question about Canadian health care

[OSUMom]

With the health care in Canada, are you able to get the insulin pump quickly upon diagnosis of Type 1? We voted yesterday here in Ohio for the Presidential primary. Health care for everyone is of great concern for me with the person close to me who has been uninsured (she received a Medtronic pump yesterday by the way due to a huge fundraising campaign!!!).

I so hope this doesn't start a big division here of any kind just want to ask a simple question - if there is universal health care - is getting an insulin pump a part of diabetes management in a timely fashion? I'm curious. :confused:

No easy fixes I know that for sure, and I like choosing my doctors - I have left doctors for what I thought was incompetence.

[Emma'sDad]

In Ontario, I know that they get the pump for free at the provincial level and not federal (yet?). I heard that getting the pump there takes awhile for that reason.

For me, if we decided to get the ball rolling to get Emma on a pump today, it would be a phone call away and my insurance says that they'll pay for it. So basically, from the time we make the phone call to the day that she's actually pumping insulin is the time that it takes for training. I know everytime we see the doctor or the diabetic nurse at the hospital, the first question out of their mouths are: "Are you ready for the pump yet?"

[Emma'sDad]

But of course, they just started that program not too long ago... I assume the wait time will get better in Ontario and when it's perfected- then the other Provinces will adopt??? Please please please?? :)

[brad]

I can't comment on the speed of getting the pump, but my understanding is that it is fast. We are 48 hours away as soon as we choose a company to go with, but that's without insurance.

Currently, there are only 4 provinces in Canada which provide funding for insulin pumps: BC, Saskatchewan, Ontario, and NFLD. All have varying degrees of coverage. Alberta still does not have a plan in place but we've been lobbying hard to try to get something.

Probably the most backward program is the Saskatchewan one. Get this, they will fund an insulin pump for a child as long as the A1c is higher than 8.5(?). If your child's A1c is below 8.5 they will NOT fund the program. :eek:

So, there is an incentive to have very poor control in order to get funding.:confused:

b.

[momtojess]

Health care for everyone is of great concern for me with the person close to me who has been uninsured (she received a Medtronic pump yesterday by the way due to a huge fundraising campaign!!!).



Obviously I can comment on Canadian healthcare, but I just wanted to say YAY!!! I am so happy for got a pump. Is she still doing alright with other supplies?

[Hollyb]

We were pumping 6 months after diagnosis. It would have been sooner but the insurance company dragged its heels. Like in the US, it depends on your doctor's approval, and whether you can afford it. Some provinces, as mentioned, do cover or partly cover the cost for children. Some families have supplemental insurance through work.

And we do get to choose our doctors -- in fact are not limited to some "list" approved by our insurance companies. However, that's assuming you live in a big enough city that there is a choice. In my town there's a doctor shortage right now so no family docs are taking new patients. I think that would be the case however our health-care system worked.

[Karenwith4]

We're in Ontario and we are just starting to research pumps. Our diabetic educator told us we could be on the pump within the month if/when we decide to go that route. The delay is a combination of paperwork and scheduling the training sessions. Some diabetes health clinics have their kids on pumps within a month of diagnosis.

The pump is provided free through a provincial government program but there are certain conditions required to keep it, including regular (quarterly) visits to our diabetic team and appropriate A1C numbers. Our diabetic educator takes care of all paperwork and we need to be "recertified" each year which I think is just a formality as long as we have met the conditions. The government also supplies funding towards the supplies (I think it is $200 a month but I could be wrong) and then private health insurance can over any drug costs above the $200 per month.
hth
Karen

ETA just to clarify a misconception - in Ontario at least UHC doesn't mean you don't get a choice of doctors or that you can't leave one doctor for another if you want - for any reason. When we were diagnosed with T1 our family doctor gave us the choice of 3 pediatric diabetes clinics available to us within a reasonable drive (30 minutes - we live in a small city). We chose the one he recommended, but we have the option of moving any time we want or feel the need. I think its a common misconception that UHC means less choice in health care. In reality it often means more choice as you aren't limited by HMOs or other insurance restrictions.

[owensmom]

Probably the most backward program is the Saskatchewan one. Get this, they will fund an insulin pump for a child as long as the A1c is higher than 8.5(?). If your child's A1c is below 8.5 they will NOT fund the program. :eek:

b.

I have not heard anything to this effect. My understanding is that in Saskatchewan they will only provide the pump to children under the age of 18 to a max cost of $6,300 and the patient has to cover the cost of the supplies.

Although we never have to worry when it comes to trips to the ER, visits to the Doctor, specialists, meeting with our team, etc. as far costs. Canadians are still paying for their provincial and private insurance plans. Other than the provinces that have now include pumps under their coverage the rest of us have to hope that we have good private insurance (due to our country's conservative attitude regarding diabetes management).

Our experience was that at our 3 month visit we informed our team that we wanted to pump and due to scheduling it took a little less than 3 months to start. The pump arrived within a week of ordering, we paid 1/3 up front and insurance then reimbursed the entire cost of the pump. We are very fortunate as insurance covers the cost of all our diabetes supplies - we pay our premiums and 20% of the cost of insulin.

In response to "No easy fixes...I like choosing my doctors." - Due to our location we have the luxury of choosing doctors that will provide our family with the best possible care - I agree, incompetence is not to be tolerated.

[brad]

I have not heard anything to this effect. My understanding is that in Saskatchewan they will only provide the pump to children under the age of 18 to a max cost of $6,300 and the patient has to cover the cost of the supplies.


That's most likely true as well, my info came from the Animas rep. Could be the fine print

b.

[Emmasmommy]

When Emma started pump Ont. still did not cover the pump we fundraised and as we went after the funds for her pump we also got people to sign the petition that went on to get the Ontario government to pay for pumps. They do now give a grant of 600.00$ every 3 months to cover the running however you can then send in to your insurance company to pay the rest. HOWEVER good luck getting money out of your insurance company we have been fighting Great West for 5 months now to get some of the money back we have sent letters stating the yearly cost for supplies and the CGM that she is on and we still get the same letter back stating that we need to go to the government for the grant UGH! so yes we now have founding but now my insurance company will not even cover a part of the cost so its all out of pocket after the 600 which doesn’t last long as well all know that the cost is WAY more then 600 every 3 months.

As fair as how long it takes to get the pump Emma started pumping 1 month after dx (we got the pump on out of pocket). and my friends daughter had her pump through the government program is less then 2 weeks! Medtronic sent it out before all the paper work was done because they said that they knew she would get approved(wow good faith on them!).

[owensmom]

When Emma started pump Ont. still did not cover the pump we fundraised and as we went after the funds for her pump we also got people to sign the petition that went on to get the Ontario government to pay for pumps. They do now give a grant of 600.00$ every 3 months to cover the running however you can then send in to your insurance company to pay the rest. HOWEVER good luck getting money out of your insurance company we have been fighting Great West for 5 months now to get some of the money back we have sent letters stating the yearly cost for supplies and the CGM that she is on and we still get the same letter back stating that we need to go to the government for the grant UGH! so yes we now have founding but now my insurance company will not even cover a part of the cost so its all out of pocket after the 600 which doesn’t last long as well all know that the cost is WAY more then 600 every 3 months.



Do you have the correct DIN #s? With Great-West you have to do all of the work for them when you submit your paper claim as more often than not you'll end up with someone clueless adjudicating your claim.

[Emmasmommy]

Oh we have the right DIN number and we have the right hand written copy as well as bill of sale but they keep sending it back say " you live in Ontario where the gov. pay the grant submit the them"

It has just been a nightmare with them!

[owensmom]

Oh we have the right DIN number and we have the right hand written copy as well as bill of sale but they keep sending it back say " you live in Ontario where the gov. pay the grant submit the them"

It has just been a nightmare with them!

Sorry you are having so much trouble. Keep fighting.

Shannon

[taylor'smom]

We received funding for the pump in Ontario but we had to wait a year after diagnosis to receive the funding (I'm not complaining mind you!) You also have to have an AIC under a certain number but I'm not quite sure what that is. They also pay you $2400 a year for supplies in quarterly increments. I believe after the election last week in Alberta insulin pumps will now be supplied-that was one of the promises if the PC party got in and they did. Hopefully all provinces are on board soon!

[Mary Jayne]

Once my son decided that he would go on an insulin pump he was on within a week! The clinic really wanted him on a pump and they were ready as soon as he was. Our private insurance paid for his pump and his supplies were covered 100%. None of it was covered by universal health care.

We have since changed insurance companies and now supplies are only covered at 80%. We purchased him a new pump this past summer (warranty was over on pump - it had been 4 yrs.) and we had to buy it ourselves - our insurance company would not cover it. But we get a substantial return on our taxes from the disability tax credit and we save it every yr so we can buy a pump every 4 yrs if we have to.

BTW, we are able to see any doc we choose to.

[brad]

I believe after the election last week in Alberta insulin pumps will now be supplied-that was one of the promises if the PC party got in and they did. Hopefully all provinces are on board soon!

I hadn't heard that it was a campaign promise, that would be awesome though.

here's the response I got for our local PC candidate. I plan on replying back with some congrats and poking with a big stick:

"Dr. Kane,

It seems that the issue that you have presented is not an isolated one. Since we have such a large number of diabetics who needs insulin pumps, we as a government should look at subsidizing in part or fully for these devices. Our government needs to come up with a long term plan to implement and fund neccessary changes to the heath care system to better serve Albertans.

I would like to talk to you further, and with many other health care professionals on ways to improved our health care system if elected tomorrow.

I can not be of much help without your vote tomorrow.

I appologize for the late reply. I thought I had responded to your e-mail, but I had not.

Lindsay"



b.

[skimom]

Once the decision was made to pump, we had it within 48 hours. My husband's private insurance gives us a once in a lifetime 50% of cost plus covers full cost of pump supplies and 90% of insulin,strips etc. My insurance as a teacher covers the balance of the cost of insulin, strips etc but will not cover anything to do with pumps (though they are examining it)
I am just thankful we have some type of coverage as there are two pumpers in my house.
As far as doctors etc, we have the greatest diabetic team and I have managed to talk to friends that are doctors and have my kids in with great specialists for their eyes, skin etc.
Our doc just asks if we have anyone in particular we would like to be hooked up with and they make it happen. I have lived in the states and although there were some great things down there, they pale in comparison to what we have here - plus EVERYONE can access great medical care here, unlike when I lived in California .All we need now is to get universal drug coverage so that familes without private insurance don't become financially strapped managing their children's diabetes.

[Brensdad]

I am truly stunned to read this. What in the heck are you all paying those huge taxes for when you can't get pumps or supplies without a huge fight between you, the government, and insurance companies??

It sounds like one of them gets a claim, and then take turns telling you the other is responsible for it. What a nightmare. I hope you all get your pumps and supplies!

[OSUMom]

Obviously I can comment on Canadian healthcare, but I just wanted to say YAY!!! I am so happy for got a pump. Is she still doing alright with other supplies?

I think we have raised enough to help with supplies - I don't know the final figure yet. My father-in-law passed away Saturday so I've been involved with family. She will be on company insurance July 1. The original plan was to raise for the pump, but I expressed my worry that we need to cover monthly supplies as well - I worried so much about that too!!

Her health has deteriated so badly that this is a "must have" type of situation. She has been hospitalized twice in the last few weeks with BG over 600 and ketones.

Thanks everyone on the Canadian health care information!!!! I just wonder how this works in other countries.

[Karenwith4]

I am truly stunned to read this. What in the heck are you all paying those huge taxes for when you can't get pumps or supplies without a huge fight between you, the government, and insurance companies??

It sounds like one of them gets a claim, and then take turns telling you the other is responsible for it. What a nightmare. I hope you all get your pumps and supplies!


:) Donning my patriotic Canadian toque and waving our flag just to clarify some things from your post.....
The delays (if any) vary by province and by clinic within the provinces based on what the patients and the doctors feel is the best approach - we could have our pump sooner if we wanted a different type with a different training option. And the situations that involve insurance companies don't sound any worse than the nightmares we hear about the battles with the US insurance companies, or people having to fundraise for their health care. I talked with our private health insurance company today (same one mentioned above) and was told that anything above the government payment for supplies is covered.

And I think you may be mistaken about taxes here - they aren't astronomical. Our family's effective combined federal and provincial income tax rate for last year was less than 10% of our income, even less if you account for our child tax benefits, and we earn almost bang on the median income for our city.

Having lived in the US and Canada, frankly, I much prefer the Canadian system.

[momofMEN]

My dd started the process for a pump in November of '07. She started pumping with IOB on January 29. We are two hours from the children's hospital where she has to go. We haven't had any out of pocket expenses! Animas sends the first three months of supplies (whatever you order...within reason) each month for free until the government funding for the Assisted Devices program kicks in. Other posters have mentioned that we will be getting $2400 each year for supplies. Emilee also has a program for children from the Ontario government for kids with severe disabilities...D qualifies because without insulin you don't live. This program pays the balance of the cost of supplies...$100 each month.

When Emilee was diagnosed, we didn't have a family doctor (we had moved the year before and hadn't found one yet). I had heard about this amazing husband/wife doctor team and wanted to have them but they were not taking patients. Well...guess who heads the peds D team...that very doctor! So we now have family doctors...they have a practice together. Not only that but this doctor is type 1, he has a dd who is type 1 and Emilee's nurse educator is type 1!!

We feel truly blessed to have the care we get in Ontario...don't believe everything you hear! I took our oldest son to the ER Saturday afternoon and he was in and out within an hour. :)

[Brensdad]

:) Donning my patriotic Canadian toque and waving our flag just to clarify some things from your post.....
The delays (if any) vary by province and by clinic within the provinces based on what the patients and the doctors feel is the best approach - we could have our pump sooner if we wanted a different type with a different training option. And the situations that involve insurance companies don't sound any worse than the nightmares we hear about the battles with the US insurance companies, or people having to fundraise for their health care. I talked with our private health insurance company today (same one mentioned above) and was told that anything above the government payment for supplies is covered.

And I think you may be mistaken about taxes here - they aren't astronomical. Our family's effective combined federal and provincial income tax rate for last year was less than 10% of our income, even less if you account for our child tax benefits, and we earn almost bang on the median income for our city.

Having lived in the US and Canada, frankly, I much prefer the Canadian system.


Thanks for the clarification. I'll try to be more accurate in the future...eh?