Health: The $50,000 Headache: The Need for Emergency Health Care Insurance.

by Larry Jackson

Larry Jackson is Vice President of Communications for the PrimeLink Lifestyle association.

"The first symptom was a headache," explains Sue Andrews. Ms. Andrews is the President of Active Care Management; a company that helps people get the medical help to which they are entitled under the terms of their private emergency medical insurance policy. She was talking about a case that occurred this past spring. As Ms. Andrews tells it, her patient's headache was the beginning of string of medical problems and complications which ultimately cost an insurance company almost $50,000 Canadian. That is, $50,000 the patient would have had to pay out of her own pocket if she had not purchased insurance.

"She was an elderly woman from India who had come to Canada to visit her son and his family," says Ms Andrews. "For reasons of patient confidentiality I cannot give out her name. I can tell you that this woman was completely healthy when she left home. She had been given a complete physical by her own doctor before she left and was given a clean bill of health. There was no reason to expect any problems. But a month after she arrived, things began to go wrong."

The headache was the beginning. She complained to her son about it. He noticed that there was also a slight slurring in her speech. He decided to take her to the local health clinic to get a diagnosis. The on-call doctor performed a brief examination, found nothing of significance, prescribed a course of aspirin and sent the man and his mother on their way.

However, the headache did not go away. In fact, by the next morning the symptoms were getting worse. The mother was also starting to complain about numbness in her arms and legs. The son began to get seriously concerned. His next step was to call the phone number given to his mother when she had purchased her emergency medical insurance plan.

That connected him to Ms. Andrews' staff at Active Care Management.

Things moved very quickly from there according to Ms. Andrews. "The on-call nurse on our 24-hour help line thought she recognized the symptoms the patient was describing. It sounded as though this woman was experiencing something called a transient ischemic attack, or as most people would call it, a mini-stroke. This is a condition that requires immediate attention if we hope to avoid long term complication. So we called the local hospital and arranged to get her in for testing that morning." The diagnosis was confirmed and appropriate treatment was given. The mini-stroke did not progress and become a full stroke. The patient went on to a longer course of treatment that ensured a complete recovery.

Total cost for the incident according to Ms. Andrews was about $20,000 Canadian, all of which was covered by insurance. The woman and her son were extremely happy with the outcome and the fact that they did not have to pay a cent for their treatment. They were even happier with their decision to purchase emergency medical insurance a month later, when the woman tripped and fell.

The woman complained about a pain in her knee. The family thought that she had bruised or twisted something. They applied icepacks and told her to elevate her leg. They did this for almost two weeks. Instead of improving, the pain actually began to get worse. The decision was made to call the nurse helpline again.

"The patient was referred to an urgent care facility for x-rays. When she arrived she mentioned that her hip was also beginning to hurt. The x-ray showed a hip fracture which required immediate surgery."

This is where the costs began to mount very quickly. The cost for treatment was charged at the non-resident rate of $3,750 per day. That included all the physician charges, the anesthetic and all of the hospital related charges. Ms. Andrews points out that some hospitals also charge what they call 'physicians fees' on top of the day rate.

The breakdown of the bill paid by the insurance company also showed a host of other charges. The initial office visit cost $100. The visit to the urgent care centre resulted in a bill for $617. The x-rays of her knee and hip amounted to a charge of $833. The consultation with the surgeon to determine where surgery was practical cost $127. The bill issued to the insurance company as a result of her fall was $26,825 Canadian. When you add that to the cost of treatment for her mini-stroke, her total bill for health care in Canada approaches $50,000 Canadian.

Geoff Burman is the president of Broker Advantage, a company that specializes in emergency travel medical insurance for visitors and newcomers to Canada. He points out that an individual can get insurance coverage that will guarantee that the bill will be paid for as little as two or three dollars per day. "The woman in the example would have paid a little more," says Geoff. "Even though she was in good health her rates would be higher because she was 80 years of age. For a four month trip to visit her son, the total cost of insurance would have been about $1,000. However, the same trip for an individual under the age of 54 would have been just over $200. When you look at what happened to that poor woman visiting her son, there should be no doubt in anyone's mind about the need to buy insurance.

Representatives for the Canadian health care system agree completely. They point out that visitors are never eligible for health care coverage under the government health care programs that the country is famous for. Newcomers, must apply for eligibility, and often do not receive health coverage until months after their arrival in the country. During that waiting period any and all health care costs they incur are their own responsibility. Without insurance, they have to pay the bill themselves.

Mr. Burman says there are many plans available. His preference, of course, is the plan that is sold by his company, the PrimeLink Visitor To Canada plan (primelinkinsurance.ca). "The point is, you have to make sure that the plan gives you the coverage that you need. You are looking for something that will pay for hospital accommodation, incidental expenses, outpatient services, physician fees, prescriptions and ambulance services. And make certain you check out the deductibles. Some plans keep their rates low by charging high deductible amounts."

The case of the mother from India is not typical. "Two distinct incidents with resulting health care charges approaching $50,000 Canadian is on the high side," says Ms Andrews of Active Care Management. But $20,000 per incident is not out of line. The Canadian health care system is among the best in the world. It is also among the most expensive. If that woman had not had insurance, her family trip could have financially ruined her son, or left her in a position where she would not know how to get the medical help she needed.

CNM