Can I Get Reimbursed for Private Surgery in Canada or Abroad?

When we help our clients arrange their private surgery, this question comes up a lot. No surprises here, as we Canadians pay a lot of taxes that are supposed to pay for our medical care, but instead we wait and wait and wait. So, when someone decides to take matters into their own hands, they want to know if they will be reimbursed by their province for their private surgery.

In general, the answer is no. If you are traveling to get surgery or treatment at a private medical facility your expenses will be out of pocket and not eligible for provincial reimbursement. However, there are special cases for reimbursing costs for access to medical care in a different province or out of the country. Those are not normally the cases that we handle, as there is quite a bit of red tape and prior approvals requirements. Rules differ from province to province.

In the province of Nova Scotia, residents of Nova Scotia have to be medically referred outside of province for insured treatment. Those services must be received in an accredited public hospital and billed reciprocally in accordance with the Interprovincial Reciprocal Billing Agreements. Prior approval is required. Your Nova Scotia Health Card must be presented in order to receive out-of-province medical treatment. There is an out-of-province travel and accommodation assistance policy in place and the rules can be found here.

If someone is to travel outside of Canada, prior written approval is required from the Department of Health and Wellness. The referral must be from a specialist registered in Nova Scotia. If the claim receives prior approval from the Department of Health and Wellness for out-of-country treatment, all medically necessary services, whether provided on an in-patient or out-patient basis, will be insured at 100 per cent. This is mostly for those seeking medical treatment that is not available in Canada but is medically necessary. Preferred accommodation, take home drugs, etc., are not covered under the provincial health plan.

A recent change was added for reimbursements of travel expenses to low-income families if someone decides to travel inside the province for surgery, endoscopy or cystoscopy. This is currently a pilot program. It provides some financial help with transportation and accommodations for the patient and their companion if a companion is deemed essential for the patient. More information can be found here.

So if you are choosing to travel out of province and country to get a private surgery that is covered by your provincial healthcare plan, there are no reimbursements available, unfortunately. However, the expenses can be used in your yearly tax filings. You would need to consult with your accountant about how to do it properly to get the most benefit.

As well, many airlines offer a free return ticket for the companion of someone traveling for surgery and requiring assistance. There are certain rules of booking that need to be followed as well, and your surgeon will need to state that you are not able to travel by yourself.

If you are interested in exploring your options in private surgery we are here to help. Please call us toll free 877 344 3544 or email us at info@healthvantis.com