You’ve heard about a breast cancer treatment, but it’s not available where you live. Are you eligible for provincial health coverage? The answer is – maybe. Here’s what you need to know to apply for funding.
- Talk to your cancer specialist
If a treatment is not available in your province, it is up to your specialist to make a formal request to your provincial health care plan for treatment if she deems it appropriate for your medical condition.
- Make a formal request
Once your specialist sends in the form, government officials will assess the request on its own merit. Provinces will only cover health care costs for medically recognized treatments by a licensed doctor at a recognized facility. That means alternative treatments are not considered. Each province grants approval based on a complex set of criteria, which may change from time to time. For example, as of June 2003, Ontario will not pay for any treatments in other provinces or outside of Canada, says Donna Kline, spokesperson for Cancer Care Ontario. The reason: women in Ontario have all treatments available within the province.
- Receive funding
If you’ve been approved, and depending on your provincial plan, the costs of the treatments and all in-hospital expenses are usually covered. Some provinces cover transportation, but meals and accommodation are not reimbursed. (Want to find out about free air travel?) In Manitoba, for instance, the amount paid is the equivalent (in Canadian funds) of what a practising physician in that province would be allowed to charge.
- Inquire about additional financial assistance
If the amount covered falls short of the fees charged by the physician abroad, apply to the Special Benefits Program of your province for up to 100 per cent of the costs. Speak with an information officer in your province at the Canadian Cancer Society to find out about available grants .
- Check your private insurance plan
Some insurance policies may cover costs such as a private room or home nursing care not eligible under your provincial health plan. Read over your personal plan to see if you have any extra coverage available.
Self-employed? If you’ve paid into a disability plan or bought critical illness insurance, check your policies for benefits. Some plans pay you in lump sums and you can use those funds toward medical care out of province and abroad.