By Robert K Stephen
(TORONTO, ON) – If you really wish to become a penniless pensioner just fall ill abroad without any travel insurance.
The OHIP website advises Ontario residents travelling abroad that it will only offer limited reimbursement for foreign medical costs and strongly advises against out of Canada travel unless it is backed up by private out of country medical coverage. It states you’ll be covered for unexpected conditions that arise out of Canada.
In other words, if there is even a whisper of health issues before you leave Canada, that flare up outside of Canada, you aren’t covered.
So, on a trip to Detroit for dinner you suffer a stroke or heart attack. Sure you only intended to eat dinner and return to nearby Windsor. Or, perhaps, you just wanted to shop at some discount outlet in Michigan for a few hours. While I have no complaints with US health care, if you have no insurance coverage rest assured it is expensive.
As an air ambulance flight from Istanbul to Toronto will cost you $160,000, you get an idea how quickly you can become a penniless pensioner.
Is a good steak and martini in Detroit, with a heart attack for dessert, worth an enormous health bill? Your choice. Last time I looked for out of Canada medical insurance its cost was paltry, particularly if you are under 60 years old. The older you are the more onerous the exclusions.
What’s that? Exclusions?
Don’t be a twit. No insurance company really wants to make a costly pay-out and, rest assured, when you signed up for your out of country medical coverage you signed away any right to privacy to your medical records. Any comment or analysis made by any doctor you have consulted prior to your trip is open book for the insurance company’s legal team to deny your claim.
Do not assume your purchase of out of country medical coverage offers you protection, particularly if you have been undergoing some medical tests prior to your departure.
For example, you have a colonoscopy and suffer a heart attack abroad. As the colonoscopy is a non routine medical test, any medical expenses incurred as a result of the abroad heart attack could be denied. While many insurance companies will offer out of country coverage for pre-existing conditions, or even undiagnosed conditions, there may be severe reductions in coverage for these conditions to the extent that coverage may be restricted to $150,000 instead of $5,000,000 for those without pre-existing or un diagnosed medical conditions.
It makes no difference how well you feel. Use your common sense and take the time to read the insurance policy, particularly the section entitled Exclusions/General Exclusions and most importantly Out of Country Coverage.
Reading these insurance policies is not easy. My advice is that if you have been tangled up in the medical system lately, and are about to travel, you must review the out of country medical coverage section of your policy very carefully. If you have any doubts, seriously consider reviewing the insurance contract with a lawyer or ask as many questions as you like with the insurance representative on the phone.
At least your conversation is taped and can be used both for you and against you.
If you think you can lie and get away with it you can until it comes time to pay a claim. And that time is the most important time.
I am not going to exhaustively review the coverage available in the marketplace, but I’ll share with you the recent experience of a very disappointed friend of mine, Kennedy Jones, who recently wrote a somewhat inflammatory article in The Square about how happy he was about the recent NHL players strike.
Poor Kennedy took a lot of flack over that article and was under a good deal of stress for expressing his frustration with the, “Pretty boys of the NHL,” as he said to me.
Poor Jones woke up on July 8 with a frozen thumb. He lacked co-ordination to shave or even brush his hair. Already suffering from a heart condition called atrial fibrillation, that makes him 4 to 5 times more likely to suffer a stroke than John Q Public, he phoned Telehealth Ontario who arranged for an immediate ambulance transfer to a local hospital.
All tests, including a neurological examination, an ultrasound of the neck, CT scan, and an MRI revealed no evidence of a stroke. Then an electrocardiogram ultrasound of the heart. That came out clean too. Four days before heading off to the EU on vacation, Jones checks in with the neurologist at the stroke clinic and he is told, “My original recommendation to you not to travel outside of Canada remains. If you are symptom free by 21 November, at our next appointment, you’ll be free to travel and I will make that notation on my records.”
Jones is not a slave to a physician’s advice but, as he is approaching retirement, he is a bit cautious about being bankrupted by medical expenses. He calls me as a lawyer and a friend and asks me for my help as he claims to have found some out of country medical coverage for an undiagnosed or pre-existing condition.
I tell Jones to cancel his EU vacation, his EU business trip, and his upcoming trip to New York to attend his friend’s 80th birthday party. I can just about see the tears well up in his eyes.
Read the fine print of the insurance policy and it says if any physician has advised you not to leave the country the out of country medical coverage policy is null and void.
But, Jones tells me, his GP, travel doctor, and cardiologist said just go but slow things down and relax. I tell Jones too bad buddy, the policy says if ANY DOCTOR advises you that you should not travel outside of Canada the policy is null and void. And, of course, the attending neurologist has written this on his records and also sent his report to Jones’ GP.
As the insurance company has access to all the medical reports for Jones he is royally scuppered until the neurologist says OK to leave the country. While Jones is free to travel five hours to Vancouver, a five hour and 45 minute flight to Portugal means no medical coverage. How unfair Jones tells me.
For such an intelligent man, I am surprised Jones has fallen prey to logic.
Lesson number one in terms of exclusions of coverage; never ever lie to an insurance company. They have complete access to your medical records. Jones heeded my advice and cancelled his out of Canada trips. However, his almost-purchased insurance policy revealed some other aspects concerning coverage.
- If you are not covered by OHIP for out of country coverage there is no out of country medical insurance policy coverage.
- You can be covered if you are medically stable 90 days prior to your departure date.
- Medically stable means that, 90 days before your departure, you have not been treated or tested for any new symptoms or conditions, changed treatments or medications, or you have had any non-routine tests or treatments for the condition or undiagnosed condition.
Kennedy was recently prescribed a new blood thinner prescription so his 90-day period may be extended from the date the prescription was filled. He also had an MRI. Is that a non-routine test for the condition?
As a lawyer, I am puzzled by the ambiguity in the policy. So, as a lawyer, I advise Jones where there is ambiguity there is risk, and an insurance company has endless resources to litigate.
Kennedy wisely heeded my advice in an attempt to avoid becoming a penniless pensioner. He tells me he might just head to Windsor for his vacation. I say that’s a good choice. He looks at me as if I am joking. No, I am not joking.
I urge him to avoid Detroit.
Remember this often quoted phrase; buyer beware. If you have had any health problems prior to departure from Canada read that policy very carefully.