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Well I just had a similar problem in Florida last year. I was in a Miami hospital with breathing problems. I got a bill for $80,000 for one week in the ICU. They didn't help me that much and I couldn't pay it. The hospital wanted all my contacts from my cell phone and a list of relatives. I suppose they were willing to call Iceland to badger and browbeat my family into paying. I am now back in Iceland, where I'm receiving better and more effective treatment than in the USofA.
When I was growing up in the 70s, no one thought about getting health insurance for trips to the US but that all changed in the 80s when stories of Canadians breaking legs while skiing or some such thing started making the news.
I don't know anyone who has travelled in recent times without health insurance. But also in the 80s, companies started excluding preexisting health conditions and rates for people over 55 went way, way up.
What changed, I think, is snowbirds. People were suddenly able to afford to spend the winter elsewhere and insurance companies began getting hit by claims from older people.
When I was growing up in the 70s, no one thought about getting health insurance for trips to the US but that all changed in the 80s when stories of Canadians breaking legs while skiing or some such thing started making the news.
I don't know anyone who has travelled in recent times without health insurance. But also in the 80s, companies started excluding preexisting health conditions and rates for people over 55 went way, way up.
What changed, I think, is snowbirds. People were suddenly able to afford to spend the winter elsewhere and insurance companies began getting hit by claims from older people.
Also, back in the 1970s, people were not yet as sue-happy as they are now, and doctor's fees weren't designed to buy them mansions and boats as well as high insurance premiums against lawsuits.
Note that US hospitals are required by law to take in anyone needing acute care regardless of ability to pay.
Let’s say you are a Canadian who has a heart attack, and get a bill for $100,000 from a hospital in Florida for treatment.
What’s the recourse if you don’t pay it?
A US credit rating means nothing. Likely no US assets to seize either (or if you had any like a condo, sell it quick). You’d be judgment-proof.
Head back across the border when released and ignore the calls.
Just don’t let the hospital get your credit card for payment. If they want a SS# give your SIN# and wish them luck.
Firstly; you should be aware that EMTALA requires ONLY emergency treatment and stabilization if you are indigent and unable to pay. Then you get kicked to the curb. Secondly; no American medical facility I've ever been involved with would even begin treating you for anything other than said emergency WITHOUT payment abilities being garnered first and foremost. So using your heart attack example: while they're hooking you up to saline drip, ECG and drawing your blood samples, your significant other is furiously proving ability to pay, yes, even handing over credit cards, while in the process of getting insurance carrier to authorize payment.
Many American medical providers will not even perform that ritual on your behalf if there is no spouse or other family member to do it for you, they'll run the card they find in your wallet and you'll let them do it!
Foolish in the extreme to suggest that in today's America, that given a heart attack situation you'll get out of any hospital down there with, firstly; just a 100k bill owing, and secondly; without them having some assurance of payment UP FRONT. https://www.commonwealthfund.org/pub...r-heart-attack
You should also be more than aware the two countries have treaty arrangements that preclude Canadians from running out on any sizable debt load that would make it worthwhile going through the necessary court process's.
As of July 11, 2019, the entry/exit initiative has been expanded to include the sharing of information of all travellers including Canadian and American citizens at land ports of entry.
It ain't that easy nor would it be advisable to dodge any debt of that nature in the manner you suggest just beating feet back across the border as though immune from repercussions.
Let's explore this a little further; Snowbird Canadians who spend time in the U.S., using a formulae that works over a three year period; The days in a current twelve month period, 1/3 of the days in the previous twelve months, 1/6 of the days of the year prior to that - if they total more than 183 days.
This form details all of the CANADIAN financial information they deem necessary to prove to their satisfaction you have a "closer connection" (financial responsibilities and footprint, properties owned, bank accounts, and proof of taxes paid in Canada) with Canada lest you be earning an income, realizing investment returns from U.S. sources without paying U.S. taxes.
2/ Make a full IRS income tax filing.
Now; should the U.S. desire to verify and "merely suspect" you are in violation of some aspect of U.S. taxation laws and have not taken steps to "prove your innocence prior to any guilt being proven" the U.S. CAN via it's treaty with Canada, attach income you derive from solely Canadian sources. BINGO! It can take thousands of dollars and years to merely prove they've attached your Canadian income wrongly. Then you are required to spend even more thousands and more years to effect any reimbursement from them for those funds they collected incorrectly/illegally.
Get the picture????
All the foregoing is admittedly related to taxation and not personal debt, BUT the two countries share a reasonably dovetailed legal system that, should the amount in question owed to American debtors be of a sizeable amount so as to make it tempting for a Canadian who own's a home in the U.S. and enjoys using that home, and SPENDING his retirement funds in the U.S., skipping on a debt of any sizeable amount, he'd better think twice, as he could lose the home and any other American assets along with his ability to cross the U.S. border for the foreseeable future if ever again.
I'm sure it happens that some Canadians might think it the only option to skip on a U.S. debt but by so doing they run many risks and will never again be able to confidently cross the border without a sudden nasty surprise awaiting them. Who in their right mind currently enjoying that privilege would take the risk?
Firstly; you should be aware that EMTALA requires ONLY emergency treatment and stabilization if you are indigent and unable to pay. Then you get kicked to the curb. Secondly; no American medical facility I've ever been involved with would even begin treating you for anything other than said emergency WITHOUT payment abilities being garnered first and foremost. So using your heart attack example: while they're hooking you up to saline drip, ECG and drawing your blood samples, your significant other is furiously proving ability to pay, yes, even handing over credit cards, while in the process of getting insurance carrier to authorize payment.
Many American medical providers will not even perform that ritual on your behalf if there is no spouse or other family member to do it for you, they'll run the card they find in your wallet and you'll let them do it!
Foolish in the extreme to suggest that in today's America, that given a heart attack situation you'll get out of any hospital down there with, firstly; just a 100k bill owing, and secondly; without them having some assurance of payment UP FRONT. https://www.commonwealthfund.org/pub...r-heart-attack
You should also be more than aware the two countries have treaty arrangements that preclude Canadians from running out on any sizable debt load that would make it worthwhile going through the necessary court process's.
As of July 11, 2019, the entry/exit initiative has been expanded to include the sharing of information of all travellers including Canadian and American citizens at land ports of entry.
It ain't that easy nor would it be advisable to dodge any debt of that nature in the manner you suggest just beating feet back across the border as though immune from repercussions.
Let's explore this a little further; Snowbird Canadians who spend time in the U.S., using a formulae that works over a three year period; The days in a current twelve month period, 1/3 of the days in the previous twelve months, 1/6 of the days of the year prior to that - if they total more than 183 days.
This form details all of the CANADIAN financial information they deem necessary to prove to their satisfaction you have a "closer connection" (financial responsibilities and footprint, properties owned, bank accounts, and proof of taxes paid in Canada) with Canada lest you be earning an income, realizing investment returns from U.S. sources without paying U.S. taxes.
2/ Make a full IRS income tax filing.
Now; should the U.S. desire to verify and "merely suspect" you are in violation of some aspect of U.S. taxation laws and have not taken steps to "prove your innocence prior to any guilt being proven" the U.S. CAN via it's treaty with Canada, attach income you derive from solely Canadian sources. BINGO! It can take thousands of dollars and years to merely prove they've attached your Canadian income wrongly. Then you are required to spend even more thousands and more years to effect any reimbursement from them for those funds they collected incorrectly/illegally.
Get the picture????
All the foregoing is admittedly related to taxation and not personal debt, BUT the two countries share a reasonably dovetailed legal system that, should the amount in question owed to American debtors be of a sizeable amount so as to make it tempting for a Canadian who own's a home in the U.S. and enjoys using that home, and SPENDING his retirement funds in the U.S., skipping on a debt of any sizeable amount, he'd better think twice, as he could lose the home and any other American assets along with his ability to cross the U.S. border for the foreseeable future if ever again.
I'm sure it happens that some Canadians might think it the only option to skip on a U.S. debt but by so doing they run many risks and will never again be able to confidently cross the border without a sudden nasty surprise awaiting them. Who in their right mind currently enjoying that privilege would take the risk?
Great points. Note that I don’t suggest this approach, and there definitely would be repercussions - such as potential future denial of entry into the US - but you’re also mixing residency and tax liability with healthcare. Anyone who is a serious snowbird would realistically need to procure healthcare before entry.
But I do disagree with some of your points up front. If you go to a hospital in the midst of a heart attack and claim you have no funds they won’t just stabilize you for an hour and wheel you out the door. They might not do extensive additional procedures but they also don’t want to risk a lawsuit.
My wife fell at work a few years ago and an ambulance came. She was a bit woozy but remembered what I told her - do not give your information right then and there. The ambulance attendant asked her several times, as did the hospital staff. So I agree they are pushy - but they won’t wheel you out.
Well I just had a similar problem in Florida last year. I was in a Miami hospital with breathing problems. I got a bill for $80,000 for one week in the ICU. They didn't help me that much and I couldn't pay it. The hospital wanted all my contacts from my cell phone and a list of relatives. I suppose they were willing to call Iceland to badger and browbeat my family into paying. I am now back in Iceland, where I'm receiving better and more effective treatment than in the USofA.
Browbeating is correct - they will either try and collect themselves or in a few months sell your debt to a collection agency.
I have no experience with the quality of Icelandic healthcare but did notice that there are wait times for many. With my US insurance I have no wait - but realize many don’t have the same access.
"When you were in hospital, you or your travelling partner surely signed forms confirming that you were ultimately responsible for payment of services rendered to you—even if you had travel insurance. Everybody signs such forms. Or you may have signed a credit card deposit."
Again, don't sign anything yourself or on behalf of anyone. Trust me, they're sneaky. Your spouse will be stressed out and the billing department will just want you to "sign some paperwork". Politely decline. "Sorry, I'm too stressed out right now to read and sign anything. I'll get to it later." Or, "my spouse is the one who signs these things, wait until they're conscious and able to do it."
I did a search and aside from this I've only found one other case of a man traveling to Las Vegas whose RBC coverage was denied. Maybe Canadians universally get coverage, or maybe they just pay.
Perhaps Canadians are too nice and just assume they have to pay the requested amount. This is the US - hospital "rack rates" are far above what they actually receive from any insurer. Worst comes to worst if you travel without healthcare coverage negotiate the amount down to 10% or so of the total bill. A hospital does NOT want to engage a collections firm, as they essentially will get a few cents on the dollar by the time it gets to them.
But - and this is a big but - things obviously have changed due to Beals v. Saldanha.
I could see a US hospital winning a judgment in their local court and then applying for enforcement in the provincial court of the patent, assuming they can find him/her. This DOES have teeth if you have sufficient assets for them to deem it worthwhile. It would likely cost them tens of thousands of dollars to go through the process.
Great points. Note that I don’t suggest this approach, and there definitely would be repercussions - such as potential future denial of entry into the US - but you’re also mixing residency and tax liability with healthcare. Anyone who is a serious snowbird would realistically need to procure healthcare before entry.
But I do disagree with some of your points up front. If you go to a hospital in the midst of a heart attack and claim you have no funds they won’t just stabilize you for an hour and wheel you out the door. They might not do extensive additional procedures but they also don’t want to risk a lawsuit.
My wife fell at work a few years ago and an ambulance came. She was a bit woozy but remembered what I told her - do not give your information right then and there. The ambulance attendant asked her several times, as did the hospital staff. So I agree they are pushy - but they won’t wheel you out.
I agree totally with your assessment that people intending to travel to any other foreign country obtaining medical insurance for their travels.
In the nature of heart attacks we'll have to disagree to an extent. I've had more than one friend and acquaintance go through that exact scenario. If the heart attack is caused by something needing further treatment such as mitral valve replacement or even a far more minor issue such as stents AND in the hospital/specialist opinion the person can be stabilized enough to be released AND given the fact payment for said treatment is NOT guaranteed/questionable - they have been released to possibly have their second attack anywhere but in that hospital. Thankfully with prescriptions in hand they've saddled up and got their butts back to Canada to have further treatments performed. The one case in particular was frustrating to listen to because the person was an independently wealthy Scot who refused to pay what he thought would be usurious costs for something he could get far cheaper in Canada. When discussing this over a dinner, his wife of many years of amazing tolerance joked "I thought my ship might come in, but alas, he made it home."
To that issue, our Out of Province supplementary travel insurance provided through our employee benefits package, was previously with Sunlife. Upon retirement it was first provided through an AO basis contract with Manulife and is now with Blue Cross. Under all three of those carriers it was in the fine print that regardless of illness, if illness occurred within continental U.S, and extended hospital stay was likely but we could be stabilized to be flown out of country, even by a private med flight - that is what would happen ASAP.
The U.S. was the only travel destination specifically mentioned for that to be the practice in our travel coverage.
We as Canadians are not familiar with the concept of being asked "how do you intend to pay for this service" by any first, second, third or of course, final responders. We take certain things for granted because of the lifelong practice of never being asked for anything at any healthcare juncture other than our Provincially issued Health card.
Having said all of this, there are many other countries where the payment question comes up first and foremost, Mexico being a prime example.
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When discussing this over a dinner, his wife of many years of amazing tolerance joked "I thought my ship might come in, but alas, he made it home." 
responders. We take certain things for granted because of the lifelong practice of never being asked for anything at any healthcare juncture other than our Provincially issued Health card.
