Canadians who had OHIP pay out of country surgery

Discuss here about Medical Disability claims and Insurance possibilities for PN treatment options
Post Reply
PaulSa
Posts: 117
Joined: Sat Apr 02, 2011 8:51 pm
Location: Toronto

Canadians who had OHIP pay out of country surgery

Post by PaulSa »

Can anyone of the Canadians who have gone through this process please share how it works? I know that I need to have the OHIP form filled by my Dr and sent in but I'm confused to how money is exchanged to the out of country Dr.? Also, will they cover consults or just the surgery? TIA
Pelvis Stressly
Posts: 297
Joined: Fri Sep 17, 2010 3:56 pm
Location: Toronto

Re: Canadians who had OHIP pay out of country surgery

Post by Pelvis Stressly »

Paul, when I went down to see Antolak (not for surgery, but for a consultation & testing), OHIP told me to just mention my case # if anyone down there asked me for payment for anything. That said, I'm not sure if they paid for everything beforehand or after (I'm assuming the former, 'cuz I'd be surprised if any doc would work 'on spec').

And I'm still working on convincing them to pay for my surgery w. Dellon, but they already agreed to at least cover the consultation w. him, so they're clearly willing to pay for more than just the surgery (if anything, it's harder to get them to agree to cover the surgery, as it's a lot more expensive than just a consultation).

How'd your appeal for the Potter trip go?
Lernica
Posts: 960
Joined: Fri Jan 14, 2011 10:31 pm

Re: Canadians who had OHIP pay out of country surgery

Post by Lernica »

Pelvis Stressly wrote:

How'd your appeal for the Potter trip go?
Yes, do tell! I'm considering making a trip to Potter myself . . .
Athlete until pain started in 2001. Diagnosed with PN in Nov. 2010. Probable cause: 3 difficult labors, 5 pelvic surgeries for endometriosis, and undiagnosed hip injuries. 60% better after 3 rounds of shockwave therapy in Cornwall, Ontario (Dec - Feb/12). 99% better after bilateral hip scopes for FAI and labral tears (April and July/12). Pelvic pain life coach Lorraine Faendrich helped me overcome the mind/body connection to chronic pain: http://www.radiantlifedesign.com
PaulSa
Posts: 117
Joined: Sat Apr 02, 2011 8:51 pm
Location: Toronto

Re: Canadians who had OHIP pay out of country surgery

Post by PaulSa »

Pelvis Stressly wrote:Paul, when I went down to see Antolak (not for surgery, but for a consultation & testing), OHIP told me to just mention my case # if anyone down there asked me for payment for anything. That said, I'm not sure if they paid for everything beforehand or after (I'm assuming the former, 'cuz I'd be surprised if any doc would work 'on spec').

And I'm still working on convincing them to pay for my surgery w. Dellon, but they already agreed to at least cover the consultation w. him, so they're clearly willing to pay for more than just the surgery (if anything, it's harder to get them to agree to cover the surgery, as it's a lot more expensive than just a consultation).

How'd your appeal for the Potter trip go?

Thanks for the info!

As for the appeal, I'm at the 3rd and final stage which is an independent review board. It's such a joke, I mean the money they are going to spend to to put this panel of Dr.'s together and whoever else (Oh wait, the tax payers will cover the tab....) they could have just given me my money....

So how much convincing do they need? No one does this surgery in Canada and you have a director of neurology signature on the OHIP form?
Pelvis Stressly
Posts: 297
Joined: Fri Sep 17, 2010 3:56 pm
Location: Toronto

Re: Canadians who had OHIP pay out of country surgery

Post by Pelvis Stressly »

PaulSa wrote:It's such a joke, I mean the money they are going to spend to to put this panel of Dr.'s together and whoever else (Oh wait, the tax payers will cover the tab....) they could have just given me my money....
That's crazy, but unfortunately I'm not at all surprised at this point! Anyway, good luck w. it!
PaulSa wrote:So how much convincing do they need? No one does this surgery in Canada and you have a director of neurology signature on the OHIP form?
I don't blame OHIP for this one. Dr. Gordon was just too vague in what specifically he was asking them to pay for in the initial application. So they naturally picked the cheapest option (hey, at least they didn't say no outright!) and replied that they'd cover an initial consultation & nothing more.

When I phoned them to explain that I'd also need testing done and also potentially surgery (if Dellon gives it the green light), they said to just get Gordon to fax them in a letter requesting all of that. After two months(!!!) of trying to get Gordon to do that, I got fed up & wrote the damn thing myself (& just got him to sign off on it)...that was finally faxed in last week, so just need to wait for OHIP's decision now.

I'm happy for our universal health care up here, don't get me wrong, but there are clearly flaws in the system, to say the least!!
Post Reply

Return to “INSURANCE & DISABILITY ISSUES”