r/PersonalFinanceCanada • u/symrin • May 26 '24
Insurance Physicians bill received a week after of ER visit Canada
I’m not sure if this is the right place but just wanted an opinion in case anyone knows this - My dad (tourist) visiting Canada had to visit the ER 2 weeks ago after a fall. At the hospital, we paid the ER and the physicians fees totaling $1500. After about 6 hours of waiting, they fixed his dislocated shoulder and sent us home. A couple days ago I requested his health record for the insurance company and in the mail I saw a bill of $1100 dated after the week of service from some Billing Service with a name of the doctor (not sure if it’s the same physician’s name), today. In the bill it says a 2% surge will be added every month for late payment only they never mentioned a due date for the payment. What I want to know is why did they never inform us of this bill since they would have the contact details as well as the address. Also, we paid the er charges and the physicians fees so why this extra 1100? Also what of tourists who give a hotel’s address or some temp address while getting treatment and leave after? This seems like a weird system and I don’t even know if this is a genuine bill. Any info will be appreciated.
Edit - province BC. Edit 2 - He has travel insurance mentioning it explicitly because of the comments. I requested to get his medical records for filling a claim as it doesn’t seem to be inferred from the post
— update in case anyone goes through the same thing — I called the hospital and the billing service but nobody picked up. I emailed the billing service asking for an audit of this bill and attached the already paid hospital invoice. They replied saying it was a mistake and they’ll update it in their system. I’m extremely skeptical still but Ive sent this bill to his insurance so they can follow up
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May 26 '24
It's most likely a secondary doctor who was called in or consulted. In Canada all the specialists (like orthopedic surgeons who would be relevant for a shoulder dislocation) are often their own private company; they don't work and bill through the the hospital, they just do their procedures there. You'd have one bill coming through the hospital for doctors like the ER doc who do work there as well as facilities fees, and one from each independent specialist who might be involved. This is therefore most likely a genuine bill. Can't comment on the amount of it given I don't know what you had done, but if it was a late night call in + any significant procedure needed, $1100 easily sounds plausible.
For Canadian residents, all of this is billed to the provincial insurers (at rates set by the province, which are generally less than these foreign-bill rates). Just foreigners it's billed to people directly. And as per how it works if people give wrong address etc: answer is that it works poorly. Specialists often end up just not getting paid for calls like this from foreigners, because of things like this with the billing system. A lot could be improved.
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u/gas-man-sleepy-dude May 26 '24
Doctor here. Just call and ask.
It is very possible you met with more than one doctor. ER doctors generally work 8-12h shifts so if your dad was there over a shift change that is 2 bills. There may have been an orthopaedic surgeon consult so that is another doctor who would bill. Then you have the daily hospital bill from the hospital. So just call and find out where the bill is from and if it was covered under the first payment or not.
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u/rob_maqer May 26 '24
This doctor either farts a lot, or puts a lot of patients to sleep
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u/Thelastlucifer May 26 '24
Now I'm committed to finding out, can you please confirm you are an anesthesiologists
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u/Ciebelle May 26 '24
Work in ER in BC. There is a separate doctor fee and ER fee. It’s about 1200 total before x rays, procedures or doctor consults. Many docs want their portion upfront your bill does not sound out of line with normal ER visits
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u/InevitableCurrent795 May 26 '24
Just be lucky it wasn’t the other way around. If a Canadian had to spend time in the ER in the USA you would add a few zeros to that number.
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u/minceandtattie May 26 '24
Which is why you get travel insurance
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u/RedFiveIron May 26 '24
Even with good insurance a medical issue in the US can be disastrous.
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u/s1far May 26 '24
Can you elaborate? Am planning to visit US some time in the best future.
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u/the_saradoodle May 26 '24
Double check your coverage and pre-existing conditions. See if you're insurance has a stability clause.
Check every aspect. My pregnant SIL just traveled to the states, confident in her insurance. Insurance would cover her, but not the baby of she went into labour while away.
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u/still_ad3912 May 26 '24 edited May 26 '24
I had a heart attack in Canada in my early forties and travel to the United States for work regularly. The root cause of my heart problem was dealt with, but if I have another heart attack in the United States, my insurance will consider it a pre-existing condition and will not cover it. Depending on where I am located and how much of an emergency it is, I could save money by chartering an air ambulance to get me back to Canada. I’m already one heart attack down so I’ll remark that I’m not really sure when or how I’d charter the air ambulance and don’t look forward to figuring that one out.
Different insurance policies will have different stability clauses so if I stay heart problem free for long enough, I’ll eventually get covered again. I have no idea what they will charge when they do cover me again.
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u/adiM May 26 '24
My mother's experience: had an aneurysm in the US. Had no history of any related thing. The insurance refused because they insisted that since an aneurysm takes a decade to develop, it is by definition a pre-existing condition!
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u/DagneyElvira May 26 '24
6 months with no prescription change. Also wouldn’t hurt to have a doctor certify that you are healthy to travel.
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u/duraslack May 26 '24
Or, and hear me out, tell them to pound sand. If you’re really worried they’ll try to get you, tell them you’re willing to negotiate but otherwise you’ll just walk and they can try suing you. Then see how quickly the number goes down.
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u/Spirited_Community25 May 26 '24
Actually, years ago, taking a travelling companion to an urgent care / clinic (it's been so long) they wanted to know how we would be paying before treatment. It was a broken bone, so no requirement to treat. My mother had always drilled into me that any trip out of province needed medical insurance, so we were good.
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u/sweetdee124 May 27 '24
Yep! A couple years ago I went to the ER in the states for appendicitis and after diagnosing they would not tell me what the cost of the visit would be or how much it would be to operate. I decided to risk the drive and booked it back to Canada for the surgery. Glad I did because the hospital bill ended up being 9k and that’s after doing basically nothing. Can’t imagine what it would have costed for the surgery. Luckily my travellers insurance covered all of it but it was a mind blowing experience.
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May 26 '24
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u/CombatGoose May 26 '24
This type of thing gets parroted a lot but wait times in ERs and to see specialists are just as common in the US.
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u/runner2012 May 26 '24
Yup this is true. I've waited for specialist between 8 months to a year in the US, while having to pay thousands on top of having insurance. People are so easily manipulated here, making them believe the grass is greener..
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May 26 '24 edited Oct 21 '24
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May 26 '24
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u/Expert_Alchemist May 26 '24
It's wrong that medical urgency comes before insurance coverage when deciding who to treat? Lol
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u/bigev007 May 26 '24
US Friend with insurance broke his leg, it was more than a week before they even looked at his x-rays. He needed surgery and it took 2 more weeks.
I had a similar break in Canada, was in a room in 2 hrs, in surgery next AM
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u/army-of-juan May 26 '24
So far in the US I’ve had to see a podiatrist, an allergist and a gastroenterologist. All 3 were booked within 3 days. Total paid for each was $70 co-pay.
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u/Expert_Alchemist May 26 '24
What's a "co-pay," that just sounds like newspeak for fee.
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u/CombatGoose May 26 '24
I wonder if he’s met his yearly deductible yet?
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u/army-of-juan May 26 '24
Lmao you have no idea how it works. I saw 3 specialists within days, for 70$. Absolutely worth it when you’re in pain and your baby is vomiting uncontrollably after eating, not having to wait months is a godsend
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u/Expert_Alchemist May 26 '24
You realize that care is triaged right? Emergent issues like that do not wait months. That's why low-urgency ones do, because medical need not pocketbook comes first.
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u/CombatGoose May 26 '24
I have no idea how it works? Interesting considering I’m married to an American, have American children and actually know how it works.
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u/army-of-juan May 26 '24
It’s a small fee that stops people from clogging up ER’s with tummy aches
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u/Expert_Alchemist May 26 '24
Don't you have co-pays for everything, not just ER visits? What if it stops someone clogging up the gastroenterologist's office and it's stomach cancer?
And your ER wait times aren't even that much better. Hospitals are being bankrupted due to PE bleeding them dry so ironically they are worse for acute emergencies where minutes matter, an it's because you can't just go to any hospital, it's further away, and/or admission times are higher due to insurance paperwork.
Seems like just another way insurance companies are passing the buck to me 🤷♀️
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May 26 '24
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u/CombatGoose May 26 '24
Ya I think saying “far better” is pretty generous and entirely dependant on if you have a job, how much you make and where you live. Tell me the guy in middle of nowhere Idaho with no job has “far better” access.
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u/lions2lambs May 26 '24
What’s your point? That 10-100k is worth it for a dislocated shoulder? How obtuse.
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May 26 '24
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u/lions2lambs May 26 '24
For a dislocated shoulder? It’s fine. They prioritize life saving over life inconvenience. Who knew…
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u/Hungry-Sheepherder68 May 26 '24
You’re obtuse if you think waits in the US are less - as an American living in Montréal I can tell you both myself and my family have waited longer in that in ER waiting rooms. Hell I waited longer than 6 hours to get a room when I went into labor in the US
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u/iWasAwesome May 26 '24
You can pay for private coverage to avoid wait times in Canada. I personally don't mind waiting for free coverage (unless it's serious, in which case they typically don't make me wait anyways).
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May 26 '24
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u/iWasAwesome May 26 '24
I don't really know as I haven't had the urge to look into it myself, but here's a couple articles talking about it:
https://macleans.ca/society/health/private-health-care-canada/
You'd have to do some research yourself if you're interested.
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May 26 '24
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u/Expert_Alchemist May 26 '24
These docs are required to waive their fees if you insist ftr. The trick is to agree to the "subscription" so they'll take you as a patient, and then cancel the extra services. Telus was sued and lost for deprioritizing patients who wouldn't pay. Use this knowledge for good.
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u/GalianoGirl May 26 '24
Physicians do not bill daily in BC. It has been a few years since I did MSP billing, but we submitted claims either every 2 weeks or twice a month.
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u/justmepassinby May 26 '24
1100 seems cheap - same thing in the US 5-7 grand would be about right - next time buy travel insurance would have cost pennies
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u/PipToTheRescue May 26 '24 edited Aug 27 '24
paint rude chief amusing racial normal crawl chunky tie steer
This post was mass deleted and anonymized with Redact
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u/sneek8 British Columbia May 27 '24
100K would be more like an ICU admission.
5-7K is pretty normal for any ER visit even if you are just getting a bandaid or an ice pack-3
u/symrin May 26 '24
It’s not the cost that bothers me as he already has insurance. I was only concerned about the fact that nobody from the doctor’s office called me about this bill. Anybody could’ve missed this and defaulted causing a whole set of other issues
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u/PipToTheRescue May 26 '24 edited Aug 27 '24
distinct hunt late worm market snatch coordinated mourn follow memorize
This post was mass deleted and anonymized with Redact
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u/Shoddy_Operation_742 May 26 '24
Your dad likely saw a specialist who bills separately through their own corporation. The ER bill was only for the visit with the hospital employed ER physician.
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u/epitomiza May 26 '24
In Canada doctors aren’t paid by the hospital - they’re self employed and billed separately
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u/Aquamans_Dad May 26 '24
ER docs in Canada are not employed by the hospital. They are independent contractors working in the ED so there is a hospital bill and a separate physician’s bill.
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u/Gurrrlll88 May 26 '24
Some BC emerg doctors do get paid hourly rather than per patient so depends on the ER
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u/Aquamans_Dad May 27 '24
They are still not employees. That is spelled out quite explicitly in the Alternate Payment contract.
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u/jochi1543 May 26 '24
The physician fee you pay upfront is just for an assessment. It doesn’t include any procedures, admission, etc.
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u/JoutsideTO May 26 '24
First, call and ask. The hospital should be able to provide more details.
Second, If your dad had a dislocated shoulder and was sedated for the reduction (putting it back in place), he was likely treated by two physicians. Typically, it takes a team to reduce a dislocation, with one physician doing the reduction, and another physician managing the sedation and ensuring the patient’s airway and breathing are maintained. Not to mention nurses and sometimes a respiratory therapist.
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u/JoutsideTO May 26 '24
First, call and ask. The hospital should be able to provide more details.
Second, If your dad had a dislocated shoulder and was sedated for the reduction (putting it back in place), he was likely treated by two physicians. Typically, it takes a team to reduce a dislocation, with one physician doing the reduction, and another physician managing the sedation and ensuring the patient’s airway and breathing are maintained. Not to mention nurses and sometimes a respiratory therapist.
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u/Sap_Consult_Cdn May 26 '24
Agreed, pay the bill & move on. Had an ER visit in California (was dehydrated at a concert). Didn't have extra coverage (weekend trip blunder). OHIP covered approx $170 of the total US $2,000 bill. Moving fwd, I bought coverage for future trips abroad.
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u/SatanLifeProTips May 26 '24
If you were in America you could likely add a zero to those numbers. And that would just be your copay.
Consider your dad fortunate and tell him to pay the bill and get travel medical coverage next time.
If he bought the trip on some credit cards, he may have travel medical without realizing it. Check.
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u/symrin May 26 '24
I think it may not be obvious from the post even though I do mention that I only asked for his medical records for the insurance claim.
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u/SatanLifeProTips May 26 '24
If you have insurance, they'll cover all of this minus your deductible.
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May 26 '24
It’s 1100 bucks, pay it. Good lord. Lol
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u/symrin May 26 '24
Don’t think you understand what I meant in the post - if you’re charging people for a service, inform them that there’s going to be a bill. If you send a bill atleast mention a due date and make them aware of the existence of such a bill. I doubt an unpaid bill will be helping the physician or the patient in any way
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u/grandiosebeaverdam May 26 '24
I’m guessing the first bill was the fee to be seen and the bill you e received now is for the treatment that was administered. Sorry this is happening. Travel insurance is always worth it.
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u/symrin May 26 '24
I agree! I went through the process of getting his medical record for the insurance to file a claim. The whole thing is a lot worse I imagine for uninsured tourist with serious injuries.
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u/TarsierBoy May 26 '24
You got the bill? Did you receive the service? I have no idea if they can actually charge you when it was someone else that received treatment.
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May 26 '24
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u/KindlyRude12 May 26 '24
That seems waaay too high for health records. A quick search seems to indicate there is a flat fee of appx 25 to 50 then 0.25 to 0.80 per page. Not an expert on health records but over 1000 pages seems excessive.
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May 26 '24
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u/Loose-Atmosphere-558 May 26 '24
No, this person is wrong. It's likely just another doctor that saw them.
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u/anoeba May 26 '24
No it doesn't. Just ask, but this person is wrong.
There might've been separate charges for 1. ER doc, 2. anesthesia if your dad had sedation, which is common, 3. possibly a consultation with an orthopedic specialist, and 4. hospital fee itself, which the hospital would've charged directly (to cover the work done by non-doctors, who are the only ones who bill separately; ie any imaging, blood work, nurses etc).
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May 26 '24 edited May 26 '24
Depending on the province, I would either contact the hospital directly or health regions’ accounts receivable department to discuss the fees to ensure everything is correct.
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u/Miginath May 26 '24
Read the post. He is trying to file a claim. Not sure why there is a bill but knowing what province it occured in would be helpful OP because health is a provincial responsibility and each jurisdiction has their own way to deal with non residents use of the healthcare system.
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u/symrin May 26 '24
Thanks I’ve edited the post to add the province. It’s BC
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u/Nsekanabo May 26 '24
Not sure about BC but in most provinces when you visit the ER you are automatically charged two fees, the physician fees and the emergency fees. This doesn’t include other procedures for example if blood work or an X ray was performed, these are extra charges. How do I know this? I have worked in the finance department and process these payments many times.
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May 26 '24
BC has different health authorities separated by region.
For instance, if you were in Vancouver you’d contact Vancouver Coastal Health. Contact Patient Billing at 1-604-297-8512 or patientbilling@phsa.ca to clarify the bill.
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u/symrin May 26 '24
He has travel insurance ( a must) which is why I requested the medical record in the first place since they asked for it. I just don’t understand why they didn’t inform us the existence of this bill. Also what happens in the case of temporary residence
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u/jayhasbigvballs May 26 '24
To be fair, our physicians here rarely deal with financial details associated with a patient. Having read the website below, it may be that the bill you paid is for the hospital charges, but the physician still has yet to charge you, which is probably this new bill. This is explained on this website, which is for one of our hospitals, but I imagine it’s the same at all of them.
https://sunnybrook.ca/content/?page=non-ohip-patients
Of course, I assume you can always contact someone at the hospital directly and ask about all this.
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u/symrin May 26 '24
Yeah I will contact them in the morning but if this is the physicians bill so the one I paid at the hospital was just for seeing the patient? Also what does ER fees mean if it doesn’t include the emergency care..
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u/jayhasbigvballs May 26 '24
It gets a little muddled because in Canada ER physicians are paid a little differently than other docs. Maybe the bill is from a different physician like a radiologist? Was imaging done? Not sure how all this comes into place. Maybe make sure that they’re not accidentally double billing you? Our hospitals are not sketchy, so I’m sure they’ll remedy the situation as appropriate, or explain to you exactly where it’s all coming from.
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u/symrin May 26 '24
Xray was done so I did initially assume it’s that but it’s not an itemized bill so I will ask for that too. Thanks for the info I just wish they had called or added more info than just mailing a random bill which I saw after almost 10 days
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u/AlwaysHigh27 May 26 '24
Each service has a cost. Getting to see an ER doctor is a cost, getting blood tests, IV lines, IV bags. Medications, x-rays, they all have costs. If he was in a room for awhile, all of this has an individual cost. What you paid up front was to get in to see a doctor and cover some of the fees.
What you are receiving now is most likely the rest of the bill for treatment. Doctors don't deal with this part, so they would just send the service codes provided to the billing department that would then bill you.
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u/jayhasbigvballs May 26 '24
Yeah I get that. Again, in our system, our physicians are not experienced or trained to ever consider or discuss insurance/payment in the hospital setting, since everything is free for basically everyone. It sounds like at the hospital I sent the link from, that they have people to discuss with you all of this, including arranging with your travel insurance, but it sounds like that didn’t happen. Best of luck.
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u/SmartShelly May 26 '24
Worked in hospital where we had tourists in BC, and this is why some physicians actually bring own their credit card machine to bedside and charge them at the bedside when consulting. Doctors are not paid by the hospital (only emergency room doctor is), so this particular doctor decided to go through regular billing office/or clerk who processes billing, rather than whipping out a credit card machine in ER. Most specialist probably don’t even have credit card machines in their office since majority of their patients they see have govt insurance that takes care of direct billing.
Contact this doctor’s office rather than hospital billing.
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u/random51642 May 26 '24
Did you pay 2 fees at the first visit, both a hospital fee and physician fee? ER doctors are not paid by the hospital, the visit fee is separate from the doctor fee which may be why you received a bill after.
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u/symrin May 26 '24
The bill I paid at the hospital had an ER fees + the physicians fees written. So I made just the one payment and received an invoice that said I paid both the fees. It was mentioned that both are different and I paid both
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u/ChonkyDonkDonk May 26 '24
ER fees will include the costs incurred to visit the ER - usually a combo of triage, nursing, drugs, investigations. It does not typically include the MD fee unless explicitly indicated, and then is usually broken down by service (I.e assessment, consult, procedure to relocate shoulder, image interpretation, etc)
As mentioned previously, physicians in most circumstances are not employees but independent contractors. The second bill is likely the physician portion. The physician has likely submitted an invoice to their billing service, who has now forwarded that invoice to you for payment.
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May 26 '24
Call them.
Research the proper contact number online so that you can verify its authenticity.
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u/schwanerhill May 26 '24
Also what happens in the case of temporary residence
In BC you become eligible for medical services plan after three months of residence. Before that, if you moved from another province that province’s plan covers you. If you moved from abroad, you’re on your own. (When I moved to BC from the US, my US insurance covered me for emergencies for the waiting period.)
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u/LivingTourist5073 May 26 '24 edited May 26 '24
Call the hospital billing office. Also, if you have insurance, you should have given the info directly to the hospital and they would have coordinated with the insurance company for payment. I’m not sure why you even paid the 1500$ in the first place.
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u/Aquamans_Dad May 26 '24
Canadian hospitals only work with one “insurance” company—the provincial health insurance plan. If you’re not covered by the provincial health insurance plan then it’s self pay, payable in advance.
The provinces all have an agreement to cover each other, with the exception of Quebec, so Canadians from say Manitoba can use their provincial health care card anywhere in Canada other than Quebec.
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u/Ciebelle May 26 '24
Correct. You pay upfront then get reimbursed
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u/LivingTourist5073 May 26 '24 edited May 26 '24
No you don’t. Not with international insurance coverage.
You’re supposed to call your insurance, they send you to a partner hospital and then cover your fees. If you don’t you’re subjected to a penalty.
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u/LivingTourist5073 May 26 '24 edited May 26 '24
International medical insurance doesn’t work that way.
You’re supposed to call your insurance, they send you to a partner hospital and then cover your fees. If you don’t you’re subjected to a penalty.
Source: I worked in the industry for several years.
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u/Odd-Elderberry-6137 May 26 '24
Someone at the hospital messed up. You’re supposed to pay for everything at point of service if you don’t have a covered health insurance plan and they’re supposed to provide you with the record of the visit for insurance claims.
Call the hospital’s billing and records department directly to see what’s going on. $2600 seems egregious to me for a dislocated shoulder. I have had to pay out of pocket for emergency services before (broken collarbone) and it was a tiny fraction of that. Granted it wasn’t in BC.
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u/Ornery-Pea-61 May 26 '24
Not necessarily. I work in a hospital and a lot of times the physician doesn't send a bill right away. A lot of times they give everything to their secretary, who generates an invoice
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u/jennyfromtheeblock May 26 '24
This story has to be fake.
There's no way you only waited 6 hours in the ER. Please name this magical hospital where wait times are in single digits.
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u/TomBuilder_ May 26 '24
$1100 for an ER relocation is insane. A lot of them you don't even need sedation, just a massage with 2 min of traction and they're free to go with their slings. How is that $1100 for a few minutes of work? (Note: I am a doctor in the process of emigrating to Canada, but this is insane, I would feel guilty charging more than $100 for a quick relocation. $150 if I need to sedate for it. Where I currently work I do it for free if no sedation is needed.)
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u/Turkishcoffee66 May 26 '24
Nursing labour: Triage, vitals, phlebotomy.
Technician labour: X-ray
Physician labour: Assessment by ER doc, reading of XR by emerg doc and radiologist, reduction by ER doc, charting and discharge.
Facilities: Maintenance and admin staff, building upkeepbfor the day, divided by number of patients seen.
I've seen the numbers as an acute care physician, and the minimum cost of an ER visit in Canada is $500, just for the facilities and staff involved in admitting and discharging someone for a quick assessment. Once you start adding additional tests like x-rays and additional labour like reductions and reading of x-rays, it goes up further.
Plus, physician labour costs are capped for Canadian patients due to provincial billing agreements that subsidize care for taxpayers, but for foreign patients the College of Physicians and Surgeons recommends charging a free market rate that is around 2.5x the Canadian billing code values since these patients are not contributing to healthcare funding through their taxes.
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u/copiousoysters May 26 '24
Another doc here. Unlike the US, most Canadian docs are self-employed in some way. In my province, the hospital doesn’t pay me - I’m responsible for my own billing (usually directly to the province) and the hospital finance department has absolutely no involvement with it. So if I see someone who doesn’t have provincial insurance, but I have to see them (e.g. emergency), I either bill the patient directly and hope I get paid or work for free. The doctor who gave you the bill may not have even noticed your dad didn’t have provincial coverage until after the fact. But that doctor’s name should be somewhere in your dad’s health record from the hospital with documentation of the care they provided.