Many Canadians file insurance claims with their medical insurance (whether be through group benefits or personal health insurance) in order to be financially covered for specific medical needs. Such needs include treatment from specialized practitioners and doctors (physiotherapists, dentists etc.), medical devices (custom braces, orthotics, etc.), prescription drugs, and coverage for when one leaves the country and travels. Some individuals find themselves in dire situations where they need certain medical coverage in order to be financially capable and survive their prognosis. Medical bills can add up quickly, especially when you need acute or chronic care; having the safety net of medical insurance provides many individuals a peace of mind. However, thousands feel defeated and often are unaware how many medical insurance claims are wrongfully denied in an unjust manner.
When you have received a denied medical insurance claim for a substantial amount, and are in need of financial support after sustaining a major injury or illness, contact a medical insurance lawyer as soon as possible. Your medical insurance claim could be mishandled by your insurance provider and the benefits you are entitled to may be illegally withheld by your insurer. As someone who is dealing with a health crisis, the last thing you need to deal with is the stress of financial loss and hardship. By contacting a medical insurance lawyer, you can gain a peace of mind and have access to the benefits you seek, sooner rather than later.
Medical Insurance Overview
Medical insurance is a type of insurance coverage that is offered to cover costs of an insured individual’s medical and surgical expenses (either within the area and country they live in, or abroad). The “insured” in this case would be the individual owner of the medical insurance policy (health insurance), or the person with the medical coverage (such as through group benefits from an employer, or as a beneficiary on a family member’s medical insurance plan). Depending on the medical insurance policy, the individuals either pays for expenses out of pocket and is reimbursed by the medical insurance company, or the insurer makes a direct payment to the medical provider (such as the hospital, doctor, or pharmacy).
Canadian Health Care
Canada is a country that has what is called “universal health care coverage”, unlike the United states, which often has citizens receive medical insurance through employer benefit packages. If you are a Canadian citizen or have permanent residency in Canada, you can apply for public health insurance (medical insurance). Each province and territory has their own health insurance plans, such as OHIP in Ontario. All provinces and territories provide full coverage for emergency medical services, which encourages citizens to seek emergency medical attention immediately, when needed. Some provinces and territories differ on what other medical services are covered.
While the “universal health care coverage” in Canada covers emergency medical needs and basic medical services (such as a visit to your family doctor), they do not cover all medical services you may be required to seek in order to manage your injury or illness. It is in these cases that one often seeks medical insurance that offers extended health plans for coverage of:
- prescription medication
- practitioner care (ex. physiotherapy, occupational therapy, etc.)
- dental care
- ambulance services
- prescription glasses
- medical devices
Travel Medical Insurance
It is important to note that travel medical insurance is assumed for “unforeseen, unexpected” accidents or illness that need emergency care when traveling abroad. Some pre-existing conditions may not be covered when traveling abroad, because the insurance company may assume that you were unfit to travel or are seeking medical coverage you would not be eligible for in your own country of residency. It is important that when you travel, you are in a stable condition with any pre-existing medical conditions you may have prior to travel. Having received a new prescription, undergone new treatment, or recent surgery, does not put you in a “stable” conditions, according to most travel medical insurance companies. It is important to note that this rule applies to pregnant women traveling, for some insurance companies may consider being pregnant as a preexisting condition.
It is also important to note that if you have engaged in any illegal activities, or overindulged in alcohol and somehow injure yourself, you may not receive travel medical insurance coverage. In this case, your behavior may have been seen as reckless and self-induced.
Contacting a Toronto Disability Lawyer
If you are incurring mounting costs that you believe should be covered by your medical insurance policy, if you have filed a medical insurance claim that has been wrongfully denied, contacting a medical insurance lawyer can get you the financial support and access to benefits that are rightfully owed. Insurance companies save millions of dollars a year by wrongfully denying medical insurance claims that are not pursued further by policy holders. If you have received a denied medical insurance claim, do not feel defeated or think that your pursuit for coverage ends here. A medical insurance lawyer can help assume all communication with your insurance company and pursuit your benefits on your behalf. When you are dealing with an injury or illness, your priority should be to focus on treating and healing your condition. A medical insurance lawyer has to proper knowledge of insurance laws, disability claims (long-term disability and short term disability), as well as personal-injury law for when you fall ill or are injured due to a 3rd party’s negligence.
Contact us today, TSF Law offers free consultations in person or over the phone; we are always there for you and provide some of the top legal services for medical insurance.
