Tina McDonald learned the hard way that Canadians who get hurt while travelling out of their home province are not covered for emergency medical flights.
Her 15-year-old daughter Kiera was visiting family in Norman Wells, N.W.T., when she got in an ATV accident, flying into a ditch and hitting her face.
McDonald, back home in Alberta, was in touch with her sister-in-law, who was with Kiera at the local nursing station. She was soon told that a doctor in Yellowknife recommended that her daughter be medevaced to the capital.
"'Do you have insurance to pay for medevac?'" McDonald says her sister-in-law asked. "And I'm like, well I'm pretty sure I do cause I can go to the states and I can go to Mexico."
Her husband said the medevac could cost $15,000. McDonald assumed that between her employer's insurance and Alberta health care, she'd be covered. But both parents agreed, either way, get Kiera on that plane.
"We're back and forth and it got to the point where it was like, just send her," McDonald said.
"Then the nurse on speaker phone said, it doesn't look like your plan is covering you."
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45 billed in N.W.T. last year
Every year in the Northwest Territories dozens of people — from tourists, to seasonal workers, to relatives visiting family — are billed thousands for medevac trips.
Medevacs, or air ambulances, are used across the country, particularly in remote regions, to get patients in emergency situations to the nearest hospital. For people who require a medevac within their home provinces or territories, the cost is generally covered by their provincial or territorial health coverage. But if you're outside of your home province and run into trouble, you could be saddled with a massive invoice.
According to N.W.T. Health and Social Services, in 2016/2017 the territorial government billed 45 people who did not hold valid N.W.T. health cards for medevac flights. The approximate cost of an air ambulance from Yellowknife to Edmonton or Inuvik to Yellowknife is between $25,000 and $30,000.
A national issue
Dr. David Pontin, an emergency room physician at Yellowknife's Stanton Territorial Hospital, says a few times a year he has to break the news to out-of-towners that they need a medevac and it's going to cost them.
"It can be a fairly difficult conversation," Pontin says. "The reaction is pretty universally one of surprise and also shock at how expensive it is."
Anyone without a valid N.W.T. health card can be invoiced — that means tourists, workers, and even southerners who have moved to the territory and haven't obtained a health card in their new home.
But Pontin says N.W.T. residents also need to be mindful when they're travelling in Canada. He warns that if they get injured on a remote road in Newfoundland or B.C., they could wind up in the same situation.
"I think most Canadian citizens don't realize that when they travel to other jurisdictions in the country that they're on the hook for these kind of emergency costs," he says.
The CBC verified that none of the 10 provincial health care plans will reimburse residents for air ambulance costs incurred while they're in other jurisdictions.
Pontin thinks there should be a campaign to get the word out to travelling Canadians that they should consider purchasing extra travel insurance — but he admits that it's not clear who exactly is responsible.
Are tourists warned?
The executive director of NWT Tourism says this issue is "absolutely" on her radar.
The not-for-profit association is contracted by the territorial government to market the territory and represents 200 tourism operators, such as hotels, aurora tour guides, and remote fishing and hunting lodges.
"What we can do with our members is make sure they know: you need to consider your own insurance and you need to advise your guests what they need to put in place," Cathie Bolstad said.
She notes that all tourism operators are required by the territorial government to have a safety plan in place for guests. She says a couple of operators approached NWT Tourism last year looking for clarity around air ambulances, so the organization worked closely with the health department to understand the service.
"Wilderness rescue and air ambulance service can be expensive, so it is wise to purchase insurance coverage before you leave home," the NWT Tourism website reads.
With nearly 100,000 tourists visiting the territory each year, Bolstad says it's also travellers' responsibility to plan ahead.
"We want to make sure they're aware some of the places they may think about going may not have the kind of services they're used to, and that they should ensure they have insurance in place."
On its website, the Department of Health and Social Services says if people do not have a valid territorial health card or status card, and their employer does not cover medical travel expenses, "you are personally responsible to pay for any medical travel you need."
"We recommend you get private insurance that covers emergency medical travel while you are in the N.W.T."
Get out-of-province insurance, says McDonald
McDonald was ultimately told that her daughter did not need to be medevaced.
She booked Kiera on a flight to Grande Prairie, and about 26 hours after the accident, she saw a doctor and was treated for kidney trauma and lacerations.
While her daughter is OK, McDonald thinks money and insurance should not have been part of the conversation. She's filed a complaint about Kiera's treatment with the territorial health department.
"I felt that this was all about money," she said.
"Through the whole process. All they cared about was the insurance, whether or not we had coverage. It was almost like they were going to be stuck with the bill personally."
McDonald also says her daughter was not a tourist in Norman Wells. She says Kiera is part of the Deline Band and the Norman Wells Land Corporation. As a treaty member and a Canadian, McDonald thought her daughter was covered.
"I want people to know that you need to get out-of-province insurance," she said.
"I assumed that I'm in Canada and that my family would be covered when we go to Norman Wells."