up in Canada run well into five figures. :(
toofache32
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Re: Huge Change In This Now

Post by toofache32 »

drawpoker wrote: Tue Sep 17, 2019 7:43 pm
toofache32 wrote: Tue Sep 17, 2019 7:35 pm

I too was wondering how Medicare status is relevant to healthcare received in another country.
In the original posting the OP stated he thought the guy was on Medicare. Now we know that was incorrect.

IF he had been on Medicare and carrying the appropriate Medigap policy, it would have paid 80% of emergency care in a foreign country. With a lifetime cap of $50,000. No benefits at all for medical evacuation costs, however, hence, the mention of the importance of purchasing travel insurance with medevac rider.
80% of whose fees?
Are hospitals/providers in other countries “in-network” with Medicare? How does this work? Medicare won’t pay anything for OON care in the US, why would they in other countries?
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ResearchMed
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Re: International Medical emergency story [travel to Canada, no insurance]

Post by ResearchMed »

drawpoker wrote: Tue Sep 17, 2019 8:44 pm
biscuits wrote: Tue Sep 17, 2019 8:31 pm
.....not sure what percentage of the costs of out-of-country emergency care it pays, but I do know that there is a lifetime cap of $50,000 on those benefits. (You are probably right about the 80%. I just don't have it in front of me right now.)
Thanks for the clarification. Don't mean to scare you, but be prepared that when USAA eventually settles up - he still could be facing a big, unpleasant bill.

"With a Medigap plan that covers foreign travel emergencies, the patient pays a $250 deductible plus 20 percent coinsurance, and there’s a lifetime benefit maximum of $50,000."


That 20% co-insurance (that we never think about because our Medigap policies pay it in the U.S.) could amount to alot if charges he rung up in Canada run well into five figures. :(
For those with this restriction, which is common with Medicare add-ons, I think...

Get a 3rd party travel insurance that is PRIMARY. That means you do NOT need to "first submit to your own insurer" and then get paid if your own insurer denies it or tops out.

If you get Primary coverage, it never bills your regular insurer, thus leaving that $50k life maximum for lesser trips, when perhaps you didn't plan ahead and don't get extra insurance... or just for later...

RM
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Re: International Medical emergency story [travel to Canada, no insurance]

Post by AlohaJoe »

toofache32 wrote: Tue Sep 17, 2019 7:33 pm
southerndoc wrote: Tue Sep 17, 2019 7:12 pm I'm assuming Canada does not have something similar to US EMTALA laws.
I was thinking the same thing. I guess, unlike US docs, they are not required by law to work for free when these scenarios arise?
Why would a country with single payer health care need a law like EMTALA? The only targets of such a law would be tourists, wouldn't it?
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Re: International Medical emergency story [travel to Canada, no insurance]

Post by biscuits »

drawpoker wrote: Tue Sep 17, 2019 8:44 pm
biscuits wrote: Tue Sep 17, 2019 8:31 pm
.....not sure what percentage of the costs of out-of-country emergency care it pays, but I do know that there is a lifetime cap of $50,000 on those benefits. (You are probably right about the 80%. I just don't have it in front of me right now.)
Thanks for the clarification. Don't mean to scare you, but be prepared that when USAA eventually settles up - he still could be facing a big, unpleasant bill.

"With a Medigap plan that covers foreign travel emergencies, the patient pays a $250 deductible plus 20 percent coinsurance, and there’s a lifetime benefit maximum of $50,000."


That 20% co-insurance (that we never think about because our Medigap policies pay it in the U.S.) could amount to alot if charges he rung up in Canada run well into five figures. :(
Thanks for the info. I believe you! We are probably looking at 20% co-insurance on about $15,000 CAD, which, thanks to an exchange rate that favours the US right now, is about $11,000 USD. I'm not scared about that. But I am scared about the future: we have a summer cottage in Canada, and this is the first big medical emergency we've faced here. (My husband had an ER visit here about 5 years ago, before he was on Medicare, when he was on a great BCBS policy I had through work. On that visit we paid about $2,000 CAD at the hospital, and my BCBS reimbursed fully and very quickly--we did not have to document the dates we crossed the border, either.) I'm scared about what happens when/if we hit that $50,000 Medigap lifetime cap, and what happens when/if no one wants to sell us travel insurance anymore due to our age or medical histories.
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Re: International Medical emergency story [travel to Canada, no insurance]

Post by biscuits »

ResearchMed wrote: Tue Sep 17, 2019 8:52 pm
drawpoker wrote: Tue Sep 17, 2019 8:44 pm
biscuits wrote: Tue Sep 17, 2019 8:31 pm
.....not sure what percentage of the costs of out-of-country emergency care it pays, but I do know that there is a lifetime cap of $50,000 on those benefits. (You are probably right about the 80%. I just don't have it in front of me right now.)
Thanks for the clarification. Don't mean to scare you, but be prepared that when USAA eventually settles up - he still could be facing a big, unpleasant bill.

"With a Medigap plan that covers foreign travel emergencies, the patient pays a $250 deductible plus 20 percent coinsurance, and there’s a lifetime benefit maximum of $50,000."


That 20% co-insurance (that we never think about because our Medigap policies pay it in the U.S.) could amount to alot if charges he rung up in Canada run well into five figures. :(
For those with this restriction, which is common with Medicare add-ons, I think...

Get a 3rd party travel insurance that is PRIMARY. That means you do NOT need to "first submit to your own insurer" and then get paid if your own insurer denies it or tops out.

If you get Primary coverage, it never bills your regular insurer, thus leaving that $50k life maximum for lesser trips, when perhaps you didn't plan ahead and don't get extra insurance... or just for later...

RM
Thanks, RM, I will look into that for future trips.
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ResearchMed
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Re: International Medical emergency story [travel to Canada, no insurance]

Post by ResearchMed »

biscuits wrote: Tue Sep 17, 2019 9:05 pm
ResearchMed wrote: Tue Sep 17, 2019 8:52 pm
drawpoker wrote: Tue Sep 17, 2019 8:44 pm
biscuits wrote: Tue Sep 17, 2019 8:31 pm
.....not sure what percentage of the costs of out-of-country emergency care it pays, but I do know that there is a lifetime cap of $50,000 on those benefits. (You are probably right about the 80%. I just don't have it in front of me right now.)
Thanks for the clarification. Don't mean to scare you, but be prepared that when USAA eventually settles up - he still could be facing a big, unpleasant bill.

"With a Medigap plan that covers foreign travel emergencies, the patient pays a $250 deductible plus 20 percent coinsurance, and there’s a lifetime benefit maximum of $50,000."


That 20% co-insurance (that we never think about because our Medigap policies pay it in the U.S.) could amount to alot if charges he rung up in Canada run well into five figures. :(
For those with this restriction, which is common with Medicare add-ons, I think...

Get a 3rd party travel insurance that is PRIMARY. That means you do NOT need to "first submit to your own insurer" and then get paid if your own insurer denies it or tops out.

If you get Primary coverage, it never bills your regular insurer, thus leaving that $50k life maximum for lesser trips, when perhaps you didn't plan ahead and don't get extra insurance... or just for later...

RM
Thanks, RM, I will look into that for future trips.
One thing to keep in mind is that timing to start the policy matters, especially if one wants coverage for pre-existing conditions (as long as one is "fit to travel" on the date that insurance is started). The best timing is to start the coverage when one makes the FIRST payment/deposit, but one only needs to cover that initial deposit amount, no matter how small. Then add coverage, as more non-refundable costs are added.

Last week we got a 5 figure check for big trip we had to cancel last spring, when very elderly MIL landed in ER with heart trouble shortly before our departure.
She's okay now, albeit a bit more frail (no surprise at almost 99), and we hesitated about cancelling, but then we realized that some of the test results wouldn't even be back before we were supposed to fly out. That was NOT going to work!.
It was all very worrisome, and although we could "afford" the loss (that money was already paid and gone, etc.), it was quite comforting to know that at least we wouldn't have to "pay again" to take that or a similar trip later.

We also get CFAR coverage (Cancel For Any Reason), which costs extra, in case something happens where our choice is more discretionary (e.g., MIL says, "I just don't feel right", although she NEVER says that... meaning if she ever did..... at that age, etc.). Or if there is a tricky political situation and we just don't feel comfortable going "there", or such.
Or even if DH suddenly realizes that a particular project/lecture suddenly cropped up.
But these are among the choices, and we've learned a *LOT* from many discussions with TIS folks, who are remarkably patient with "newbies".

RM
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biscuits
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Re: International Medical emergency story [travel to Canada, no insurance]

Post by biscuits »

Thanks, RM, that's helpful. Can you recommend any particular insurance companies?
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ResearchMed
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Re: International Medical emergency story [travel to Canada, no insurance]

Post by ResearchMed »

biscuits wrote: Tue Sep 17, 2019 9:30 pm Thanks, RM, that's helpful. Can you recommend any particular insurance companies?
I'd start with www.TripInsuranceStore.com - a broker, and that's who we use (no extra charge to go through them).
They vet the insurers they work with, so I don't read about problems with collecting, etc.

We use Travel Insured (through TIS), but you *might* have some specific issues that make some other insurer that TIS works with better for your purposes.

Call TIS just to ask how it all works. They are really great to get started on that learning curve.
And once, the owner (Steve) suggested that we didn't really need a separate policy for a particular trip... he knew us a bit by then, and... he was right! (I'm forgetting the reasons.)

We also us MedJetAssist. That kicks in once one is admitted to a hospital as an INpatient. Then YOU get to decide if you want to be medevac'd home or to specialty hospital, if stable enough for full air ambulance.
No beancounters make the decision, nor do local medical staff need to declare themselves perhaps not quite up to the task....

RM
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Re: International Medical emergency story [travel to Canada, no insurance]

Post by biscuits »

student wrote: Tue Sep 17, 2019 8:39 pm
biscuits wrote: Tue Sep 17, 2019 8:15 pm When we were crossing the border into Canada (at Calais, Maine), we asked for passport stamps, and were told by the border agent: "We don't just hand those out the way we used to. You would have to go into the office and have an interview and a criminal background check. I see you are NEXUS members, so that may speed things up, but it could take a while."

I explained that we needed a record of the border crossing for insurance purposes, and the agent said, "Oh, you can just go online and request that." She made it sound easy and automatic, and I pictured just going online and downloading a record. But then I found out that it is not easy--just figuring out how where and how to file the request takes a while. I have no idea why they don't just stamp your passport anymore. I will try to find out next time we cross the border (we travel to Canada frequently).
Thanks for the reply. Very strange. I thought the passport stamp is simply a record of you entering the country. Found this https://www.gands.com/knowledge-centre/ ... ts-anymore Interesting.
Thanks for digging up that information. I see that those immigration lawyers are recommending that their clients save their boarding passes now that Canadian immigration officers are no longer stamping passports. What should the motorist do?
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Re: International Medical emergency story [travel to Canada, no insurance]

Post by biscuits »

ResearchMed wrote: Tue Sep 17, 2019 9:40 pm
biscuits wrote: Tue Sep 17, 2019 9:30 pm Thanks, RM, that's helpful. Can you recommend any particular insurance companies?
I'd start with www.TripInsuranceStore.com - a broker, and that's who we use (no extra charge to go through them).
They vet the insurers they work with, so I don't read about problems with collecting, etc.

We use Travel Insured (through TIS), but you *might* have some specific issues that make some other insurer that TIS works with better for your purposes.

Call TIS just to ask how it all works. They are really great to get started on that learning curve.
And once, the owner (Steve) suggested that we didn't really need a separate policy for a particular trip... he knew us a bit by then, and... he was right! (I'm forgetting the reasons.)

We also us MedJetAssist. That kicks in once one is admitted to a hospital as an INpatient. Then YOU get to decide if you want to be medevac'd home or to specialty hospital, if stable enough for full air ambulance.
No beancounters make the decision, nor do local medical staff need to declare themselves perhaps not quite up to the task....

RM
RM--Thanks so much for taking the time to pass on all this helpful information and advice! I really appreciate it.
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Re: International Medical emergency story [travel to Canada, no insurance]

Post by hmw »

southerndoc wrote: Tue Sep 17, 2019 7:12 pm I'm assuming Canada does not have something similar to US EMTALA laws.
No. All Canadian citizens and legal residents are insured by their provincial plans. So it is an non-issue for residents of Canada.

I think there is some details missing from the OP. Did the patient have acute coronary syndrome or just stable angina? If CPR was performed, it would favor ACS. It is a true medical emergency, I don’t see how any Canadian MD would wait and ask for payment up front. If it is true, this MD can potentially lose his/her medical license. You can certainly make a written complaint to the Ontario college of physicians and surgeons which governs the practice of medicine in Ontario.

My Aunt from California suffered a hip fracture while visiting Vancouver about 10 years ago after getting hit by a motorized scooter on the sidewalk. And the [(removed) --admin LadyGeek] scooter didn’t even stop! She was operated on at a downtown teaching hospital. There was no demand for payment before the surgery. Her BCBS plan paid for all the expenses after she returned home.
OnTrack
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Re: International Medical emergency story [travel to Canada, no insurance]

Post by OnTrack »

biscuits wrote: Tue Sep 17, 2019 8:31 pm His USAA policy is a Medigap plan. I'm not sure what percentage of the costs of out-of-country emergency care it pays, but I do know that there is a lifetime cap of $50,000 on those benefits. (You are probably right about the 80%. I just don't have it in front of me right now.)
I checked with Kaiser regarding their Medicare Advantage plans and I was told that they do not have any lifetime caps, so they do not have the $50,000 lifetime cap for foreign travel. They do require repatriation for additional medical care once the patient is medically stable enough. Also, the bill must be paid up front by the patient (or family) and then is reimbursed later. Kaiser also covers urgent care outside of the US which I think Medigap does not.

I'm not advocating for or against Medicare Advantage vs. Medigap, but this is one difference. Also, This is specific to Kaiser, not sure about other MA plans.
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Re: International Medical emergency story [travel to Canada, no insurance]

Post by HawkeyePierce »

I would hope USAA updates their policies. Many countries are getting rid of stamps. Hong Kong, New Zealand, Australia, Canada, the list goes on.

Half the stamps in my passport aren’t even readable.

And of course you can travel across much of Europe without encountering an immigration agent.
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Re: International Medical emergency story [travel to Canada, no insurance]

Post by SrGrumpy »

biscuits wrote: Tue Sep 17, 2019 7:59 pm If anyone has any suggestions on how to get these border crossing records more quickly, I would love to hear them.
Oddly enough, the Feds make it easier for foreigners than for citizens to get travel records. We go to CPB's I94 web site, type some info, and it shows within seconds. Does Canada have a version for foreigners? Also, cell phone records, GPS would be an additional clue to your movements. Since the much-hyped (here) USAA is military-focused, this should be a cinch.
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Re: International Medical emergency story [travel to Canada, no insurance]

Post by student »

SrGrumpy wrote: Wed Sep 18, 2019 2:25 am
biscuits wrote: Tue Sep 17, 2019 7:59 pm If anyone has any suggestions on how to get these border crossing records more quickly, I would love to hear them.
Oddly enough, the Feds make it easier for foreigners than for citizens to get travel records. We go to CPB's I94 web site, type some info, and it shows within seconds. Does Canada have a version for foreigners? Also, cell phone records, GPS would be an additional clue to your movements. Since the much-hyped (here) USAA is military-focused, this should be a cinch.
Interesting. I think even if Canada has one, it may not be as easy. My rationale is that the I94 website likely does not apply to Canadians coming to US as they don't need one, so Canadians probably won't be able to get a record at this site. So I assume the same is true for US citizens visiting Canada if they have such a system.
student
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Re: International Medical emergency story [travel to Canada, no insurance]

Post by student »

student wrote: Tue Sep 17, 2019 8:07 pm
biscuits wrote: Tue Sep 17, 2019 7:59 pm True story of medical emergency in Canada, with more detail and action items:

My husband had a medical emergency recently while visiting Canada from the US. He received excellent emergency care from the EMT's, quick ambulance transportation to a rural hospital, CT scans and excellent emergency care in the hospital, and admission for three nights. We were not asked for payment upfront, but rather were asked to pay the hospital bill ($11,488 CAD) upon discharge, and we paid with a credit card. A bill for the ambulance ($1000 CAD) was mailed later, and we paid this by credit card. He was referred to a larger hospital for EEG and a consultation, and we paid $250 CAD (cash--our choice) for the specialist physician fees, and $550 for the EEG (credit card). He needed an MRI and got one very quickly, with quick radiology report, at a "private pay" facility for $1,250 CAD (paid by credit card). An MRI for an out-of-country patient through the government health care system would have cost $2,250, and might not have happened so quickly.

We are now in the process of seeking reimbursement from our insurance company. We thought we had covered all the bases before leaving the US for this trip: my husband is on Medicare, and has a supplemental policy that reimburses up to $50,000 for out-of-country medical care on trips not exceeding 60 days. We also purchased a large policy for medical evacuation and emergency medical coverage (he did not need emergency evacuation).

Here is the one thing we did not anticipate: my husband's insurer, USAA, requires proof of the exact dates on which we entered and departed Canada. The only proof they accept are airline tickets, airline itineraries, and passport stamps. We drove, and the border crossings we used no longer stamp passports--they scan them. Hotel receipts and gasoline receipts are not acceptable, and so, to obtain electronic copies of our travel records from the US and Canadian border agencies, we have had to file the equivalent of Freedom of Information Act requests with both governments. We filed those weeks ago, and were told it can take 30 days or longer to get a response. We are still waiting. Good thing we were able to pay those credit card bills, and that USAA tells us we have 15 months to file the claim.

Next time we cross the US-Canada border, we will ask again for passport stamps--we were told we'd have to submit to time-consuming interviews to get them, even though we are NEXUS cardholders. We would have opted for the interviews had we known how difficult it was to get the electronic records of our border crossings after the fact.
Thank you for the story. USAA position is understandable. What I don't understand is why so difficult to get a passport stamp.
Now that I thought about it more, I think USAA should let travelers register with it in advance with their travel plan and this registration should be sufficient.
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Re: International Medical emergency story [travel to Canada, no insurance]

Post by BogleMelon »

For those who may want to shop for protection while traveling, I found this article very useful https://expeditionportal.com/buyers-gui ... -services/
"One of the funny things about stock market, every time one is buying another is selling, and both think they are astute" - William Feather
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Re: International Medical emergency story [travel to Canada, no insurance]

Post by talzara »

biscuits wrote: Tue Sep 17, 2019 7:59 pmHere is the one thing we did not anticipate: my husband's insurer, USAA, requires proof of the exact dates on which we entered and departed Canada. The only proof they accept are airline tickets, airline itineraries, and passport stamps. We drove, and the border crossings we used no longer stamp passports--they scan them. Hotel receipts and gasoline receipts are not acceptable, and so, to obtain electronic copies of our travel records from the US and Canadian border agencies, we have had to file the equivalent of Freedom of Information Act requests with both governments. We filed those weeks ago, and were told it can take 30 days or longer to get a response. We are still waiting. Good thing we were able to pay those credit card bills, and that USAA tells us we have 15 months to file the claim.
Canadian government agencies must respond within 30 days. Not "30 days or longer."
A Travel History Report is a record of a traveller's entries, exits or both into Canada. This information is collected by the Canada Border Services Agency (CBSA). ... When you request your Travel History Report directly from the CBSA it can take up to 30 days to complete.

https://www.cbsa-asfc.gc.ca/agency-agen ... v-eng.html
biscuits
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Re: International Medical emergency story [travel to Canada, no insurance]

Post by biscuits »

talzara wrote: Wed Sep 18, 2019 11:46 am
biscuits wrote: Tue Sep 17, 2019 7:59 pmHere is the one thing we did not anticipate: my husband's insurer, USAA, requires proof of the exact dates on which we entered and departed Canada. The only proof they accept are airline tickets, airline itineraries, and passport stamps. We drove, and the border crossings we used no longer stamp passports--they scan them. Hotel receipts and gasoline receipts are not acceptable, and so, to obtain electronic copies of our travel records from the US and Canadian border agencies, we have had to file the equivalent of Freedom of Information Act requests with both governments. We filed those weeks ago, and were told it can take 30 days or longer to get a response. We are still waiting. Good thing we were able to pay those credit card bills, and that USAA tells us we have 15 months to file the claim.
Canadian government agencies must respond within 30 days. Not "30 days or longer."
A Travel History Report is a record of a traveller's entries, exits or both into Canada. This information is collected by the Canada Border Services Agency (CBSA). ... When you request your Travel History Report directly from the CBSA it can take up to 30 days to complete.

https://www.cbsa-asfc.gc.ca/agency-agen ... v-eng.html
Thank you, talzara, good to know. I just checked the confirmation I received from Canada Border Services Agency on August 29 and it reads: "If your request is complete, it will be processed within 30 calendar days from the date of receipt, unless an extension is required." So, on Sept. 18, we are within the 30 days. Here's hoping. And here's hoping it includes both entrances and exits, as I have not gotten any response from the US side.
biscuits
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Re: International Medical emergency story [travel to Canada, no insurance]

Post by biscuits »

student wrote: Wed Sep 18, 2019 6:16 am
student wrote: Tue Sep 17, 2019 8:07 pm
biscuits wrote: Tue Sep 17, 2019 7:59 pm True story of medical emergency in Canada, with more detail and action items:

My husband had a medical emergency recently while visiting Canada from the US. He received excellent emergency care from the EMT's, quick ambulance transportation to a rural hospital, CT scans and excellent emergency care in the hospital, and admission for three nights. We were not asked for payment upfront, but rather were asked to pay the hospital bill ($11,488 CAD) upon discharge, and we paid with a credit card. A bill for the ambulance ($1000 CAD) was mailed later, and we paid this by credit card. He was referred to a larger hospital for EEG and a consultation, and we paid $250 CAD (cash--our choice) for the specialist physician fees, and $550 for the EEG (credit card). He needed an MRI and got one very quickly, with quick radiology report, at a "private pay" facility for $1,250 CAD (paid by credit card). An MRI for an out-of-country patient through the government health care system would have cost $2,250, and might not have happened so quickly.

We are now in the process of seeking reimbursement from our insurance company. We thought we had covered all the bases before leaving the US for this trip: my husband is on Medicare, and has a supplemental policy that reimburses up to $50,000 for out-of-country medical care on trips not exceeding 60 days. We also purchased a large policy for medical evacuation and emergency medical coverage (he did not need emergency evacuation).

Here is the one thing we did not anticipate: my husband's insurer, USAA, requires proof of the exact dates on which we entered and departed Canada. The only proof they accept are airline tickets, airline itineraries, and passport stamps. We drove, and the border crossings we used no longer stamp passports--they scan them. Hotel receipts and gasoline receipts are not acceptable, and so, to obtain electronic copies of our travel records from the US and Canadian border agencies, we have had to file the equivalent of Freedom of Information Act requests with both governments. We filed those weeks ago, and were told it can take 30 days or longer to get a response. We are still waiting. Good thing we were able to pay those credit card bills, and that USAA tells us we have 15 months to file the claim.

Next time we cross the US-Canada border, we will ask again for passport stamps--we were told we'd have to submit to time-consuming interviews to get them, even though we are NEXUS cardholders. We would have opted for the interviews had we known how difficult it was to get the electronic records of our border crossings after the fact.
Thank you for the story. USAA position is understandable. What I don't understand is why so difficult to get a passport stamp.
Now that I thought about it more, I think USAA should let travelers register with it in advance with their travel plan and this registration should be sufficient.
That would work for the honest traveller. But USAA would perhaps worry that people would try to game the system, not reporting that they were out of the country for more than the 60 consecutive days that are covered.
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Re: International Medical emergency story [travel to Canada, no insurance]

Post by dm200 »

No personal experience, fortunately, but several years ago, a casual acquaintance of mine (insured on Kaiser Medicare Plan, same as I have) was injured in Montreal - I think as a pedestrian hit by a car. According to him. at the time, he received very prompt and excellent care for his injuries. His injuries were not such that he was unable to travel soon after the injuries. When he got back, he connected with Kaiser for continuing care/treatment.
The only challenges/issues he faced then were the paperwork matters between Kaiser and the providers in Canada. The Kaiser medicare plan does cover certain aspects of health/medical care while traveling outside the US.

Since we are on the Kaiser Medicare plan (NOT original Medicare and Medigap), I don't know if those would provide benefits in Canada or not.

Maybe others would know about Original Medicare coverage in Canada and about Medigap as well.
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