Most Canadians know that if they end up in an American hospital, they could be on the hook for hundreds of thousands of dollars in medical bills.
What many don’t realize is that the same is true in reverse, and that it’s not uncommon for visitors to Canada who need and receive medical treatment to find themselves facing huge health care fees they can’t pay. So many don’t.
Over the last six years, the Fraser Health Authority has written off more than $16 million in unpaid debts owed by non-Canadians who ended up in its hospitals and then were billed at least $25,000, documents obtained by Black Press show. While Fraser Health reported about $100 million in revenue from non-residents over that time period, the health authority also estimates that it only collects around 70 to 80 per cent of the money charged to non-residents.
The uncollected money is almost pocket change in the grand scheme of Fraser Health’s billion-dollar annual budget. But the $16 million is also roughly equivalent to the cost of upgrading Abbotsford Regional Hospital’s emergency room.
At the same time, details contained within “bad debt lists” compiled by the health authority and obtained by Black Press show that many foreign patients that get treated here but then don’t pay aren’t trying to abuse the Canadian health system. Many, in fact, do their best to pay their bills before being swamped by the sheer scale of the charges.
Others come to Canada with travel insurance, only to find it grossly inadequate when they end up in hospital. And the documents show repeated instances of foreign insurance companies either denying their clients’ claims, or outright telling patients not to pay their bills.
(The “bad debt list” obtained by Black Press is purged of any information that could identify patients or their illnesses.)
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Earlier this year, Fraser Health wrote off three separate bills for more than $100,000. One patient was visiting from China, and another came from India. A third patient was Indonesian, but married to a Canadian and living in Canada “without status.”
The visitor from India had come to B.C. to visit family, only to end up facing a health care bill of more than $125,000.
The patient had insurance, but the policy covered a maximum of $8,583. Faced with bills that far exceeded that total, the person signed a $500/month payment plan, and eventually paid a total of $27,278. But those payments ground to a halt for a reason that is redacted from the document. The account was later sent to a collection agency, before being written off this spring.
The Indonesian patient had three hospital admissions and “several outpatient visits.” By the end, he or she was left with a bill of more than $370,000. The person agreed to make payments of $200 per month. At that rate, it would take 155 years to pay off the total amount owed. Still, the person paid $11,855 before payments stopped. The sentence that follows a redaction suggests the patient sought legal services.
“The contract was terminated and the proof of claim was mailed to the lawyer’s office,” the document says.
It adds that “no further internal collections could be made” and states that the account was not forwarded to a collection agency. The instance appears to have been the first time in at least five years that a debt was written off without a collection agency being contacted.
The writeoff associated with the Chinese visitor followed a similar path. After accumulating about $300,000 in health care bills, the person agreed to pay $100 per month, and did so for at least two years before the contract was terminated. An invoice was later mailed, but calls and emails brought no response. A phone number was later disconnected, and collection efforts ground to a halt. Had the person continued with the monthly payments, it would have taken 252 years to pay off the debt.
Other details from the bad-debt list shed more light on how patients end up getting stuck with bills they can’t pay.
One American facing more than $30,000 in bills had been visiting friends in B.C. and “thought medical was free in Canada and did not expect to be billed.” And several non-Canadians had been living in the country and obtained a personal health number and thought they had MSP coverage, only to be told they did not meet residency requirements.
The documents also suggest that insurance companies regularly try to escape having to pay out large sums of money to Fraser Health.
On at least 10 occasions, patients were left on the hook for tens – and sometimes hundreds – of thousands of dollars of treatment after their insurance companies denied their claims. Many insurance policies simply do not cover the large amounts charged to foreigners. It’s also common for insurance companies to tell their clients not to pay Fraser Health.
In October 2016, the health authority forwarded three almost identical cases to collections. In the three cases, Fraser Health was paid a fraction of the costs it billed, with an unnamed “European insurance company” refusing to discuss the matter. In each case, an unnamed entity was described in identical language as having “disagreed with FHA’s daily rate for non-residents as they believed the lower interprovincial rates should be applied.”
The single biggest writeoff taken by Fraser Health occurred last spring, when the authority wrote off a debt of nearly $1 million accumulated by a man from India, who had been visiting family. The patient had insurance, but the company denied the claim. In the most serious such health crises, the health authority will spend tens of thousands of its own dollars to transfer a patient to a hospital in their home country. That didn’t occur in this case, the documents say, because “a hospital in India that would take the patient could not be found.”
With the patient unable to pay his bill, the health authority was forced to take a $992,917 writeoff.
The people stuck with massive health care bills in the Fraser Valley are a diverse bunch. The approximately 140 writeoffs are linked to patients from about 40 different countries, spanning the globe from developing Asian nations to rich and prosperous European powers.
Unsurprisingly, it was people from the two nations probably most inclined to visit the Fraser Valley – the United States and India – who also ended up in hospital facing large bills most often. Americans slightly outnumbered Indians in the final tally.
Jacqueline Blackwell, a spokesperson for Fraser Health, said the “priority is to provide health care services to patients who come to us in need,” and that “a person’s ability to pay is not a consideration in providing care.”
Nevertheless, patients who are uninsured and/or non-residents are required to pay for treatment and services at rates set by the provincial government “with input from health authorities.”
The amount charged to foreign visitors in recent years has been rising, Blackwell said, because of more and longer stays in hospitals and more emergency room visits.
The documents also note that Fraser Health once contacted the Canadian Border Services Agency. Blackwell said that was done “to confirm a person’s residency or travel status,” but stopped because of patient confidentiality concerns.
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When visitors to Canada end up in a hospital here, they may end up speaking to one of Fraser Health’s “patient financial counsellors.”
The duties of such a counsellor, though, are not only to help a patient better understand, and cope with, the financial implications of their health. They’re also to get Fraser Health the money owed to it.
In describing the job, a Fraser Health spokesperson said: “The counsellor works with the patient and their family to explain the rates and billing process, assists them in working with their insurance company, assists them with health records, obtains all required signatures, and seeks payment.”
But an online job posting goes into considerably more detail about that last bit. And it’s no little part, consuming the bulk of a job listing posted on LinkedIn.
The counsellor can help set up payment plans and find some financial middle ground between health care provider and patient. But if the money doesn’t materialize, the counsellor takes an active – and personal role – in trying to get the patient to pay up.
The job – which requires a Grade 12 education, completion of an accounting course and three years’ experience – requires the counsellor to follow up on delinquent accounts by “initiating telephone contact and/or written correspondence with patients/insurance carriers/financial parties in order to promote/facilitate payment.” When needed, the counsellor transfers the outstanding accounts to collection agencies and provides them the necessary paperwork.
When all those efforts fail, and people can’t pay, it’s the counsellor who recommends writing off the debts.