Replies to This Discussion

Permalink Reply by JamieN on August 16, 2010 at 6:44pm

Hi Juan, I live in Ontario and got my most recent pump through the ADP (Assistive Devices Program) in Ontario through OHIP (Ontario Health Insurance Plan). There's some paperwork involved of course, which needs to be signed by your endocrinologist and diabetes educator (probably both need to be registered in Ontario). But from beginning to end, the process took perhaps about a month or so to happen.

Permalink Reply by Juan Suarez on August 16, 2010 at 9:14pm

Thank you Jamie for your time and info.

Permalink Reply by JamieN on August 17, 2010 at 6:10am

I probably should have shared more about how it works in Ontario. OHIP does also pay for supplies, and will send a cheque every 3 months ($600). You only need to keep receipts should they ask for them. They will cover a new pump every 5 years, although I'm not sure what happens if the pump breaks after 4 years which is the warranty period for the pumps (hopefully not though!), but that will probably work out over time. You would need 3 month residency in Ontario before you could qualify for OHIP, but once you have OHIP your wife would be eligible for the program. Of course there is a ministry form to be filled out by an endo and a diabetes educator. Unfortunately due to doctor availability (or lack of availability in some areas) it can take a while to get in to see an endo, but perhaps with a referral from her endo in Quebec, depending on where you might live in Ontario, should you choose to move. If you have private coverage (ie, through work), they still cover pumps and supplies, but as the plans get reviewed, we may find that it gets dropped out for Ontario residents because of the provincial coverage, but so far, that generally hasn't happened.

Permalink Reply by Jeleis Nolan on August 16, 2010 at 8:08pm

Hello Juan,
I live in Alberta but our health care coverage is amazing!!!! Like the best I have ever heard of. It is thru Pacific Blue Cross because our head office is in BC. We have to send our receipts in but ALL prescriptions are 100% covered and when my 4 year old is ready for a pump it is FULLY covered.I have called the company liek 3 times to triple check and it sounds great. We are so impressed with everything from this coverage. I don't know if maybe theres an Atlantic Blue Cross that would be similiar? We don't have to pay anything for our coverage but if it came down to it I would absolutely pay for the coverage I have now for my children.Might be worth looking into. The phone number on my forms to talk to someone is 1-888-873-9200. It does have addresses for each province and the one for Quebec is 550 Sherbrooke West PO Bos 3300 Postal Station B Montreal, Quebec H3B 4 Y5. It does say on the claim form "NATIONAL CLAIM FORM" not sure what that means. Maybe call them and tell them about mine and see what you can get. Hope this is helpful and maybe you can get your wife a great new pump and she won't have to do injections anymore. Wish you all the luck in the world and seriously it IS worth it if you can get something comparable. That number I believe is for all of Blue Cross. If you would like additional personal info that would help when talking to the represntative just msg me and I will be happy. Just don't wanna broadcast it across Canada:) Keep me updated, There is Blue Cross addresses in every single province but I just gave you the Quebec one since that is where you are living. Take care. Hope you wife is doing well.

Permalink Reply by Juan Suarez on August 16, 2010 at 9:18pm

Jeleis, thank you, but as I see this is for a "private health insurance", but of course i am going to call them to know about it, and i will be in contact to see what is going on.

thank you again.

Permalink Reply by Melissa (son Payton) on August 17, 2010 at 8:13am

I live in Edmonton Alberta and I have group insurance through my husbands work for my 4 year old which pays 80% BUT I have also individual Alberta Blue Cross Plan #C (which is one down from the best). They mailed me the contract in writing showing that for my individual (non-group) coverage, I am only covered for prescription items like insulin and only 80%. They do not cover any of the pump.

Jeleis, are you with group insurance with Blue Cross? If so, Juan may need to get a Job that has group Blue Cross insurance to get this kind of coverage.

My friend who is with the group plan with Alberta Blue Cross however gets 100% coverage with them. They don't have to pay for infusion sets, strips, nothing. She works with the Hospitals here in Edmonton.

All in all, individual plans seem to be incompariable to group plans no matter who you work for. Then also, group plans with the same insurance company differ depending on what coverage the employer wants to pay for.

Your best bet Juan is to get provincial coverage. Check out Newfoundland too, I heard a rumor but who knows.

Permalink Reply by nel on August 16, 2010 at 8:23pm

Hello Juan ,

This website is maintained by Barb Marche , our TuD friend ; obviously we all need to get involved in this kind advocacy to make it work for all Canadians , who do not have Extended Health Benefits through their Employer .
A bit of reading , however it will tell you clearly which Provinces through their Pharmacare program are /are not paying for pumps for Adults....Yukon and Ontario the only ones ?

http://www.diabetesadvocacy.com/pump_coverage.htm

Maybe Barb will get to read your posting and respond soon too .
Can I add a " Welcome to Canada " too ?

Permalink Reply by Juan Suarez on August 16, 2010 at 9:13pm

Thank you nel for the info form Diabetes Advocacy, its a complete information about the different kind of views from the provinces. I can see that Quebec does'´t have the best Health Benefits for this topic.

Thanks for the Welcome to Canada, and yes of course its a great opportunity to see how does the provinces are made.

Thanks again for the info.

Permalink Reply by JamieN on August 17, 2010 at 7:22am

Thanks nel, that's good info. I don't mean to change the subject, but this does touch on an important point - diabetes advocacy which I belive is so important, and appreciate people like Barb who make a difference and bring information to all of us. I've also seen this for those with disabilities as well as my husband is blind, so have had an opportunity to see it from another perspective as well.

It's really too bad that there's such a wide gap between the haves and have nots in Canada, and that programs are clearly not available across the board for everyone. It is apparent that for most of us, it is an accident of where you are born or where you have chosen to make your home. It is a shame that if you choose to live somewhere that you might not get the treatment options, and it's not always obvious until you really need it. Before my diabetes diagnosis and meeting my husband, I would have believed that we were all equal, but now, not so much. Having said that, I am optimistic that we can all make a difference if we just make enough noise as a community.

Permalink Reply by Kelly on August 17, 2010 at 8:45am

Hi Juan,

Let me start by saying I'm so happy to meet a diabetic hubby! I think it's awesome that you're interested in learning more about how to support your wife.

I work for a HR consulting firm, so I see a lot of plans and I work with the people who design/negotiate them.

It is very common for employer-paid plans to pay some or all the amount of pump and supplies for children. It's uncommon for these plans to pay for insulin pumps and supplies for adults.

Payton is correct -- coverage is not dependent on which insurance company you're covered under (e.g., Blue Cross or Manulife) because all insurance companies offer different levels of coverage. It's your employer who determines what is in and what is out. Many companies have "flex" benefits programs where you can elect the level of coverage you want, too. I don't know much about plans for individuals.

Many companies offer a "Health Spending Account" where you can use pre-tax dollars to pay for health and dental expenses not covered under the plan. If you have one, take advantage of it and speak to your HR department about how you could use them to pay for the pump.

As well, you can write off your medical expenses on your taxes. I wrote about this before. See below for the link.

http://www.tudiabetes.org/group/canada/forum/topics/save-money-on-m...

And I agree with others -- advocacy is very important!

Permalink Reply by Barb Wagstaff on August 17, 2010 at 10:27am

Thanks for the mention folks!
You are all so right...the disparity between provinces is riddiculous!
Loud voices are the answer but sadly I have seen some provinces that have been very proactive and still nothing.
Juan, there are some people in Quebec that are working to try to change the policy in Quebec. It is often a slow process...children, young adults and then hopefully everyone.
Another option to consider is that many pump companies will offer payment plans and you can shop around for supplies.

We will not stop until ALL people who want insulin pumps in Canada are able to get them without worrying about cost!

Barb

Permalink Reply by nel on August 17, 2010 at 12:11pm

And as Barb knows , my continued involvement with the Canadian Diabetes Association ...not only for pumps , also for medications as related to all types of diabetes .More work ahead and will not stop yet.....we need to be heard and be seen ...almost 3 million PWD here in Canada .