Paying for health care - the top five things you need to know

Tuesday, November 15, 2011 - 4:17pm

By James Whitehead

Everyone in Canada gets free health care, right? The short answer: no.

It is true that for the most part, Canadians don’t pay for basic health care. At least not directly out of pocket. It’s a system we all contribute to through our taxes and we all benefit. But not everything in our health care system is covered.

David Kersey, manager of financial operations at Capital Health, said there are some costs that might surprise people. Part of his job is to recover some of those costs following a hospital stay. Sometimes he has to send patients a bill.

“The last thing a patient wants to deal with, especially in the Canadian health care system, is the financial side of things,” he said. “They’re here to get well.”

Sometimes a patient is surprised to receive a bill. Kersey said the surprise often comes from not understanding how the health care system works or the extent of their own medical coverage.

“Unlike a U.S. hospital, we don’t vet for how you are going to pay for your hospital visit, or the incidentals that may be incurred during a hospital stay,” Kersey said. “We treat you and sort out the financial aspects later.” 

Here are five things you need to know before you visit the hospital so you can avoid a surprise in the form of a bill in the mail.

Provincial coverage

Strange as it sounds, living in Canada is not enough to guarantee health care coverage.

Kersey said it’s important to make sure you have an up-to-date provincial Health Card (formerly Medical Services Insurance, or MSI). Otherwise the hospital may look to you to cover your medical costs.

“Despite the fact that you are a resident, the system will charge you personally unless and until you can provide a valid MSI card,” says Kersey. “It’s like driving without insurance. You get a ticket. You have to be able to prove you have insurance.”

The good news is that provincial coverage, when you have it, is good anywhere in Canada. Just make sure you don’t let your coverage lapse.

The ambulance

Unlike other emergency services such as the police or fire department, ambulance services are subsidized by our taxes but not completely covered.

“You have to pay for [part of] the ambulance,” said Kersey. “Be aware. Know that.”

In Nova Scotia, being transported to hospital by ambulance in the care of paramedics – other than if you’re in a car accident – will run you around $134.52 as long as your provincial insurance is up to date.

If you’re not covered by MSI, the same ambulance service is $672.57. Sometimes private insurance will pay for medical transportation. For example, if you need an ambulance because you were involved in an motor vehicle accident, your vehicle insurance provider will be billed $672.57 directly. Regardless, it is important to understand that either you or your insurer will have to pay Emergency Health Services (EHS) if you are taken to a hospital by ambulance.

For more information, the EHS website provides a more detailed outline of how their fees and billing work.

(This paragraph has be altered to provide more clarification.)

Know your health insurance

Private health insurance is designed to cover the areas of health care that the province doesn’t. If you don’t know what your coverage is, you could be setting yourself up for a surprise bill, Kersey cautioned.

Capital Health charges $130 per day for a semi-private room and $160 per day for a private room. Kersey said it’s vitally important patients understand what their insurance coverage is prior to being in the hospital.

“They need to know what their insurance coverage is to avoid receiving any surprises in the way of an invoice at the end of the day,” he said.

Unfortunately there is no other way for hospital staff to know what kind of insurance a patient has until they talk to the insurer.

“There was a time when insurance cards would identify what kind of insurance the individual had,” Kersey said. “Now they don’t.”

Know what you’re signing

Several services not covered can be requested by a patient. These services normally require a signature by the patient or next of kin to accept financial responsibility.

Being in the hospital is a stressful time. The last thing most people want to deal with is signing documents let alone reading them first. However, not knowing what you’re signing could cost you a lot.

One example is the bedside television. Patients can request this service right from their bedside phone. However, there are two options. Basic television is $9 per day plus taxes. Premium is $11.10 per day plus taxes. However, this fee is waived if you are paying for a private or semi-private room either personally or through insurance.

Kersey said he can’t stress enough the importance of understanding what you are agreeing to before signing any documents. One of the most common calls he has to deal with is people who sign documents without understanding them first.

“We’ve got people coming in with the two biggest stressors in a person’s life: their health and personal finances,” Kersey said. “Make sure that you take the time, make sure that you understand what you’re signing.”

International coverage

When it comes to travelling, Kersey recommends making sure you have your own health insurance.

“If you step one foot across the border, make sure you have health care coverage,” he said. “There isn’t anything saying that the province of Nova Scotia, which delivers the funding for health care for its citizens, is going to pay for you to be in a hospital in Maine.”

Kersey noted that Canadian citizens living abroad can also get themselves into a financial pickle if they come back to Canada and require health care.

“If you do not have permanent residency in Nova Scotia, you have to pay,” he said. “The only way you’re covered is if you have re-established permanent residency. You have to have valid coverage under a provincial plan.”

International students and tourists also need make sure they have insurance and understand the extent of their coverage.

“If you’re not a legal resident or covered under the Canada Health Act you have to pay, and it’s not cheap,” said Kersey.

Some of the numbers are staggering. An emergency room visit for international visitors costs around $520. An inpatient stay is more than $3,800 per day and a night in the ICU can be upward of $15,000.

You will be treated

As important as it is to be aware of the costs associated with health care, Kersey said the most important message to remember is that if you are injured or ill, Capital Health will treat you, no matter what.

“If someone comes to our door, it is our duty and philosophy to treat them and make them better, to the best of our ability,” he said.

A Capital Health nurse checks in on a patient in the intensive care unit.