What Canadians need to know about travel health insurance

TORONTO â€" A Calgary woman who was seriously injured after a balcony railing gave way at a Mexico resort was faced with fees and painful treatment, raising questions about what exactly travel medical insurance covers and doesn’t cover in an emergency.

Travel Health Insurance Association of Canada (THIA) President John Thain says the Mexican hospital that asked Katarina Pacileo for $2,500 up front was an unusual situation.

“It’s almost universally accepted that you, as a travelling Canadian, won’t be out of pocket once [you’ve] produced evidence on who the insurance company is,” he said, saying if you give your insurance company’s phone number to the medical facility, most invoices for medical coverage will be sent directly to them for processing. “But we can’t guarantee that.”

Pacileo claimed she was then asked to pay the hotel for the damaged balcony, which Thain said would not be covered by travel health insurance.

“If you get sued for a third party for whatever reason while in Mexico, it’s not really what the coverage is designed for,” he said, noting that the insurance is strictly for health-related emergencies.

Not the same as a full medical plan

Thain cautions that travel medical insurance is for “unforeseen, unexpected” accidents or sickness used in emergencies. He says in his experience, Canadians are most often surprised when medical incidents related to unstable pre-existing conditions aren’t covered.

“If you’ve had a change in prescription or been to see a doctor to have treatment updated on that condition, then that’s not a stable condition, and it would be not covered while you were out of a country,” he said, suggesting you consult your doctor to understand how your policy applies to your particular health conditions.

Pregnancy and alcohol

THIA notes that pregnancy-related conditions may not be covered or may be limitedâ€"including a premature delivery.

Skydiving, bungee jumping, or other excursions you might be looking forward to on your trip are also likely to fall outside your coverage should they result in injury.

“People tend to engage in activities they might not otherwise engage in while they’re on vacation,” said Thain.

Not to mention alcohol-related injuries â€" which could be measured by the legal limit of your home province or the location where the accident occurred.

“There can be alcohol exclusions if somebody overindulges in alcohol and somehow injures themselves or get injured where alcohol was the primary contributing factor,” said Thain.

Before your trip

The Financial Services Commission of Ontario suggests you make sure to shop around for a policy that reflects your health, age, any medication you’re taking, where you’re going and the length of your trip. It’s also important to note that just because you’re not leaving Canada, you will need out-of-province coverage should you encounter a medical emergency.

It’s possible that your employer, union, credit card, bank “gold” card or home insurance policy already offer enough coverage, so check there first.

Thain says calling insurance companies (usually at a 1-800 provided to you) if you’re ever unsure of key definitions or which policy is right for you. It’s incumbent upon you to fill out the medical questionnaire accurately, since claims can be denied due to mistakes that may or may not be related to the incident.

“Travel insurance can provide coverage up to $5 million dollars in certain cases, so it’s a big risk,” said Thain.

“If it was discovered after the fact that the information was incorrect, your claim can be denied and the results can unfortunately be quite large.”

Keep your insurance contact handy

The assistance telephone number given by your insurance provider should be kept with you and given to any travel companions, suggested Thain, who says doctors and nurses will be available to make sure you’re getting the right treatment and advise you where to go.

“People you may be travelling with should have access to that number, too, because it’s possible given what the emergency is, you might not be able to make that call yourself.”

Pacileo, who was with her husband when she received medical care in Mexico, returned to Calgary on Tuesday and is recovering at home after treatment at a local hospital.

“We’re Canadian, and I will never take that for granted,” Pacileo told Global News on Wednesday. “They just don’t care. You could die in the street and they don’t care.”

Watch below and READ MORE: Calgary couple’s Mexican getaway ends in health care nightmare

© Shaw Media, 2014