Question for Canadians

cpapernewbie wrote:

Wiw, I will move to Manitoba then

BC do not pay a single cents of anything related to CPAP

And that was going to be my question... I wish I had extended health because it is all out of pocket.

Jabberwock:
OHIP pays NOTHING toward your CPAP equipment. A basic CPAP or APAP setup (machine, hose, heated humidifier and mask) are paid for once every 5 years by Ontario's Assistive Devices Program (ADP), up to a maximum of 75% of the cost of the equipment, caping out at around $750. Most employer insurance programs pick up the rest of the cost.

By the way, if you need bi-pap (and are in Ontario) your setup is free -comes from the ventilator pool in Kingston.

It is possible that your employer insurance plan is playing silly-beggars with you by saying that they will only match what ADP does. So, here is your arguement:

ADP is a provincially-funded plan available to all Ontario residents who have a valid OHIP card.

Your plan at work is a private plan and is NOT provincially-funded... it is funded by you and your employer. Your insurance company has no business putting a limitation on your private plan based on what the gov't does with ADP. There are likely some specific terms in the contract that speak to medical equipment. If there are no specifics, there should be -I'd suggest lobbying your employer to get some terms in the contract that are clear and specific. My employer plan (Manulife) tried this stunt with me and, after a few phone calls, I wrote a long letter, admonishing them for this "slight-of-hand" trickery and requesting that they pony up for masks. I won.

This business of saying "we will only do what the gov't plan does" is pure crap. The gov't plan is a minimum-coverage" plan and is free. Your benefits at work are supposed to be MORE than the minimum offered by the gov't AND, you and the employer are paying for them.

Thanks for the info on ADP Will. I wasn't aware of that program; I assumed it was OHIP who paid a portion of my initial set-up. My health plan did pick up the rest of the set-up.

The terms of my private insurance plan (administered by Sunlife but negotiated between the unions and the Employer) are actually quite clear.

"CPAP's, BiPAP's and related dental appliances (where a CPAP or BiPAP cannot be tolerated)—limited to one every 5 years and a maximum eligible expense equal to cost less all eligible CPAP, BiPAP or dental appliance repairs incurred during the previous 5 years"

Since there is no specific mention of masks, and there is no provision for separate coverage of a mask anywhere else in the agreement, it is considered to be a part of the CPAP and falls within the five year coverage.

I will definitely be writing to the plan administrators and my Employer telling them how completely inadequate their coverage is, and will likely file a claim anyway just to see what they do with it officially.

I guess it could be worse; I could be living in BC

yep, in BC I never get any sleep study. Probably 1-2 years waiting time..

I have to pay my provincial medical insurance and paid dental & CPAP 100% from my own pocket

Guess why people still live in BC

Because they can't afford to move ??

Jabberwock,

My work plan is administered by Great West. We have the same thing of paying the difference once every 5 years for a cpap machine but masks, hoses, etc are a different thing. It's not specially said how many per year, but they call it "reasonable" -- on what basis do they decide "reasonable"? I can't get them to tell me. I've gone about once a year and one time went about 8-9 months and haven't had any problems. When my doctor & I decided that I needed to get a full-face mask because of nasal congestion despite my having just gotten a new mask a couple of months ago, my doctor wrote a note and it got paid.

Good luck with yours. Definitely submit a claim and see if they'll accept it.
France

[quote="jabberwock"]Thanks for the info on ADP Will. I wasn't aware of that program; I assumed it was OHIP who paid a portion of my initial set-up. My health plan did pick up the rest of the set-up.

The terms of my private insurance plan (administered by Sunlife but negotiated between the unions and the Employer) are actually quite clear.

"CPAP's, BiPAP's and related dental appliances (where a CPAP or BiPAP cannot be tolerated)—limited to one every 5 years and a maximum eligible expense equal to cost less all eligible CPAP, BiPAP or dental appliance repairs incurred during the previous 5 years"

Since there is no specific mention of masks, and there is no provision for separate coverage of a mask anywhere else in the agreement, it is considered to be a part of the CPAP and falls within the five year coverage.

I will definitely be writing to the plan administrators and my Employer telling them how completely inadequate their coverage is, and will likely file a claim anyway just to see what they do with it officially.

I guess it could be worse; I could be living in BC