I am currently overseas working on a project and my wife is with me. During the flight, she began to feel ill and by the time we got to our hotel, it was obvious that she was coming down with what at the very least was a bad cold The next day, her condition worsened with high fever and difficulty in getting a good breath of air. We decided that it was time to see a doctor
That is not necessarily easy in a foreign country and you learn to do some research on the medical facilities, particularly hospital emergency wards which can be places of horror. Fortunately, the people I work with were able to recommend a Walk In Clinic affiliated with one of the better hospitals so we went there
We live in a country with single payer (socialized) healthcare and I have supplementary insurance through my former public service employer which covers those things that the main healthcare system may not cover. That includes coverage while travelling to foreign countries for me and my dependents. That supplementary coverage is provided by a private insurer and has not been a major problem when filling prescriptions at home or receiving dental care. However, the travel insurance portion of this coverage has been subcontracted to an American insurer located in Virginia.. That's where our problems began
We arrived at the clinic which was clean, modern and efficient. I explained my insurance situation and indicated that according to the policy provisions I would have to get prior approval from the insurer. Fortunately, while that was happening, they were triaging my wife and that process went ahead. The number that I was supposed to call was a 1-800 number but no one present at the clinic had authorization to make calls over 7 digits. They had to find someone to authorize the call. Finally when the call was finally made, we were cut off time and time again when the phone was answered at the other end. When we finally did get to speak to someone, I provided my insurance details and was then referred to another person who would review my insurance status. I knew that they would want to talk to the clinic people so they were standing by waiting. After a little over 10 minutes I was told that I indeed had the insurance and I was referred to another person who would open a case file That took at least 20 minutes, most of it on hold. I was given a case number and referred again to a "treatment adjuster" who would adjudicate the medical situation to decide what they would pay for. That took 5 minutes and the adjuster told me that they would have to speak to the doctor, the clinic admin. and my wife. My wife was in the examining room with the doctor so they had to go and get them and have first the doctor indicate her diagnosis and second my wife certify that she agreed to treatment. They left to continue treatment and the adjuster said that she needed to speak to someone from the clinic. That happened and I was put back on the phone. The diagnosis was acute bronchitis so they indicated they would cover only the exam, medication, blood tests and urinalysis. Anything above that would require another authorization. However, they would not accept an invoice from the clinic since they were not "in their ledgers" so I would have to pay and claim the amount on our return home. That ended that. The clinic administrator, when she saw my visa expressed surprise that I was Canadian. She said that they saw this kind of thing frequently with Americans but not with other nationalities.
During the US healthcare debate, I commonly heard protests about putting one's healthcare "in the hands of a government bureaucrat." I was amused by this since we receive high quality, effective and reasonably efficient healthcare without ever having to deal with a government bureaucrat. The real horror I have found is dealing with a for profit insurance company bureaucrat
If this had occurred in Canada we would simply have gone to our primary care physician who would have, if necessary, ordered tests and prescribed the appropriate medication. I understand that this is a relatively minor occurrence when compared with people who have to go through this for serious conditions such as cancer or heart disease.
We'll have to see if the claim goes through. We'll be home soon and back to a sane and rational medical system.