This red tape is not exclusive to Ontario. British Columbians face a similar bureaucratic nightmare and do not even have the small window created in Ontario in which the premise of retroactive approval is broached, thanks to the lawsuits launched by bakerlaw, in some cases pro bono. We have also heard from people in other provinces who faced similar problems. However, the largest volume of cases appears to be in Ontario followed closely by BC.
And quite apart from whether retroactive approval may granted, the process to apply for prior approval is so convoluted as to create the suspicion that bureaucracy is being used to prevent access. At the very least, the process could be more user-friendly.
The approval process should be initiated with an application submitted by the patient. One of the reasons that OHIP has given for their now strict adherence to the prior approval regulation is that having an application allows the ministry to help look for alternate available services in Ontario. However, without the application, their mandate and workload are such that they will not tell you or your doctor about those alternate services. Consequently, if the application process could be started with the submission of the forms, signed by either the patient or the doctor, not both as now required, there is an opportunity for the referral process to be engaged.
Further, the section requiring prior “approval” should be amended to simply require that an application form be submitted instead of having to wait for the Ministry’s approval before beginning treatment, i.e., prior “submission” instead of “approval”. This would be a significant benefit given the onerous and sometimes lengthy nature of obtaining approval. A patient who submits an application is given no assurances regarding how long it will take to be processed – a day, a week or even weeks or months. In those circumstances, a patient who has already submitted the application may not be able to wait for a decision from the Ministry, so “submission” should be enough to meet the time requirements. A patient is already undertaking a risk that the treatment will not be covered by going out of country without approval first and has to front large amounts of money in any event to start the treatment.
These and other improvements can be made in all provinces with little impact on the overall costs of their out of country programs, especially if, as argued, early involvement with the patient could facilitate matching them with alternate services within the province.
The Health Ministers need to be reminded that people do not go out of country for treatment because they want to; rather, they go because they have to. Travel costs are not covered. People are away from their loved ones when they are at their most anxious.
As you may recall, CARP called for changes to the prior approval process and awaited the results of this Divisional Court case and the Ministry’s response to determine the next course of action. Clearly, they have not heard from enough people that this inequitable situation must change. We will be writing to all the Ministers of Health to invite them to redress this inequity. And we invite you to write or send an email to the Minster of Health in your province and/or your local member of the legislative assembly using E-VOICE or contact your Federal as well as Provincial Minister of Health:
