What Claimants, Hospitals, Private Insurers, and Health Care Providers Need to Know.

Cross Border Healthcare Claims

What Claimants, Hospitals, Private Insurers, and Health Care Providers need to know!

cross border healthcare information

In general, Canadian Snowbirds and their families tend to have fairly extensive health insurance coverages that are available to them while travelling throughout North America. For example:

A) if they are involved in a car accident – Personal Insurance Benefits (PIP) also known as Statutory Accident Benefits (SABs)* are immediately available regardless of fault. Subject to which Canadian province and the severity of the injury, PIP or SABs can provide up to $1,000,000 per person of medical, rehabilitation and attendant care funds. In addition nearly every policy provides underinsured or uninsured motorist protection.

B) most travel with private medical travel assistance policies;

C) most have travel cards such as Visa, Mastercard, and Amex which provide also travel health benefits;

D) Government funded universal health insurance programs; and,

E) if employed most have major medical and prescription plan benefits.

Need we say more?

Most US Hospitals, and Health Care Companies are exceptionally efficient in dealing with local accidents and local state laws and regulations. Unfortunately when dealing with Canadian insurers, submitting claims can become exceptionally confusing. More importantly Health Care accounts must be submitted correctly and in a timely fashion. If not, claimants can find their services delayed or denied. Furthermore, Hospitals and Health Care companies can prejudice their statutory and common law rights of “subrogation” and ”recovery” if the proper claims submission process is not followed.

Why are Canadian Motor Vehicle Contractual Accident Benefits so Important?
Car Accident Benefits assist in the immediate payment of hospital and health care accounts. It allows hospital discharge planners, social workers, and health care workers to facilitate the injured party and their family’s return home. The benefits when properly accessed, help ensure the appropriate care is seamlessly provided on both sides of the border.

How does a US Hospital and other Health Care Companies access injured parties benefits?
In general, a claimant is responsible to submit their claims to their insurance company(s). Health Care Companies – with permission from the claimant, can remit its accounts directly to an insurer. Claimants insurance policies have claim limits, and will only respond when certain requirements are met. Probably the most confusing aspect is what is known as “priority of payment”. When a claimant has multiple insurance polices there is always a questions as to which insurer pays first and how much? For example in Ontario, Canada, medical and rehab accounts need to be submitted as follows: First – to the Ontario Health Insurance plant; Second – to any purchased travel and medical policies; Third – private employer health insurance plans; and Fourth – their car insurance policy. Needless to pay ”priority of payment” varies based on the number of possible insurers and of course which state or province the contract was purchased.

Two serious considerations for Claimants, Hospitals, private insurers and Health Care companies:

  1. Each state, province, and private insurer, has different Statutory time limits in which to bring contractual insurance claim. If a claim or action is not made within the prescribed time period, it will be statute barred.
  2. Most hospitals, private insurers, and health care companies have the right to recover outstanding accounts either by contract and/or common law.

Cross Border Accidents are complicated. Fortunately at Snowbirdaccidents.com we can help Claimants, Insurers, Hospitals and Health Care companies quickly identify and process these Canadian cross border claims. We can arrange for some of the best Personal Injury Lawyers who work collaboratively throughout various jurisdictions, ensure Claimants, Hospitals, Private Insurers, and Health Care Companies claims and remedies are properly protected.

For a free Cross Border Confidence consultation

snowbird accident helpline


snowbird accidents