In follow-up to an earlier discussion, the College wishes to offer some guidance in hopes of avoiding difficulties for both physicians and their patients who are seeking coverage for treatment outside of Canada. These comments are of a general nature. Definitive information should always be sought directly from Medicare.
- There are basically three situations where such might occur, only one of which would normally require any input from a New Brunswick physician.
Firstly, patients who are outside of Canada and require emergency treatment can apply to Medicare for reimbursement. Such is somewhat limited. For example, hospital in- patient services are compensated at $100/day, out-patient care at $50/day and physician services reimbursed at New Brunswick rates. The difference between these amounts and what the patient will actually pay highlight the importance of supplemental private insurance.
It sometimes happens that patients seek compensation for non-emergent treatment which they have pursued and received outside of Canada, but for which they have not sought pre-approval from Medicare. They may have received mistaken information that there would be some coverage. Medicare is legally precluded from compensating patients in any amount for such after the fact.
Finally, patients may need or wish to pursue treatment outside Canada for a number of reasons. While assistance with travel and accommodation is never available, full funding for the actual treatment may be, so long as the request is approved by Medicare in advance. However, it is critical that the request must be accompanied by evidence that neither the proposed treatment, nor an equally good alternative, is available anywhere in Canada. It is the absence of any Canadian alternative, not the convenience or timeliness of treatment at a foreign centre, that is determinative of the entitlement to coverage. In this situation, a New Brunswick physician will be required to support the request by providing evidence to that effect. The amount of such will vary with the circumstances. Almost inevitably, supporting documentation from local or regional specialists will be expected. Without such information, and prior approval from Medicare, no coverage can be provided.
12/07
