It's often called the "losing your house" medical bill.
And for those who have been unlucky enough to get one - and there have been many - it's the last thing they had ever imagined would happen while on vacation.
As Canadians, we rarely worry about our health insurance coverage. We just take it for granted that we're covered. But when we leave our home province, we need to think about the limit of our health-care coverage.
Even more precisely and importantly, when we leave Canada, we shouldn't leave home without comprehensive travel insurance.
"When anybody contacts us, we always recommend that they take out additional travel insurance, no matter where they're going," says Deb Slobogian-Jones, Manager of Out of Province Benefits/Reciprocal Agreements at Manitoba Health.
Although Canadians rarely think about the cost of health care, they need to consider this when they leave their home province. Health care is terribly expensive, and in the United States and other countries around the world, as a tourist, you're largely on your own to cover the costs. "On many occasions, an out-of-country physician will treat the patient and then bill the patient directly for those services,"says Slobogian- Jones explaining how Canadians without travel insurance are cared for at hospitals in the United States, Mexico and other hot holiday destinations. "These bills should be presented to Manitoba Health for consideration of benefits," she says. "Other times, out-of-country physicians won't even treat you without a credit card prepayment."
The cost of health care - especially in the United States - is astronomically more expensive than it is in Canada. That's because, she says, the U.S. has a for-profit health insurance coverage system that has higher costs.
For that reason, insiders in the travel insurance business refer to large bills as the "lose your house" claims, says Wendy Shrimpton, manager of marketing services at Manitoba Blue Cross.
"Those are the kinds of expenses that can bankrupt a family," she says. "The charges can be pretty enormous in the U.S."
Shrimpton says she's not trying to be alarmist. Instead, she says she only wants to drive home the fact that for just a few dollars a family can buy travel health insurance for their two-week vacation to Disneyworld and not have to worry about getting sick or injured and coming home to Canada with the worst souvenir of all time: a massive medical bill. To that end, she offers up a litany of examples.
- Parents with a newborn go on vacation to Hawaii. Their child gets a fever and pneumonia and they go to Emergency at a hospital. Their travel insurance coverage cost $70, but their hospital bill was more than $4,200. Travel insurance picked up the tab.
- A 55-year-old man walking down the strip in Las Vegas trips and breaks his ankle. His bill was more than $3,000, of which Manitoba Health paid $98. But his additional insurance covered the rest.
- A 20-year-old woman goes to California and loses her sight in one eye. She paid $69 for insurance coverage. Total hospitalization was $29,795. Manitoba Health paid about $1,080, insurance paid the rest.
Slobogian-Jones says Manitoba Health does provide some coverage to travellers, but it's based on medical costs in Manitoba.
For example, Manitoba Health will pay between $280 and $570 a day for Emergency hospital care outside of Canada. For out-patient care - a visit to a hospital Emergency department for a fever, for example - the province will pay up to $100 Canadian.
"If the treatment is only $50 U.S., we would pay that cost equated in Canadian funds, but if it were $400, we would only pay $100 Canadian," she says. "Physician claims incurred out-of-country on an Emergency basis are paid equal to what a Manitoba physician would receive for the same service in Manitoba," she says
"We've seen costs in the United States that are well over $1,000 just for an Emergency room visit and we would only insure $100 Canadian for that visit."
And medical costs in other common vacation destinations - Cuba, Mexico and Jamaica - are equally expensive, so she recommends if you leave the country, you buy travel health insurance from any number of providers, including Manitoba Blue Cross, a non-profit provider.
But even when travelling outside of Manitoba this winter, be it to Alberta for a ski trip or snowmobiling near Lake of the Woods, travel health insurance is a shrewd decision. A reciprocal agreement is in place between all the provinces and territories that provide coverage of insured services to all Canadians when they travel in Canada, with the exception of physician care received in Quebec. But just like your normal Manitoba Health coverage, it doesn't pay for uninsured services like ambulance. (In Quebec, no agreement is in place, so healthcare providers give patients the bill, but it's often less costly than other provinces. Regardless, Manitoba Health will often cover the costs.) "As an example, if I was travelling to Vancouver and I incurred any type of insured medical service cost, I would not have to pay for that service," Slobogian-Jones says. "The health ministry of B.C. would bill Manitoba Health for the medical costs."
Although it may seem as though you don't need additional coverage - you likely could pay for an ambulance out of pocket - most people fail to realize that if they fall very ill or are badly injured while travelling in Canada outside Manitoba, the cost of air ambulance can run into the tens of thousands of dollars. And that's not covered under Manitoba Health.
"There have been really sad cases where someone has had a brain aneurysm in B.C. and the person has been put in a longterm care facility there because the family couldn't afford to bring their loved one home," she says. "We don't pay for that person to come back to be cared for in Manitoba, and the family is responsible for what could easily be a $25,000 bill for an air ambulance."
Shrimpton says most providers of travel health insurance offer coverage for these services when people travel outside their home province in Canada, but it's easy for people without insurance coverage to forget they may need coverage.
Many Manitobans, for example, think nothing of spending a weekend in Northwest Ontario - cottage country. But even that trip can also turn costly if something goes wrong. "Air and/or ground ambulance costs can range from $5,000 to more than $25,000," she says.
Nikki Makar, an individual benefits consultant with Manitoba Blue Cross, says even people with travel health insurance coverage need to be certain their plan covers them for where they intend to travel for vacation - in Canada and abroad.
And it's also important to be certain they understand the potential limits and exclusions in the policy. Two important terms to be aware of are "pre-existing conditions" and "stable and controlled."
While Manitoba Blue Cross and other insurers may not ask individuals under age 55 about pre-existing conditions and whether they're stable and under control, many other providers do. And it's always better to ask about your coverage before you leave than to find out on holiday, in the hospital receiving care for an illness that you'll have to foot the bill because it was caused by a pre-existing condition that isn't covered in the policy.
"Whatever product they're buying, they really need to understand what a "pre-existing condition" means and what is considered stable and controlled," she says. "Ask, 'Are you going to cover me if I'm stable and controlled, and how long do I have to be stable and controlled to cover the particular illness that I have?'"
But just because you've got a medical condition, doesn't mean you can't find insurance coverage, Shrimpton says.
"A good example of that is someone who has had a heart attack and surgery afterward," she says. "At Blue Cross, we would consider someone to be stable and controlled after one year, not including regular check-ups at the doctor where nothing substantial takes place."
Then again, don't assume you're covered even if you are only taking high blood pressure medication, especially if your medication has been altered in the last year. "A lot of people think, 'They've reduced my medication; I'm in much better shape,' but the reality is if they change the medication, there could be a risk of a reaction."
That person could have a stroke while on vacation - perhaps as a result of changes to blood pressure medication - and the insurer may deny coverage because the change in medication dosage is an indication the condition wasn't stable and controlled.
Furthermore, it's important to find out other limitations regarding coverage. While Manitoba Blue Cross policies don't stipulate that high blood alcohol levels can make coverage null and void, other insurers might have a clause that denies coverage under those circumstances.
The important thing is to ask before you leave town, Makar says.
"The key we push always is awareness," she says. "You have to be aware of your medical condition first of all, and then you have to be aware to ask the questions to make sure that when you're travelling, you know full well that any condition you may have is going to be covered."
That advice also applies to the many Manitobans who have group coverage through their work or pension plans. "You should always ask the limitations of the coverage," she says.
Some people may want to top up coverage for a vacation outside Canada, but they need to be aware that many providers, including Blue Cross, do not top up group plans. "You'd have to buy the coverage for the entire duration of your trip from us, for example," Shrimpton says.
Still, the additional cost can be worth it if group coverage or coverage provided through credit card benefits isn't comprehensive enough.
Even with all the bases seemingly covered, it is important to remember to bring policy documents with you while on vacation. Many providers also issue ID cards for clients. It's very likely you could be asked for the card or other proof of insurance in order to receive treatment.
"Should something happen, then you have information on that documentation that will tell you what to do," Shrimpton says. So, for example, if you're in Mexico and you fall and break your ankle, you can go to the hospital and present your card, and the hospital will call CanAssistance or another intermediary that will confirm your coverage and give the go-ahead for treatment. "In severe instances, you just get medical treatment immediately, but if they can deal with it prior (to providing treatment), the hospital will want to make sure it can get paid," she says.
Individuals who don't have coverage may be asked to pay up front or the hospital may bill Manitoba Health. But once the province pays its share, a collection agency may take over the bill and try to recover the amount owing.
But Slobogian-Jones says it's very easy to avoid this unpleasant outcome: buy coverage before leaving for vacation.
"It's always better to spend $80 ahead of time instead of possibly ending up with a bill that could be $80,000."
Joel Schlesinger is a Winnipeg writer.