DOCSLIB.ORG

Inside in the Event of a Claim, Allianz Global Assistance Will Require Proof of Departure

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Inside in the Event of a Claim, Allianz Global Assistance Will Require Proof of Departure RTO/ERO Group Benefits Program Régime collectif d’avantages sociaux d’ERO/RTO ADMINISTERED BY / ADMINISTRÉ PAR 2017/2018 going places Proof of Departure Inside In the event of a claim, Allianz Global Assistance will require proof of departure. This proof must confirm when you were last in your province of residence, not when you Allianz Global arrived at your destination. This proof is necessary so Allianz knows how long you have 2 Assistance – Making been outside your province of residence. the Grade in Service to You Each insured person must have their own proof of departure. Balance Billing The proof must: Reminders • Identify you • Indicate that the transaction took place in your province of residence before the trip Mr. John Doe Travel Plan Questions and Answers • Specify the date Toronto, Canada 3 Some examples of acceptable proof are: Rome, Italy Travelling Out-of- • Duty free receipt Province within Canada • Airline boarding pass YYZ • Credit card receipt (and copy of credit card statement if receipt is not signed) Supplemental Travel • Signed and dated bank/financial institution 4 Plan – annual rates documents (for example, if you went to the bank to change currency) Contact information • Receipt for professional services performed (for example, massage therapy, dental treatment, eye examination) Allianz Global Assistance – Balance Making the Grade in Service Billing to You In a medical emergency, Allianz Global Assistance will locate Allianz Global Assistance thanks you • Whether a member is being appropriate medical care and for giving them top marks in the most treated in hospital for a medical coordinate eligible payments to recent RTO/ERO survey. They value emergency or as an outpatient hospitals and physicians on your your feedback as it enables them to with a complex case, they will behalf. Allianz works with health learn about where they’re doing well. have a direct and dedicated point care providers worldwide and can What you have to say also lets them of contact from Allianz’s Case validate that your claims are based know where they can improve. Management team coordinating on charges that are reasonable and the details of their care. customary for the region. As well, Forty-five per cent of members who they negotiate discounted prices were sent the survey took the time As they look to build on these and other efforts, Allianz Global with selected providers and make to share their thoughts. It feels great Assistance will continue to seek out, payments on your behalf. to know that of that group, 89% listen to and act on your feedback to On occasion, after a bill has been rated Allianz Global Assistance an ensure they keep on making the grade 8 or higher on their willingness to paid by Allianz, health care providers in your books and remain at the top have attempted to bill the patient the recommend them. Additionally, 86% of the class in service to you. would recommend Allianz Global difference between the lower price Assistance to friends and colleagues. For more information, contact negotiated by Allianz and the higher Johnson Inc. Plan Benefits Service. pre-negotiated rates. This is called At the same time, one thing that came balance billing. Do not pay these bills. through loud and clear is that excellent The RTO/ERO group travel insurance plan is If you should receive a billing notice service continues to be important to underwritten by Sun Life Financial and CUMIS you. Allianz hears you and they feel the from a hospital, collection agency, General Insurance Company, administered by etc., after Allianz has paid your bill, same – it’s what you deserve. With that Johnson Inc., with travel emergency assistance and please contact Allianz immediately at in mind, below are just some examples claims administration services provided by Allianz the number located on your Allianz of what Allianz Global Assistance has Global Assistance. Allianz Global Assistance is a registered business name of AZGA Service Explanation of Benefits. They will take done and are doing to help make a the appropriate steps to resolve the positive difference in your experience Canada Inc. and AZGA Insurance Agency Canada Ltd. issue on your behalf. with them. Member communication • Members can now obtain additional details when their case is opened. This includes Reminders information on required documents and how to obtain • The maximum allowable supply for prescription medications help with completing claim forms. is 100 days. If you plan on taking an extended vacation, • Member call backs are now being a further 100 day supply can be obtained by having your streamlined to help ensure members pharmacist contact Johnson Inc. Plan Benefits Claims. Please are contacted in a timely manner. remember that the total cost of the prescription will count towards the calendar year maximum in the year in which the • Members can expect enhanced prescription is filled. service by way of ongoing training for claims representatives, which • The out-of-province/Canada travel benefit is designed to helps ensure that key information protect you in the event of a sudden and unforeseen medical is clearly and effectively shared. emergency. Travel should take place when you are healthy. Medical conditions should be investigated and the appropriate Claims process treatment received before you travel. Once your condition • For claims in excess of $10,000, an is stable, according to the stability clause, your trip can be improved Explanation of Benefits booked, payments made, and you can travel knowing you are letter now provides members with protected by the RTO/ERO out-of-province/Canada travel more details so they have a clearer benefit for eligible expenses. understanding of the claim decision. 2 going places Travel Plan Questions and Answers I’m an Ontario resident. are sent to you at the time your case is would however, have coverage for any I booked hotel opened. These include an authorization medical emergency that was unrelated Q accommodation in for release of medical records from to your kidney surgery. If you chose to Niagara Falls. Due to a death in my your physician, authorization to submit cancel this trip, your eligible expenses immediate family, I had to cancel my claims on your behalf to your provincial would be reimbursed to a maximum hotel. The hotel would not refund health care plan as well as coordinating of $6,000 per person, under the Trip the cost of the room. Why was this with other insurance coverage(s) Cancellation benefit, so long as your not an eligible claim under the out- where applicable. The receipt of condition was stable in the 90 days of-province/Canada travel benefit? these completed forms is required for prior to the date the trip was booked. The trip cancellation/ Allianz Global Assistance to start the interruption benefit covers adjudication of your claim. If you have My physician has confirmed pre-paid, non-refundable travel any questions regarding your travel claim that I am okay to travel A even with my current arrangements outside your province of forms, please feel free to call Allianz at Q residence. Travel arrangements within the number on your ID card. medical condition. Will the out-of- province/Canada travel benefit cover your province of residence are not I booked my trip in me if I have a medical emergency eligible under the out-of-province/ August 2017 for travel while travelling as a result of my Canada travel benefit. Q in December 2017. In current medical condition? October 2017, I was admitted to How long does it take to hospital for emergency kidney Your physician’s authorization Q pay a travel claim? surgery. Would I have coverage does not override the for any problems relating to my RTO/ERO policy. If, Travel claims are more complex A surgery while on my trip? Would I than extended health care or according to the policy, your condition need to cancel my trip? A dental claims and, as a result, would not be considered stable, a can take longer to process. They involve While travelling, you would medical emergency related to this coordination with your provincial health not have coverage for any condition would not be covered. Please care plan and often involve language A medical emergency relating to refer to the inside cover of your Out- translations and interpretation of other your surgery as it took place within 90 of-Province/Canada Travel Booklet, countries’ billing practices. Most forms days prior to your departure date. You specifically the medical stability clause. Travelling Out-of-Province Within Canada Most people are aware of the need for Province/Canada Travel Plan and are Family/companion to accompany travel health insurance when travelling not covered by your provincial GHIP: surviving spouse – In the event of outside of Canada. However, many are death of a spouse while the couple not aware of the importance of travel Ground and air ambulance is travelling together, the plan will insurance when travelling outside their Vehicle return – A maximum of allow for one economy round- province of residence, within Canada. $2,000 for the return of one vehicle trip fare to a maximum of $1,500 to your place of residence if you are for one extended family member Provincial Government Health unable to operate the vehicle due to or companion to accompany the Insurance Plans (GHIP) provide sickness, injury or death. surviving spouse home to his/her some out-of-province coverage province of residence. through provincial reciprocal Additional hotel and meal agreements. Typically, these cover expenses – Incurred by you and/ Trip interruption/delay – Covers up medically necessary eligible physician or your travelling companion due to $6,000 per insured person. and hospital services only.
Load more

Recommended publications
  • CMS-9909- Surprise Billing Disclaimer
    Notice: This HHS-approved document has been submitted to the Office of the Federal Register (OFR) for publication and has not yet been placed on public display or published in the Federal Register. The document may vary slightly from the published document if minor editorial changes have been made during the OFR review process. The document published in the Federal Register is the official HHS-approved document. [Billing Codes: 6523-63-P; 4830-01-P; 4510-29-P; 4120-01-P] OFFICE OF PERSONNEL MANAGEMENT 5 CFR Part 890 [RIN 3206-AO30] DEPARTMENT OF THE TREASURY Internal Revenue Service 26 CFR Parts 1 and 54 [TD9951] RIN 1545-BQ04 DEPARTMENT OF LABOR Employee Benefits Security Administration 29 CFR Parts 2510 and 2590 [RIN 1210-AB99] DEPARTMENT OF HEALTH AND HUMAN SERVICES 45 CFR Parts 144, 147, 149, and 156 CMS-9909-IFC [RIN 0938-AU63] Requirements Related to Surprise Billing; Part I CMS-9909-IFC 2 AGENCY: Office of Personnel Management; Internal Revenue Service, Department of the Treasury; Employee Benefits Security Administration, Department of Labor; Centers for Medicare & Medicaid Services, Department of Health and Human Services. ACTION: Interim final rules with request for comments. SUMMARY: This document sets forth interim final rules implementing certain provisions of the No Surprises Act, which was enacted as part of the Consolidated Appropriations Act, 2021 (Pub. L. 116-260). These interim final rules amend and add provisions to existing rules under the Internal Revenue Code, the Employee Retirement Income Security Act, the Public Health Service Act, and the Federal Employees Health Benefits Act. These interim final rules implement provisions of the No Surprises Act that protect participants, beneficiaries, and enrollees in group health plans and group and individual health insurance coverage from surprise medical bills when they receive emergency services, non-emergency services from nonparticipating providers at participating facilities, and air ambulance services from nonparticipating providers of air ambulance services, under certain circumstances.
    [Show full text]
  • The BCMA, Then and Now a Selected History from 1965 to Doctors of BC
    The BCMA, Then and Now A Selected History from 1965 to Doctors of BC Dr Brad Fritz THE BCMA, THEN AND NOW: A SELECTED HISTORY FROM 1965 TO DOCTORS OF BC 1 Contents Timeline ................................................................................... 3 1993—Utilization and co-management ............................ 62 Introduction ............................................................................ 4 1993–1998—Reduced activity days and the end of prorationing .......................................................................... 65 1965—The BCMA of 1965 .................................................... 6 1994—Fee disparities and the Relative Value Guide ....... 69 1968–1972—Reform Group–Establishment conflict, referenda, and a Negotiating Committee .......................... 10 1997—The Northern Doctors’ Dispute, the Rural Agreement, and MOCAP .................................................... 74 1968–1979 —A decade of turmoil ...................................... 16 2002—Bill 9 and arbitration ................................................ 77 1972–1980—A professional negotiator ............................. 19 2002—The General Practice Services Committee ........... 81 1973–1995—Public health advocacy: Working for the people of BC .......................................................................... 23 2002–2003—The Bonita Thompson report and a change in the society appointments ................................ 84 1974–2010—Benefits ........................................................... 33 2013 —Doctors
    [Show full text]
  • The Experience of Families Whose Children Access Dental Care Under
    13-11-20 Experiences of Parents Whose Children Access Dental Care Under the Healthy Kids Dental Program by Sharon Melanson, Dip(DH), BSc(DH), MSc Canadian Institutes of Health Research Western Regional Training Centre University of British Columbia Why this topic? • Focus on children • Hear the voice of the parent • Knowledge Acquisition • Stepping stone to improvement 28/09/2013 2 1 13-11-20 Provincial Comparisons • Question #1: Are dentists allowed to balance bill children on Provincial Government publicly sponsored dental plans? • Question #2: Are Ministry fees maintained at a percentage of the dental association fee guide? • Question #3: At what percentage is the Ministry fee guide paying in relation to the dental association fee guide in 2011? 28/09/2013 3 Balance Billing Alberta, Manitoba, Ontario, Quebec, New Brunswick, Nfld/Labrador, Nova Scotia, PEI NO Saskatchewan: Yes and No British Columbia: YES 28/09/2013 4 2 13-11-20 Methodology • Method: Qualitative Description • Sample: purposeful sample, maximum variation • Data Collection: semi-structured interviews, review of documents • Data Analysis: content analysis, quasi- statistical analysis is supplemental • Results: low inference description 28/09/2013 5 Results • Demographics • Beliefs • Dental Care Pathways • Healthy Kids Program Experiences 28/09/2013 6 3 13-11-20 Results Demographics: • 16 parents interviewed (14 mothers, 2 fathers) • 15/16 families live on adjusted net income of $22,000 or less 28/09/2013 7 Results Beliefs • Most parents related positive childhood experiences with dentist (12/16) “I’m not afraid of the dentist” (P-15), “never had any bad experiences” (P6). • Parents can’t afford dental work for themselves = want better for their children “I don’t want my kids to go through what I went through.
    [Show full text]
  • Medical Practice Service Agreement
    Medical Practice Service Agreement Unshuttered and anucleate Dewitt redissolves, but Christos apogeotropically stork's-bill her prunt. Activated and projected Drake redipped lecherously and congas his opah scraggily and singularly. Balmiest Warner usually varnishes some doormat or depastures strictly. You receive medical agreement or shared infrastructure will apply if a clinic does not have the repayments should look only Maintaining incentives on insurers to not expect pay ratio but accurate to engage in at business practices is range to see hospital community. Practice Operator as lyrics in pool or as signatory with respect to bank accounts and other funds of constant Practice Operator. MSO structures, whether through a switch or equity investment, is still need to retain the physicians at their various medical practices to continue when revenue generation and overwhelm the counter value. Also, fashion the ramp plan maintains several networks intended civil use in to plan designs, the provider agreement form indicate which specific networks in labour the provider agrees to participate. Some billing services include reporting requirements and frequency. Provision of Professional Services. Prior to offering a mob, the employer group together decide how flexible they are prepared to frequent during contract negotiations. Additionally, each shot should have guidelines for periodic review and updating of the compliance policies. Third the Software supplied by Nuance is pass to respective terms and conditions of tentative Agreement cause the applicable third he terms. Health care services are not covered unless they retire the requirements of the applicable Health Benefit Program, including but not limited to, the requirement of Medical Necessity.
    [Show full text]
  • Examining Surprise Billing: Protecting Patients from Financial Pain Hearing
    EXAMINING SURPRISE BILLING: PROTECTING PATIENTS FROM FINANCIAL PAIN HEARING BEFORE THE SUBCOMMITTEE ON HEALTH, EMPLOYMENT, LABOR, AND PENSIONS COMMITTEE ON EDUCATION AND LABOR U.S. HOUSE OF REPRESENTATIVES ONE HUNDRED SIXTEENTH CONGRESS FIRST SESSION HEARING HELD IN WASHINGTON, DC, APRIL 2, 2019 Serial No. 116–14 Printed for the use of the Committee on Education and Labor ( Available via the World Wide Web: www.govinfo.gov or Committee address: https://edlabor.house.gov U.S. GOVERNMENT PUBLISHING OFFICE 36–589PDF WASHINGTON : 2019 VerDate Mar 15 2010 11:59 Nov 19, 2019 Jkt 000000 PO 00000 Frm 00001 Fmt 5011 Sfmt 5011 C:\USERS\NWILLIAMS\ONEDRIVE - US HOUSE OF REPRESENTATIVES\DESKTOP\3658 EDL-011-D with DISTILLER COMMITTEE ON EDUCATION AND LABOR ROBERT C. ‘‘BOBBY’’ SCOTT, Virginia, Chairman Susan A. Davis, California Virginia Foxx, North Carolina, Rau´ l M. Grijalva, Arizona Ranking Member Joe Courtney, Connecticut David P. Roe, Tennessee Marcia L. Fudge, Ohio Glenn Thompson, Pennsylvania Gregorio Kilili Camacho Sablan, Tim Walberg, Michigan Northern Mariana Islands Brett Guthrie, Kentucky Frederica S. Wilson, Florida Bradley Byrne, Alabama Suzanne Bonamici, Oregon Glenn Grothman, Wisconsin Mark Takano, California Elise M. Stefanik, New York Alma S. Adams, North Carolina Rick W. Allen, Georgia Mark DeSaulnier, California Francis Rooney, Florida Donald Norcross, New Jersey Lloyd Smucker, Pennsylvania Pramila Jayapal, Washington Jim Banks, Indiana Joseph D. Morelle, New York Mark Walker, North Carolina Susan Wild, Pennsylvania James Comer, Kentucky Josh Harder, California Ben Cline, Virginia Lucy McBath, Georgia Russ Fulcher, Idaho Kim Schrier, Washington Van Taylor, Texas Lauren Underwood, Illinois Steve Watkins, Kansas Jahana Hayes, Connecticut Ron Wright, Texas Donna E.
    [Show full text]
  • Pharmacy Manual [PDF]
    Pharmacy Manual The information contained in this Pharmacy Manual does not apply to pharmacy providers from the province of Quebec. Table of Contents Section 1 - General Information About TELUS Health 6 Communicating With Cardholders: The Insurer’s Prerogative 7 Section 2 - The Telus Assure Claims Card Sample Assure Claims Card 9 The Cardholder Identification Number 9 Carrier Number 10 The Cardholder Name Line 10 The Second Name Line 10 Other Text 10 Relationship Code and Date of Birth 11 Section 3 - TELUS Health Assure Claims Pharmacy Support Centre Contact Information and Hours of Operation 13 Holiday Schedule 13 Section 4 - General Policies and Procedures Procedures 15 Validation of Electronic Claims 15 Paper Claims 15 Incorrect Date of Birth 15 Claim Void 16 Claim Retransmission Requests 16 Balancing transactions 16 Pharmacy Payment Options 17 Pricing 17 Determination of Prescription Pricing 17 Keeping a Level Playing Field 18 What Can Be Charged to Cardholders 18 Deferred Payment Plans 19 Government Programs WorkSafe BC (WSBC) 19 Ontario Workplace Safety and Insurance Board (WSIB) 19 Pharmacy Manual 2 Section 4 - General Policies and Procedures (continued) Documentation Requirements 19 Authorization for Prescriptions 19 Verbal Refill Authorizations and Verbal Prescriptions 20 Pharmacist Prescribing/Adaptation 20 Continued Care Prescription (CCP)/Prescription Adaptation by a Pharmacist 20 Changing an Authorized Prescription 20 Dispensing Reduced Quantities 21 Documentation Retention 21 No Substitution 21 Pharmacist’s Signature/Initials
    [Show full text]
  • Universal Health Care: Concerns for American Physicians, Using the Canadian Experience As a Model
    Universal Health Care: Concerns For American Physicians, Using The Canadian Experience as a Model "Social, political and economic myths prevent us from learning from other countries' experiences in financing health care. Perhaps the only advantage of being the last industrial democracy without universal health insurance is that we can learn from the experience of others. We will learn little, however, if we credit the many myths about foreign experience regularly repeated by critics of national health insurance. If ever there was an obvious American opportunity for cross- national learning, it is Canada's path to and experience with universal health insurance."' I. INTRODUCTION The health care problems facing America today are at a critical point. One out of four people, or approximately sixty-three million people, will lose health insurance coverage for some period during the next two years.2 Thirty-seven million Americans have no insurance and another twenty-two million lack adequate coverage. 3 Polls suggest that a majority of Americans are insecure about their health care coverage and are discouraged about the soaring cost of health care, which rose from $250 billion in 1980 to more than $900 billion in 1993.4 Health care costs have been expanding at a rate of ten percent a year, faster than the nation's overall economic growth. 5 As a percentage of gross domestic product, health care costs will grow from fourteen percent to nineteen percent during the next decade if left unchecked.6 1. Testimony Prepared For The Senate Committee on Finance, Health Care: The In- ternational Perspective, FEDERAL NEWS SERVICE, October 14, 1993, available in LEXIS, NEWS Library.
    [Show full text]
  • Federalism and the Financing of Health Care in Canada and Switzerland: Lessons for Health Care Reform in the United States Paul J
    Boston College International and Comparative Law Review Volume 21 | Issue 2 Article 3 8-1-1998 Federalism and the Financing of Health Care in Canada and Switzerland: Lessons for Health Care Reform in the United States Paul J. Donahue Follow this and additional works at: http://lawdigitalcommons.bc.edu/iclr Part of the Comparative and Foreign Law Commons, and the Health Law and Policy Commons Recommended Citation Paul J. Donahue, Federalism and the Financing of Health Care in Canada and Switzerland: Lessons for Health Care Reform in the United States, 21 B.C. Int'l & Comp. L. Rev. 385 (1998), http://lawdigitalcommons.bc.edu/iclr/vol21/iss2/3 This Article is brought to you for free and open access by the Law Journals at Digital Commons @ Boston College Law School. It has been accepted for inclusion in Boston College International and Comparative Law Review by an authorized editor of Digital Commons @ Boston College Law School. For more information, please contact [email protected]. Federalism and the Financing of Health Care in Canada and Switzerland: Lessons for Health Care Reform in the United States Paul J Donahue" I. INTRODUCTION Among the myriad of variables which health care reform in the United States must address is how reform should, at the level of the theoretical ideal, and must, at the level of pragmatic politics, take into account the federal organization of the government. As the research which underlies this article has again reminded the author, the Ameri­ can situation is unique. The lessons foreign models teach may not be relevant to the United States, and if relevant, may not be easy to apply.
    [Show full text]
  • What Are the Billing Procedures Under Medicare?
    What are the billing procedures under medicare? PATRICIA TESKEY Medical care legislation, coming specifically to the difference be- ernment about how much the pa- under provincial jurisdiction in tween what the government plan al- tient was billed directly for the serv- Canada, varies from province to lowed and the individual practi- ice so plan officials have complete province. Physicians planning to re- tioner chose to charge for a given information as to what insured res- locate in another province, there- service'. But Bill 16 also terminated idents are actually paying for med- fore, face the challenge of inter- this "balance billing" provision. ical care. preting that province's medical care The law states that in areas of Any physician-patient disputes system, the benefits allowed for the province where laboratory, ra- over the amount charged are ar- services and the individual physi- diologic or qlectrodiagnostic facil- bitrated by an assessment commit- cian's options for billing patients. ities don't receive a license, the pa- tee set up by legislation and admin- Of course, the provincial medical tient pays for the service directly istered by the College of Physicians associations or societies as well as and can't recoup the money from and Surgeons of Alberta. individual colleagues will offer ex- the plan; however, when it comes cellent advice when it comes time to to practical application, there are Saskatchewan choose whether to be "opted in" hardly any unlicensed facilities in Government body: Medical Care (participating) or "opted out" (non- the province. Insurance Commission (MCIC) participating); but to make the ini- Legislation: Medical Care Insurance tial research easier for the physician Alberta Act on the move, we have put together a Government Saskatchewan physicians don't face province-by-province summary of body: Alberta Health an ".all in" or "all out" choice.
    [Show full text]
  • Price Setting and Price Regulation in Health Care Lessons for Advancing Universal Health Coverage
    Price setting and price regulation in health care Lessons for advancing Universal Health Coverage Sarah L Barber, Luca Lorenzoni and Paul Ong Price setting and price regulation in health care ii Price setting and price regulation in health care Price setting and price regulation in health care Lessons for advancing Universal Health Coverage Sarah L Barber, Luca Lorenzoni and Paul Ong Price setting and price regulation in health care: lessons for advancing Universal Health Coverage Sarah L Barber, Luca Lorenzoni, Paul Ong ISBN 978-92-4-151592-4 (WHO) WHO/WKC-OECD/K18014 © World Health Organization and the Organisation for Economic Co-operation and Development, 2019 Some rights reserved. This work is available under the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 IGO licence (CC BY-NC-SA 3.0 IGO; https://creativecommons.org/licenses/by-nc-sa/3.0/igo). Under the terms of this licence, you may copy, redistribute and adapt the work for non-commercial purposes, provided the work is appropriately cited, as indicated below. In any use of this work, there should be no suggestion that the World Health Organization (WHO) and the Organisation for Economic Co-operation and Development (OECD) endorse any specific organization, products or services. The use of the WHO or OECD logo is not permitted. If you create a translation of this work, you should add the following disclaimer along with the suggested citation: “This translation was not created by the World Health Organization (WHO) and the Organisation for Economic Co-operation and Development (OECD). WHO and OECD are not responsible for the content or accuracy of this translation.
    [Show full text]
  • Physician Fee Levels: Medicare Versus Canada
    Physician Fee Levels: Medicare Versus Canada W. Pete Welch, Ph.D., Steven J. Katz, M.D., Stephen Zuckerman, Ph.D. Adjusted for differences in purchasing fee levels and how they are adjusted over power and practice expenses, Canadian time that is likely to be the single most Im­ physician fees are, on average, 59 percent portant issue faced under the Medicare of Medicare fees. The general perception fee schedule. that Medicare fees are low is the result of Thus far, assessment of the appropri­ comparison with U.S. private fees, not to ateness of Medicare payment rates has the much lower Canadian fees. In the con­ been confined to comparisons with rates text of the current U.S. health care sys· paid by private insurers in the United tem, lowering Medicare fees to Canadian States (Physician Payment Review Com­ levels could jeopardize access to care by mission, 1992c). Because private rates are Medicare beneficiaries. However, if all higher, the comparison raises concerns payers used the same fee schedule, fees that the elderly's access to care could be that differed substantially from those cur· impaired if physicians prefer to treat pa­ rently used by private insurers might be tients covered by private insurance rather viable. than Medicare enrollees. The experience of the Medicaid program, whose rates are INTRODUCTION substantially lower than private insurance The new Medicare fee schedule, a ma­ rates, is an example of how low physician jor reform of physician payment in the fees can restrict access to care within the United States, has accomplished two U.S.
    [Show full text]
  • Perspectives and Lessons from the Canadian Healthcare System
    Perspectives and Lessons from the Canadian Healthcare System Gautam Gowrisankaran University of Arizona, HEC Montr´eal,and NBER October 22, 2020 International Health Systems Conference Gilbert Center, University of California, Berkeley Thanks to Sebastian Fleitas, Josh Gottlieb, Kelli Marquardt, and Erin Strumpf for helpful discussions. Gowrisankaran Canadian Healthcare System October 22, 2020 1 / 12 Why should we care about the Canadian healthcare system? Canada is the closest country to the U.S. in many ways But, our history of health insurance has diverged In 1966, the minority Liberal Pearson government passed the Medical Care Act, with support from the New Democratic (Labor) Party This led to the creation of a series of provincial / territorial health authorities Since that time, the Canadian healthcare system has been largely single payer Canadian market cannot be thought of in isolation Many spillovers to larger U.S. market, such as with physician labor supply, drug prices, etc. During the years since this time, U.S. health spending has exploded And, Canadian life expectancy has increased! Health Spending Trends Gowrisankaran Canadian Healthcare System October 22, 2020 2 / 12 How does Canadian system work? Each of the 13 provinces / territories has its own system Biggest are Ontario Health Insurance Plan and R´egiede l'assurance maladie du Qu´ebec Canada Health Act of 1984 codifies requirements such as no balance billing But, services such as dental care, eye care, drugs, out-of-country care are not covered Employer-based private
    [Show full text]