Canadian Healthcare- so far

So, due to an early morning mis-step, or rather missed step, I’ve now had an up-close and personal look at Canadian healthcare.

A bit of background… I’ve been purchasing and using individual health insurance in the US since about 1990. So I know that system pretty darned well, both before and after ACA. ACA was a huge improvement, but we clearly need a better system.

As a new Canadian permanent resident, OHIP (Ontario health insurance) will cover me after 3 months (Nov 23rd) Until then, I bought “visitor’s insurance” from Manulife to cover me for those 3 months. Visitor’s insurance has no deductible, and covers everything from ER to prescriptions, labs, physical therapy.¬†It does not cover pre-existing conditions, like my lymphedema. Cost: about $392 USD for 3 months. Yes, $130 per month. Similar insurance in Virginia would be about $500 USD/month.

First, I went to Sunnybrook Emerg. (It’s called Emerg here, not the ER.) I had managed to hurt BOTH legs, but there were no obvious wounds.

The triage intake  explained that ER had 13 people ahead of me, and that I could choose to wait, or be first in line at Urgent care when they opened in 2 hrs. So I chose to wait for Urgent Care.

So, in the meantime, I was given Tylenol & ibuprofen and ushered in to the bookkeeper. They were surprised that I didn’t have OHIP, but explained that I would be responsible for paying the bills at time of service. It would be up to me to work it out w/my insurance company.

If I had been covered by OHIP, I would have just shown my card at each place of treatment- that’s it. As it was, I had to pay, collect the papers & scan them to send in. Certainly not a hardship, considering. (Notice the savings involved in having me do my own paperwork, instead of their office trying to coordinate with all kinds of different companies.)

Throughout the whole thing… emerg, fracture clinic, GP, more x-rays, checking for blood clots… I was treated just as if I were Canadian. The doctors met with me, examined me, decided what was or wasn’t necessary, and sent me for procedures. The treatment and facilities were equivalent to anything I’ve seen in the US. (Actually, the people were a bit nicer.)

Here’s a BIG difference. In the US, fees are not transparent. In fact, depending on which insurance you have (or don’t), the price for any procedure varies. Insurance can negotiate better prices than if you paid out-of-pocket. (Big scary detail from personal experience: If your policy does not cover a procedure, you get no discount. These “catastrophic” policies are dangerous in that regard.) I was shown the fees (and paid them) before each service.

Here are a few prices (converted to $USD) to ponder:

  • Emerg- $628
  • Leg X-rays- $58 each (there were lots!)
  • GP Visit (30 min)- $47
  • GP Visit- $31
  • Orthopedic surgeon exam & review of x-rays: $146

So, even paying out of pocket, the fees are MUCH less than one would expect to pay anywhere in the States. I’m well on the way to recovery (sprained ankle on one side, mildly fractured tibia on the other) and have 9 days to go before OHIP (but who’s counting?)

Some observations:

  • The most quiet place in Sunnybrook hospital: Accounts Payable. I may have been the only person they saw all day.
  • My insurance case manager has called me 3 times, to ask how it’s going, what the doctor has advised, etc. They have approved everything that has been suggested. They actually seem more concerned about how I’m doing than how much I’m costing them. (Clearly, they’re losing money on me!)
  • OHIP doesn’t cover everything. Supplemental insurance can be purchased, but many employers or unions provide it. (Prescriptions for those under 65, vision, dental and travel insurance for outside Canada.)
  • The only “waiting” I’ve heard about is for things like cataract surgery. The people who need it most are first in line.
  • Each province has their own slightly different insurance plan, and they reciprocate, so that every Canadian is covered anywhere in Canada.
  • Canadians love their healthcare, but they do complain- about hospital parking lot fees!

The system is not perfect, but it’s much more effective and humane than what I’ve experienced in the US.

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