(Part 5 of my UnCommon Sense Series of rarely offered information,
opinions, and articles.)
I travel to the United States a lot on business and for conferences, etc. I am also blessed with (or have developed - but that's another story) an extremely robust immune system. Up until now, I never bothered with travel health insurance. Sure, an immune system can't prevent an accident, but for what I was doing down there, I was willing to assume the risks. Besides, being an Ontario resident, I knew that OHIP (Ontario Health Insurance Plan) would cover most expenses up to at least the OHIP equivalent fee schedule amounts.
Then, on a visit to Denver, I developed a chest pain that would not go away. I won't go into the medical details, except to say that taking your own vital statistics can have a measurable effect on your vital statistics, and the pain was found to be nothing more than some minor chest joint inflammation. However, since I had been down there doing high ropes course safety training, my brain was in Elmer the Safety Elephant mode, and I decided to just check things out at a nearby hospital. I learned a great deal from this experience - mistakes and surprises which you may now benefit from:
1. TIMING
The onset of pain was around 6pm. I left it until 1am to get checked out. The emergency department wanted to rule out angina or heart attack (obviously) and ended admitting me and putting me into my own room for the rest of the night. I was given breakfast in the morning and then I checked out. Problem? According to the hospital, because I was admitted after midnight and left on the same calendar day, I was (in their system) an out-patient. The fact that I was admitted, given a room and meal, and charged full rate for all of that was inconsequential. OHIP's reimbursement limit is eight (8!) times higher for in-patients than for out-patients.
Lesson 1: If there is a chance you need need to be admitted to a U.S. hospital (and you have a choice), get yourself there before midnight or ASK what their policy is.
2. CHOICE OF HOSPITAL
When I finally decided to get a professional opinion on my puzzling ailment, I went to the front desk and inquired where the nearest hospital might be. They had no idea. I gave them significant grief about that. We ended up picking one out of a phone book. I later discovered that this was one of the most expensive hospitals in the area.
Lesson 2: Not all U.S. hospitals charge the same amounts. Assuming (again) that you have a choice, ASK if this is the most appropriate place for you to be.
3. EXTORTION
When I arrived at the hospital, I was fully aware that I was not covered by travel health insurance, and that there was almost certainly going to be some out-of-pocket money involved. Even in my somewhat anxious and exhausted state, I did my best to ask about what these charges might be, what I was signing, and what I had choices about from a financial perspective. I was told in no uncertain terms that this was not the time to be concerned about any of that, and to simply let them do what they wanted to. I could not have imagined what I was getting myself into. Months later, I was able to piece together some of the consequences...
"Do you have any kind of headache? Would you like an Aspirin?" I never take headache medication, but on this occasion, sure. For a single 81 mg tablet, I was charged $11.40 USD. No, that did not include the cost of the nurse who brought it to me - that was all billed elsewhere. In fact, once you have signed the consent form, they can charge you whatever amount they set, even though they refuse to tell you the costs.
Lesson 3: Do not ask, DEMAND to know what you will be charged for each and every medication or procedure. The good doctor and nurse probably don't even know what their organization will end up charging you. EDUCATE them. And yourself.
4. THE OBSERVATION SCAM
Another cute trick is to have a variety of medical practitioners pop in on you to see how you are doing. Every doctor who does this will send you their own bill, on top of anything the hospital is charging. For months after my incident, I was getting bills from people I had no recollection of ever meeting. Another scam was rolled out when I had awoken the next morning feeling close to 100%. They wanted to run all kinds of additional tests, etc. At this point my brain was beginning to function again. I refused all further procedures, and demanded to be discharged. The hospital refused to let me go unless a physician OK'd it. Half an hour later, he came in, asked me how I felt ("fine"), and signed the paper. I happened to recognize his name on a bill that came 3 months later: $250.00 USD for 'observation'.
Lesson 4: Demand to be seen by as few doctors as possible - each one will bill as if you'd spent the day with them. Know your rights. If you want to leave then go. Unless you are under arrest, their policies will only nail your bank account.
5. PAPERWORK
When I filed my claim with OHIP, following all of their published guidelines, they could not process it for six (6) months because of their backlog. When they finally did, they sent it all back. I had not included a form UB92 from the U.S. hospital. None of their guidelines mention this requirement. Getting it out of the hospital was another protracted battle. If you do unfortunately end up in a U.S. hospital, demand a copy of form UB92 before you go, or have them send it to you as soon as possible.
Lesson 5: When filing a claim, call OHIP first and make sure you are sending them EXACTLY what they will be needing. Be specific.
6. THE BOTTOM LINE
Now for the really scary part. My ninety (90) minute emergency room visit and five (5) hour room rest came to well over $2000.00 USD ($3000.00 CAD at that time), and that was only because I started refusing procedures. The OHIP limit for all out-patient claims: $50 CAD. That's right, $50. If you were classified as an in-patient, it goes up to a whopping $400 limit.
Lesson 6: The cost of travel health insurance is probably worth it. BUT BEWARE - I have been told that it can be just as much hassle getting any of your money back through them too.
My plan? If I ever get sick in the U.S. again, I will go to the emergency waiting room and sit there until I feel better or I keel over. And I won't sign or accept anything until we both learn exactly what the cost will be.
The foregoing is my opinion. You can send me yours by clicking here.