Couple sees red over OHIP | Toronto & GTA | News | Toronto Sun

A government run single payer system must by nature ration care, since they are unable ot correctly manage the system. When politicians attempt to develop systems using tax dollars to gift back benefits to those who paid taxes for votes.

Couple sees red over OHIP | Toronto & GTA | News | Toronto Sun.

Couple sees red over OHIP

By ,Toronto Sun

First posted: | Updated:

 

TORONTO – Never in Bobby Taylor’s rough-and-tumble football career did he endure anything as tough as watching his wife go through cancer treatment.

Nor did he go through anything as hard as paying for it — all $600,000 of it, and counting.

That’s how much Taylor, a 70-year-old Toronto bar owner and former Canadian Football League receiver, has spent at a U.S. cancer centre since his common-law spouse, Judy Grant, was diagnosed with multiple myeloma — a rare, deadly and incurable form of blood cancer — in August of 2009.

The couple looked stateside for treatment because Grant, who at the time was rapidly getting worse, would have had to wait seven months to see a specialist in Toronto, Taylor said, adding that it was Grant’s doctor at St. Michael’s Hospital who recommended a U.S. hospital that specializes in myeloma.

“If we didn’t go, she’d be dead by now,” Taylor said from the couple’s home in the Queen St. W and Spadina Ave. area.

The financial burden has been enormous. In one way or another, all of the treatment Grant received south of the border — the testing, drugs, chemotherapy and two stem-cell transplants — fell outside OHIP’s conditions for covering out-of-country care, making her another example of how increasingly difficult it has become for Ontarians to get coverage for procedures done outside Canada’s borders.

Now, Grant isn’t even being covered for the expensive drugs she has had to take since her return home to Toronto last December — one being a weekly injection of Velcade, a “maintenance” drug costing more than $1,800 a shot.

She doesn’t qualify for coverage because she has fallen into the gap between having multiple myeloma and suffering a relapse — the two conditions under which she would qualify for having the drug covered by OHIP, a spokesman for the provincial health ministry said.

The couple have all but given up the fight for any reimbursement for Grant’s treatment in Arkansas, but have hired a health lawyer to help them fight for coverage of the drugs she is currently taking to keep her cancer under control.

“What we’ve learned about our health care system is…it’s not the best system in the world,” said Taylor. “It didn’t take care of us, (and) it sure didn’t take care of her…I pay taxes like everybody else, and I always thought that if I got sick, or Judy got sick, OHIP would take care of us.”

After Grant was diagnosed, her doctor recommended the Myeloma Institute for Research and Therapy in Little Rock.

Grant left for Arkansas, and Taylor began sending tens of thousands of dollars to the clinic for her tests and chemotherapy.

Then came two stem cell transplants averaging around $260,000 each. Grant’s stem cells were harvested, treated and then infused back into her.

A second transplant months later would be done to destroy any cancer the first transplant may have missed.

Taylor and Grant were out of luck in being reimbursed for the first transplant, unaware — and never told, they say — that they had to apply for OHIP coverage before any out-of-country treatment commenced.

They won’t see any cash for the second transplant either, Taylor said because it was deemed “experimental” and, therefore, not eligible.

But it’s OHIP’s denial of coverage for Grant’s current drug treatment that angers Taylor the most, and he advises Ontarians to buy private health insurance to avoid a similar situation.

“I thought that once we did the two transplants, we’d get home and…OHIP would at least pay for her maintenance,” he said, referring to it as “two-tier” health care.

While Taylor is far from poor — after retiring from football in 1974 with the Toronto Argonauts, he became a successful bar owner, and currently owns the Black Bull on Queen St. W. — Grant’s medical bills have meant considerable sacrifice.

Taylor sold one of two taverns he owned to help pay for Grant’s medical bills, leaving him with just the Black Bull. The couple also mortgaged their cottage and had to open a mammoth line of credit.

“I trusted (the health care) system,” Grant said. “I’ve never been sick, I’ve never (misused) the system…And now I’ve needed them, and they weren’t there for me.”

Ontario first began tightening conditions for out-of-country care in the 1990s as a way of both combating the crushing recession at the time and to shore up budget shortfalls. Since then, medical services considered experimental or research-based are ineligible, and treatments sought elsewhere must be unavailable in Ontario — or available but with a wait time long enough to put the patient’s life at risk.

Also, approval from OHIP must be granted before any out-of-country services are performed.

And as of last April, only specialists can apply for out-of-country care on behalf of a patient, whereas before, a family doctor could do it. It’s an amendment that critics say puts patients with time-sensitive ailments — such as Grant’s cancer — at risk.

One critic says OHIP’s conditions for out-of-country coverage have become too stringent.

“(The latest change to the claim rules) makes it virtually impossible for an appeal to be granted,” health lawyer Perry Brodkin told a QMI Agency reporter last week, adding that the agency has abandoned its sense of public service and instead operates similar to a private insurer.

14 responses

And people have told me ‘Be grateful you’re in Canada instead of the US where you’d have to sell your house if you get cancer or break an arm’. It’s not that they’re stupid but they’ve been brainwashed by so many people – such as Michael Moore.

Indeed!
Such stories are repeated all too often Ralph – of OHIP denying funding for life saving treatment that has to be received out of the country. And very often, within Ontario. So much for our moral superiority.

What’s your ideal form of medical insurance?

I like critical illness insurance, and accident insurance coupled with a high deductible refund health plan that utilized a health savings account, a health disbursement arrangement, and a health escrow account.

There’s no one answer. Depends on where you live, your height, weight, health, objective, needs, finances etc. It’s like asking what is the best mode of transportation, to which the answer coudl be feet, bike, boat, care, airplane, train etc

Why is it getting so difficult to find true Critical Illness Medical Insurance in the market? And what do you think of the contention of ‘access based on need’ in the Canadian system? I think it’s a moot claim.

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