Medicare and Canada Medical Bill
 

Has anyone been successful in fighting Medicare to pay a bill from a Canadian Hospital. We are on our third appeal and have had no luck. Was airlifted from a cruise ship to a Canadian Hospital and Medicare refuses to pay the bill of around $!00,000.00.

I'm so sorry to hear about this, and unfortunately, your problem isn't unique. Medicare doesn't pay for any care overseas, including a medical evacuation. Did you happen to have Medevac insurance? If so they may cover the bill. Otherwise I'd keep appealing.

If you travel internationally and don't take out additional insurance, you are generally on your own for any costs, particularly airlifting. Same applies to most commercial insurance, not just Medicare.

Where you in US waters? I was listening to a podcast recently where they cover this. They said traditional Medicare only covers it if the event occurs in US territory and the closest hospital is in a foreign country. They also mentioned that some supplement plans may cover it. They recommended medical/travel insurance for outside the US.

Are you sure they said "supplement plans"? As I understand it, a supplement plan will never cover anything that is not covered by traditional Medicare. The only thing they cover is the 20 percent coinsurance after Medicare has approved the claim and paid the other 80 percent. Supplement plans are not set up to cover anything else. If traditional Medicare rejects a claim, a supplement will pay nothing.

Sounds as if your coverage is Medicare A (hospital inpatient), B (Outpatient) and D (medications) with a Medicare Supplemental ("Medigap") policy. If that is the case you deal directly with Medicare, and they cover almost no services received abroad.

There are a few exceptions however: how close your ship was to an American port when the emergency occurred, medical treatment rec'd on the ship, etc. You can appeal any decision made by Medicare by jumping through their hoops: Sounds as if you've already done so, but "visit Medicare.gov/claims-appeals/how-do-i-file-a-claim to get the “Patient’s Request for Medical Payment” form CMS-1490S" (Medicare website, "Medicare Coverage Outside the United States"). It might be worth your while to check this out if you've not already gone this route.

The other type of coverage would be a Medicare Advantage (PPO) coverage. If the card you present for medical services is NOT the Medicare card but instead a card issued by an insurance company, and you use that when obtaining care, then that is what you have. That coverage varies widely though; some Medicare Advantage policies do cover medical services abroad. Our does: for medical services received abroad it will pay UP TO the amount that they'd have paid had you received your services from American providers. The kicker though is that they don't reimburse the provider directly: you still have to pay out- of-pocket for services received abroad, then deal with your insurance company to get reimbursement.

If you continue to hear "no" from Medicare, then it might be worth your while to talk to an attorney who specializes in such types of cases. If you are already on the hook for $100,000, then a few thousand more to get expert help might not be a bad idea.

Never say never...

There are some cases where a Pt's co-insurance will pick up something Medicare declines...

Federal BCBS is one that will pick up certain claims Medicare declines...

I have medicare advantage. My assumption is that when I travel outside of the US (cruises) I am not covered. There are a few exceptions to not being covered. I think you will need a professional at this point and my assumption is that the professional in your first interview will tell you if you have a chance of success.

Does any of your credit cards provide insurance coverage when your travelling ?

Medicare will cover services that are initiated in an emergency room entrance. You can move to inpatient IF you are admitted through emergency. Maybe the place of service is being coded incorrectly.

A good reminder to educate ourselves about our insurance coverages before an emergency happens. I always get Medipac when traveling away from home and I read every single line on that contract.

I don't know about Canada, but when you become an inpatient, any hospital charges would be submitted by the hospital to Medicare Part A. It doesn't matter whether you were admitted by the emergency room or by your personal doctor. If there is one thing that all hospitals know how to do, it is how to get paid by Medicare.

[QUOTE=alemorkam;2383908]Has anyone been successful in fighting Medicare to pay a bill from a Canadian Hospital. We are on our third appeal and have had no luck. Was airlifted from a cruise ship to a Canadian Hospital and Medicare refuses to pay the bill of around $!00,000.00.[/QUOTE

Last month I needed an MRI here in Florida. The hospital billed about $3,600 for that. Medicare paid $69. BC/BS will pay a couple hundred. The hospital is NOT allowed to bill me for the rest. That’s why Medicare doesn’t pay for medical service in foreign countries. It often pays 10% of the bill and says the hospital can’t bill the patient for more than what the co-insurance pays. Foreign hospitals want to get paid whatever they charge. And MedEvacs are wildly expensive, even in this country.

Check with SHINE; they may be able to help you. They do help with rejected claims.

Hopefully a much lower bill can be negotiated. But what happens in real life if the poster decides not to pay the bill and "stiffs" the Canadians? Sued in US courts? Extradition to Canada?

Hmmm, I thought healthcare was free in Canada, even for those coming in without authorization? Just claim asylum.

“Free” healthcare? Now that is an interesting idea. Are you under the impression that doctors and surgeons, nurses and administrators all work free? Buildings for hospital, supplies and equipment, also drugs are all supplied by someone “free”? The helicopter, pilot and medivac support all work free? Or that the Canadian tax payers are so very wealthy that they can afford to pay huge amounts of taxes towards healthcare that the American taxpayers can’t come close to affording?

My experience in my European native country - at the time under Communism - is that when you don’t pay doctors; they don’t work. I had to bribe my guy with a carton of US cigarettes to get a shot. He was about to use a rusted, huge (I called it horse) syringe and I gave him another carton of cigarettes to give me the documentation I got the shot, but not to actually touch me with that syringe.

Interesting perspective, valuable because it is coming from someone with firsthand experience.

Thanks

From the US government.

https://www.medicare.gov/publication...ted-states.pdf

So Canada's free health plan they brag about does not cover foreigners? I thought those countries with universal coverage did.

So are you under the impression that Canada can cover EVERY individual in the world who needs any kind of health care in Canada? Any idea how much that would cost, and who would pay for it?

No, Canada actually has no “free” health care, my Canadian aunt and uncle have to pay high premiums for extended health care, dental care and hospital care and even that plan has monetary limits for coverage and deductibles for any service. Perhaps you are thinking of provincial plans such as OHIP which is paid for by deductions from the employment pay slip which only covers some things. And there are refugee intake areas that provide “free” dental, some medical etc services as charitable functions - is that what you mean?

There has been a lot of dumping on Medicare Advantage here, so I thought I'd check the documents for United Health Care Villages

Sounds like (subject to the denial gremlins) transport and care would have been covered.

I think OP needs a good lawyer familiar with foreign judgments too. Many are not enforceable in the US. There is a very large amount of money involved in this case.