What Is a Medical Emergency?

Canadian travel insurers interpret this generously. This is how the Travel Health Insurance Association of Canada defines emergency: “an unforeseen illness or injury which requires immediate treatment to prevent or alleviate existing danger to life or health…” Not all insurers use this definition, but generally they interpret emergency quite liberally and don’t limit it to something that is life-threatening. The best rule is: contact your emergency assistance service hotline and let them guide you. Most plans require you to contact them when you have an emergency, usually within 24 hours. If not, your benefits may be reduced. The reason they do this is that they can make a quick assessment and refer you to the nearest, appropriate medical service. On the other hand, if it’s an emergency requiring 911–call and get to the nearest hospital, get into treatment, then call your emergency assistance service with the details and they will instruct you further.

Going it alone and making your own hospital arrangements, “authorizing” treatments or other procedures, or failing to notify your emergency assistance service of your emergency as soon as you can is a high risk game. Your assistance service is there to see you get appropriate care and for that they have to be notified right away. In the great majority of cases the medical director of your assistance service will let your attending physicians and staff do what they think appropriate. But there are times when attending staff may want to do procedures that may not be necessary at the time, or could wait until you are transferred to a Canadian hospital if transfer is necessary. In that case the medical director must give approval for such a procedure to be done. And if not, and you choose to go ahead, you may very well have to pay that part of the bill. All insurers require you to notify them of any major medical emergency needing treatment. For minor conditions, such as those in a walk-in clinic, it’s ok to have them done and file later for reimbursement. But you need all of the proper paperwork and clear identification of what was done, where, was a doctor involved and what was the outcome. But if in doubt, why not call and advise the assistance service? That’s what your cell phone is for.

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