GHIP Reimbursement

Spring 2007 CSANews Issue 62  |   Posted date : Jun 06, 2007.Back to list

Bird talk - Le Jaseur
Dear Bird Talk,

I know you have received many letters regarding out-of-country medical expenses submitted to OHIP, but I thought your readers might be interested in my experience.

On June1, 2005, I underwent coronary bypass surgery. When applying for out-of-country medical coverage for the following winter I took out a policy with Medipac with a $5,000 deductible, in order to keep the premium as low as possible. My thinking was that my only medical concern would be my heart.

Unfortunately, on January 1, 2006, I developed fairly severe dizziness. As a physician I was fairly sure it was my inner ear, but I contacted Medipac and was advised to seek medical care at the local hospital, which I did. My total bill for visiting the Emergency Department came to just under $5,000 U.S. (including a CT Scan which cost $2,000 U.S.), for which I was responsible. Medipac submitted my claim to OHIP and I received payment of $317.18 CAD to cover my total expenses. I contacted Medipac on several occasions to appeal this payment and was told that this was the total that OHIP was prepared to pay.

In frustration I contacted my local MPP and the Honorable George Smitherman, Ontario Minister of Health, and was informed that for out-of-country emergency out-patient hospital services OHIP paid a maximum of $50 a day, regardless of what medical procedures are followed. Physician services are paid at the rates listed in the Ontario Schedule of Benefits.

I was given the option of appealing to a review board, within 15 days of receipt of the letter, which I received in December 2006. By this time I was back in Florida for this winter.


I decided (a) I could not do this within 15 days, and (b) it would be an exercise in frustration.

I think this arbitrary decision on the part of OHIP is very unfair. Once you enter the Emergency Department of any hospital, including those in Canada, you are at the mercy of the Emergency physician. I know that in my case he did not exceed normal and standard medical care. I also know that there are many abuses to the system, but this was not one of them.

The Canadian Snowbird Association is in communication with all provincial Ministers of Health regarding their failure to abide by the Canada Health Act. I wish that the process, which has been going on for many years, could be speeded up so that other snowbirds do not have to undergo my experience.

Yours sincerely,
Adam M. Wilkie M.D.

Response:
An exercise in frustration indeed! $50.00 CAD per day is an insult to our intelligence. I find it hard to believe that any of the “incidental” values attributed to our provincial medical services are actually listed in a “Schedule of Benefits” but they are! Please read the letter from the Federal Minister of Health, Hon. Tony Clement in our CSA Update. Minister Clement is putting the Provincial Health Ministers on notice and we are optimistic that we will gain some serious ground on this issue – soon! Our next stop will be the Attorney General’s office as most provinces are breaking the law!

We’re glad you recovered from your illness, and even happier that you were able to return to your winter hotspot.

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