Mark Graesser

In January this year, while on my annual five-month sojourn in New Zealand, I returned from a weekend backpacking trip in the mountains with severe stomach pains. When these did not improve over a couple of days, I went to a doctor. From my symptoms and the circumstances, she diagnosed a stomach bleed resulting from overuse of ibuprofen, which I had been taking to alleviate the aches and pains of my chosen recreation. She prescribed medication, which led to immediate improvement, but also advised that I should have a gastroscopy to rule out a more serious problem. She referred me to a surgeon, who would quickly perform the procedure on a private basis, in a private hospital. (New Zealand has a public system much like Canada's, but with a separate private pay-as-you-go option.)

I immediately called the number on my SSQ card to report the incident and establish a basis for a claim. An AXA agent opened a file and assigned a reference number; from previous experience I had learned that this was a critical part of the process. I also provided my email address, and all subsequent communication was conducted by that means. This was good, because of the 7-hour time zone difference, and because it meant that I had a written trail of the 30-odd message exchanges with a tax-team of AXA and SSQ agents over the ensuing five months.

I asked my New Zealand doctor to complete the standard MCP out-of-province claim form on the first visit. I have found that this is a good way to document all medical claims, since it includes the doctor's address, diagnosis and fees. She also provided a copy of her referral letter. This and all subsequent documentation I scanned and emailed to AXA. After several days I was told that the AXA “medical team” had “pre-authorized” the gastroscopy, but that the cost would not necessarily be covered by SSQ “because there is a pre-existing condition.”

What??? It turned out this was supposed to mean that they would have to determine whether or not there was a relevant pre-existing condition, “a formality.” I was asked to sign a consent form giving access to all my medical records, and to provide the “coordinates” of my family doctor in Canada.

Meanwhile, over the next 3 weeks, I proceeded with the gastroscopy and follow-up tests and consultations, all of which were reassuring. I continued to send copies of my receipts for all of this, now exceeding $2,000, but received no assurance that the costs would be covered. When I queried the apparent delay, I was told that the “pre-ex” investigation could take “weeks, or even months.” On May 1, I was finally told that I was cleared, and that I should now complete the SSQ claim form with any additional receipts. On July 5, the full amount of my claim, correctly converted from New Zealand to Canadian dollars, was deposited in my bank account.

All's well that ends well, in this case at least. From my experience, I recommend that travellers take with them copies of both the MCP and the SSQ claim forms, and to be sure that they have all of the information these require (including their family doctor's contact information). In my case, communications were greatly facilitated by the fact that I have a full office set-up in New Zealand, including a scanner, for managing all of the communications.