How does it work if a Canadian need medical services while travelling the in USA?

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Cariad

First call your travellers insurance. Different insurance companies have different policies. They may ask you if you can wait til you get home because they only cover medical emergencies. You need to find out first though.

I would also call OHIP Out of Country Claims to see if they will reimburse you. (the out of country form has numbers you can reach from out of country) If it is not emergency, you are likely NOT covered. What you insurance company likely will do it ask you to be denied by your provincial plan, and THEN apply to them with the denial letter. Even if OHIP does cover, they only pay what they would normally pay in Canada. And, you will be asked to pay up front in the USA for any medical service. (unless your travel insurance makes arrangements IN ADVANCE with the medical facilty-also why you need to call them first)

I don't know where you are from in Canada, but most areas are the same. Here is what the OHIP site says:
OHIP will pay only for insured, emergency out-of-country health services that are rendered to an insured person. To qualify as an â€˜emergencyâ€™ there are a number of criteria that must be satisfied. These criteria are set by regulation and all conditions listed below must be met:
the treatment must be medically necessary, and
the treatment must be performed at a licensed hospital or licensed health facility, and
the treatment must be rendered in relation to an illness, disease, condition or injury that :
is acute and unexpected, and
arose outside of Canada, and
requires immediate treatment

(I gave answers for OHIP, but they generally apply across Canada)

NWIP

It can depend on the company, but usually you have to pay yourself and then you will get refunded when you file for it when you get home. My nephew had to do it and they paid upfront then got refunded right after they got home.

thinkingtime

It depends who you see.

Some smaller places will want cash and give you a receipt to get reimbursed for the government or your insurance. A larger centre may take your insurance but, in my experience, won't be interested in your health card.

You may have trouble getting reimbursed for a non-emergency.

Jeff H

Generally you will have to pay up front and then apply to your insurer for reimbursement, at least that is what my girlfriend had to do. Check with the doctor to see if they accept a credit card and use that to pay for it. Also contact your insurer first, generally travel insurance will only cover emergencies so check with them to see if the "problem" will be covered. Although your provincial medical insurance will still cover costs they will only cover costs generally based on what they would pay to a Canadian doctor. US medical costs are significantly higher in most, if not all, cases so you could end up being responsible for a fair amount of money. This is especially true if the doctor sends you to the hospital or a clinic for any tests.

u r dumb

My suggestion is to get travel medical insurance
Its a different country so showing your Health card you will not get anyone impressed or who cares for it

What to do?

FYI, under US law, you cannot be denied medical care at an emergency room based on ability to pay. I know that's not what you asked, but I just wanted to make sure that you know that if you DO have a genuine emergency, you will be treated regardless of the finances.

vancouver_syndicate

most places will make you pay and they you get reimbursed by your insurance company.

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