Out-of-Country Newborn Care

Authority Health Insurance BC
Details

While travelling abroad, Cheryl gave birth prematurely. Her newborn required approximately two months of neo-natal intensive care before the two could return to British Columbia. Once home, Cheryl submitted an out-of-country claim for the medical costs that were not covered by her private insurance. Health Insurance BC (HIBC) only refunded a fraction of her claim, and Cheryl could not determine why. She came to us.

We investigated HIBC’s calculation of Cheryl’s reimbursement: $41 each day her newborn was at hospital. The Hospital Insurance Act Regulations specify that out-of-country newborn care is paid at a maximum daily rate of $75 or at a lower rate specified by the ministry.

We asked the ministry to review Cheryl’s claim. The ministry agreed, but stood by its earlier decision that the amount paid to Cheryl was consistent with ministry policy. Next, we looked into the explanation for the reimbursement amount provided to Cheryl. The ministry agreed the information could be better, and provided Cheryl a more detailed explanation of the decision.

Cheryl’s complaint led to significant changes. As a result of our investigation, the ministry reviewed the standard reimbursement for out-of-country newborn care, as the rates had not increased for approximately 20 years. The ministry changed its policy and is now funding out-of-country newborn care at $75 a day – the maximum amount allowed by regulation.

Names in our case summaries have been changed to protect the privacy of individuals. This case study can also be found in the 2016-2017 Annual Report.

Category Health
Type Case Summary
Fiscal Year 2016
Location The Interior