Cross-Border Medical Care, Holiday Edition
December 13, 2018 7:24 PM   Subscribe

Dual Canadian-U.S. citizen paying for Medicare needs crucial medical tests but also wants to spend the holidays in the U.S.. What is the possibility of them getting those tests done here? Snowflakes inside.

My senior mother has chronic health issues that have only become more complicated over the past year. A recent ultrasound revealed a mass that, from what I surmise from our conversations, is possibly a tumor. Radiologist says the next steps are a CT and bone scan. Doctors have put in a requisition for these tests, but both Toronto hospitals where they've put in the requests have dragged their heels on scheduling. Which seems insane, considering this might be a tumor.

Here's the complicating factor: she lives in Canada; I live in the U.S., and she wants to spend the holidays with me. But I want, most of all, for her to get the care she needs--as quickly as possible. I've had lots of luck getting scans quickly where I live, and my mom pays into there any way her Canadian doctors can requisition a test here? Would she end up having to pay out-of-pocket for this? I don't know how her Medicare works; she's never had to use it, seeing as she lives in Canada.

Ideally I'd like her to get her tests done in Toronto as quickly as possible so she can still be with us here and she'll get at least some peace of mind, but things are starting to look like she'll either have to miss coming down here for the holidays or these hospitals won't even bother getting her scheduled until sometime in January, which seems like an unacceptably long wait time to me.

Any insight into how to handle this issue--or past experiences with this sort of cross-border dual-citizen medical situation--welcome.
posted by Miss T.Horn to Health & Fitness (6 answers total) 1 user marked this as a favorite
A few resources for Medicare questions are listed on the MeFi Wiki ThereIsHelp page, including:
Medicare Rights offers a National Helpline at 1-800-333-4114 to answer questions from people with Medicare, their family members and friends.
posted by Little Dawn at 7:48 PM on December 13, 2018

I don't know anything about the US side, but in Toronto the best way to get a fast CT scan is to say you're available any time. That is ANY time. The CT machines run 24 hours and the person willing to come in for 10pm or midnight or whatever appointment can usually get one quickly. My mom regularly gets scans scheduled within a week for non-urgent issues.
posted by If only I had a penguin... at 8:24 PM on December 13, 2018

It seems possible that they can do the requisition, apparently that’s what Canadians crossing to Buffalo for quick MRIs have to do. (Or it was when I looked into it.)

I doubt very much the province would pay for any testing that could be done in Canada (at least without a fight down the line - have read news stories about people having to sue for payment of treatment and tests [that were paid for out-of-pocket] that *aren't* available in Canada. OHIP or the equivalent would have to approve stuff in advance, and that definitely wouldn’t happen sooner than January. And they only consider it if the test/treatment isn’t actually available here, wait times are irrelevant as far as they’re concerned, regardless of clinical impact.)

Hopefully something can be done with Medicare, otherwise I think you’d have to just carry those costs. (Would you consider medical tourism, involving a cheaper country?)
posted by cotton dress sock at 9:10 PM on December 13, 2018

Your Mom paid into Medicare, but has she signed up for it? It's not unlike the ACA enrollment process, in that there are a bunch of versions (including so called managed Medicare, which is the bastard love-child of Medicare and HMOs), and you are not automatically enrolled unless you were already getting Social Security benefits before age 65. I believe the enrollment process takes a few months, but it's possible to get emergency Medicare (I've only seen this in situations like stroke or heart attack, but maybe there are other qualifiers.) AFAIK, Medicare will only pay for services ordered by a Medicare - enrolled doctor done at a Medicare - enrolled facility. Most (all?) hospitals are enrolled in Medicare, some doctors are not. Depending on the plan, there are various % of out of pocket cost sharing.

Insurance aside, have you been able to talk to her doctors about the urgency of this? The word tumor definitely sounds scary, but there are many many tumors that are slow growing. Or if it is something urgent, the doctor might be able to get it scheduled sooner, or submit a requisition to a place with a shorter wait time.

Good luck to you and your mom.
posted by basalganglia at 2:11 AM on December 14, 2018 [1 favorite]

If I were in your place I would spend the holidays with mum in Toronto, and make her available anytime 24/7 for a scan. Unless she has signed up for Medicare the wait would likely be longer to go the US route. Even if you had to board the dog, get a hotel, not be with other family, etc. the scan comes first. If you can’t cross into Canada (I know this is a privilege not open to everyone) I would ask her to stay in Canada and be available for the scan. This is sucky, I know - but could be life or death.
posted by Mistress at 5:19 AM on December 14, 2018

wait times are irrelevant as far as they’re concerned, regardless of clinical impact.)

This is simply not true. My uncle had prostate cancer (note this isn't one of the urgent ones) and he was offered treatment paid for by the province in the US (including travel costs, lodging, and per diem for him and a companion) because there would have been a wait in Ontario.

When I had a not-that-urgent cancer, the hospital wouldn't give me a firm surgery date until 2 weeks before hand. The same clinic deals with a much more urgent cancer and they said if they got a new case of that all the non-urgent surgeries would get rescheduled, so they didn't even bother scheduling the non-urgent too far ahead of time. Basically, if the type of cancer in question were an urgent one, they'd be dropping everything to do it or paying for it elsewhere. It's possible that as anxiety-inducing as the uncertainty may be, they're not that worried that the cancer in question is a rabbit.
posted by If only I had a penguin... at 6:32 AM on December 14, 2018

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