Ali's Adventures

October 3, 2012

Backyard injuries and health insurance surprises

Filed under: Kids,Learning,Move — by Alison @ 12:12 pm

One of the big things we knew would be different when we moved to the USA was the health care system. My husband has a good job with a very large company, and the health insurance plan seems comprehensive. It was a bit confusing having to pick a plan, seeing as how our previous options only focused on the type of hospital room we wanted. Although we have good coverage, my main health plan was to not need to visit a doctor ever while living here.

Unfortunately, the kids didn’t fully get on board with that plan. At the end of August, E hurt her foot playing around in our backyard. I took her to an urgent care clinic and then a few days later to the Children’s Hospital, which should have been our first stop. The Children’s Hospital was great, there was free parking and it’s bright and airy.

We’ve been getting the bills from the insurance company, all has been covered. I think the total cost for the foot injury has been around $2000. And it wasn’t even broken. It’s been interesting seeing these invoices, and getting a copy of the hospital report.

It’s made me appreciate our Canadian health system. We’ve never had a serious illness in Canada, and I understand that the wait times for specialists is very long, but at least there’s never a concern about paying for anything. We’re getting close to the cap of our health care spending allowance, and without our carry-over from last year another injury could result in us having to pay out of pocket.

But the best and most concerning insurance letter arrived yesterday. As E’s injury was a result of an accident, the insurance company has asked for further details so that they can determine if “another party” caused the injury and if they “may be responsible for the cost of your medical care”.

This is a side of private health insurance that I had never considered. Insurance companies want to make sure that they don’t pay if they don’t have to. I wonder if health insurance premiums increase the more claims you make, like car insurance. I’m hoping we don’t have to find out.

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2 Comments »

  1. I’m glad her foot is okay! And doubly (or more) glad that we have the healthy care we do

    Comment by Sara — October 4, 2012 @ 9:21 pm |Reply

  2. Your premiums on a group plan are generally locked in much the same as here in Canada. They may not cover pre-existing conditions though. People who pay for health insurance out of pocket can see premiums increase based on claims.

    Comment by Karen — October 4, 2012 @ 11:36 pm |Reply


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