Referring a Patient for Medical Services Outside of Canada

»  Obtaining Pre-Approval
»  Urgent Requests
»  Approval for Immediate Care After Regular Hours

Obtaining Pre-Approval

If you refer a patient for medical care outside Canada, prior authorization from MSP is required for payment of claims for services rendered outside the country.

To obtain pre-approval for payment of out of country services, the attending medical specialist must submit either a written request or an Application for Approval of Insured Out of Country Medical Services, providing detailed information about the medical necessity for the referral and what options available within B.C. and Canada have been investigated.

The decision to approve MSP payment for out of country medical services is based on the following criteria:

• the service would be a benefit if performed in B.C.
• the service is being provided by a licensed physician or oral surgeon
• the service is medically required
• the service needs to be performed outside Canada because appropriate, acceptable treatment of the patient's medical condition is not available in Canada, or a delay in accessing treatment would have medically significant consequences for the patient
• the service is generally accepted by the medical profession in B.C. to be a non-controversial and worthwhile treatment for the patient's medical condition
• the service is provided in an accredited acute care general hospital.

• Approvals for payment do not include financial assistance toward travel or accommodation, services provided by non-physician practitioners or take-home drugs. Patients should be aware that the cost of hospitalization and physician fees can be much higher outside Canada and a substantial portion of these costs remain the responsibility of the patient.
• Benefits for outpatient dialysis provided in a hospital or other approved facility and day-care surgical services are paid at a set rate. For the rate currently in effect, contact Out of Country Claims.
• Extended health benefits or travel insurance through private insurers do not normally pay for pre-planned medical/hospital care outside of the province. Patients should be advised to confirm the terms of their additional coverage when making arrangements for out of country medical care.
• Usually it takes seven working days to process an application for out of country coverage. It is recognized that an urgent situation may arise that cannot wait seven days.

Urgent Requests

Urgent requests can be faxed to the Administrator of Out of Country Claims at 250 405-3588.

Please ensure that the urgency for immediate attention is clearly indicated so MSP can take appropriate action when a decision is made. These requests can usually be processed in less than two working days if detailed information is provided. Be sure to include the telephone or fax number where you can be contacted when a decision is made.

You should not confirm arrangements for your patient to obtain services outside Canada until you have received a response to your request for pre-authorization.

Approval for Immediate Care After Regular Hours

In the rare event that your patient requires immediate life saving care or immediate care to avoid medically significant irreversible tissue damage and:

1. the required medical care cannot be provided in B.C. or Canada
2. pre-authorization is not possible because it is outside regular office hours (8:00 to 4:30, Monday to Friday)

• the emergency care is not experimental
• the care is provided by a licensed physician in an accredited acute care general hospital; and
• the emergency care is likely to be of a potential benefit to your patient.

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Last Revised: June 27, 2008