ONTARIO: Woman who needed air ambulance in Nova Scotia stuck with $12000 bill

ONTARIO: Woman who needed air ambulance in Nova Scotia stuck with $12000 bill

French River couple fighting to have $12K air ambulance bill covered

Erla, 81, fell ill with a heart attack. She required immediate transport from the hospital in Sydney (on Cape Breton Island) to Halifax. Paramedics called for an air ambulance and she was spirited away on the one-hour trip. Gladly, she has made a near full recovery.

Wenborne, 86, and Erla, who live in French River, received a bill for $12,000 for the air ambulance trip. After trying to resolve the issue quietly – and failing – they requested a hearing with the Health Services Appeal and Review Board.

“We know full well the limitations of this board, and that they can't override legislation, but we thought if we could get this issue in front of them, they could bring it to the government,” Dean said. “We're trying to illustrate that, if you travel outside of the province, there's a liability in front of you right away and you probably don't know about it. And, if you want to get insurance coverage specifically for ambulance alone, that type of policy doesn't exist.”

Wenborne laid out his case Thursday at the Holiday Inn in Sudbury. For example, he said, Ontario pays for medical costs to non-resident Canadians if they fall ill in this province. Surely some kind of reciprocal agreement should be in place, Wenborne wondered.

The Ministry of Health and Long Term Care, represented by Susan Croft, Kathryn Fleming and Linda Lalani, said while the ministry concedes Erla was covered by OHIP and the transfer by air ambulance and land ambulance were medically necessary, neither of those ambulance services are certified under provincial legislation. In fact, no ambulance service — air or land — outside of Ontario is certified under the Ontario's Health Insurance Act.

“Ontario generously pays ambulance costs for visitors from other provinces. How could this not be a justifiable reason to pay for the ambulance costs in a life-and-death emergency for an Ontario resident while in another province?” he asked. “I know there is no legislation that permits this; however, if one were looking for a reason to consider Erla’s appeal, could one find a better one?

“Lastly is the fact that Ontario will pay for emergency medical or hospital services for an Ontario resident who is out of the country. Amazingly, however, Ontario cannot find a way to pay for emergency life-saving air ambulance service for that same resident if he or she is in Nova Scotia.”

In his defence, Dean used the instance of an Alberta mother who, in 2015, went into early labour while visiting family in Timmins. She was flown by air ambulance to Health Sciences North, as the Timmins hospital wasn't equipped to deal with premature births before 32 weeks gestation.

Then there was the time the provincial government opted to split costs with Alberta after Amy Savill, a resident of High Prairie, Alta., required medical assistance.

While the couple are grateful for the care they received, they are fighting a $12,000 bill from the air ambulance service in Nova Scotia. Because they were in another province, the Ministry of Health denied their claim for coverage under the Ontario Health Insurance Plan (OHIP).

“Ontario did in 2015 pay a portion of the costs of our air ambulance service to transport an Alberta woman from Timmins to Sudbury,” Wenborne commented. “This would have been in direct contravention of OHIP legislation at that time. The point I am making is that Ontario’s payment for a portion of that flight set a very clear precedent that I would suggest can be used by the board to justify allowing Erla’s appeal.”

The review board will take a few months to make their decision. Failing a positive outcome for the Wenbornes, Dean said he will be negotiating with the ambulance service in Nova Scotia to decrease the bill, “but we shouldn't have to do that in the first place.”

In general, Wenborne said, Canada’s health care coverage is excellent from sea to sea to sea. Unless, he pointed out, one requires an ambulance.

In May 2018, the governments of Ontario and Alberta agreed to split the cost of the bill, even though out-of-province residents are required to pay the cost of an air ambulance in Ontario unless it's between two hospitals and they return to the first one within 24 hours.

“For some strange reason, in all the reciprocal agreements, ambulance services are not included,” he said. “It seems to make no difference how urgent or necessary that ambulance service is, there is going to be a direct cost to the person receiving the service. If the ambulance service that is required is an air ambulance the cost may easily be beyond the financial capability of the recipient.”

Nickel Belt MPP France Gelinas, in whose riding the Wenbornes live, said the situation is unfair on many levels.

“With a new government and a new minister of health, I don't want this issue to be put on the back burner. The ministers of health from all the provinces and territories have it within their power to change this with the stroke of a pen.

“Who knows that if something happened in another province that cost $12,000, which is a medical emergency to keep you alive and you will get a bill, I guarantee nobody knows that,” she said. “We are Canadian. The program that defines us is medicare. That means your care is based on needs, not on ability to pay. We have inter-provincial agreements so it doesn’t matter as a Canadian whether I’m Ontarian. I can travel to any other province and medicare will cover me. This is what everybody believes. But medicare has changed since it was introduced by Tommy Douglas.”

For one thing, Gelinas said, there were no air ambulances in Douglas’ day. She called the agreements and legislation that cover health care and ambulance service archaic.

She was taken to a hospital in Sydney, where she was stabilized and a temporary pacemaker was put in. However, the nearest hospital that could perform the followup tests and procedures was in Halifax.

Within the Nickel Belt riding, Gelinas said five families who have been slapped with bills related to medical care have approached her.

“Nickel Belt isn't even that big,” she said. “If it happened to five people in Nickel Belt, I'm sure it's happening to many more, but no one is talking about it.”

“If it’s happened to five people in Nickel Belt, I’m guessing it’s happening to a few other people,” she said. “Nobody knows about it, nobody talks about it.”

In the case of the mom from Alberta, when the pressure was applied to both governments, they conceded it was wrong, and agreed to pay, Gélinas said. 

Gelinas said inter-provincial accords need to be updated. She plans to bring the matter to Queen’s Park.

Dean questioned them on the Alberta mom's situation, however, no real clear answers were provided as they aren't able to speak about specific cases.

“It needs to get done now; the sooner, the better,” she said. “So that families don’t end up with $12,000 or $18,000 bills that frankly, you should not have to pay. It was an emergency; it was medically necessary. “¦ We should not stick them with a $12,000 bill afterwards. If it’s covered within your own province, it should be covered when you’re in another province.”

“Erla’s life probably depended on that flight,” he told the review board. “It is also probably worth noting that if Erla’s heart attack had occurred in most of rural Ontario, air ambulance service would have been required.”

Erla is recovering well, but there are some lingering effects from the heart attack, said her husband, Dean, 86, speaking on her behalf at the hearing.

Despite their unfortunate experience, the Wenbornes say they plan to continue travelling to Nova Scotia.

“My wife’s got a brother and a sister there, and we like to visit Nova Scotia. Many, many years ago, I was stationed in Sydney when I was in the air force. That’s where I met my wife,” he said. “Nova Scotia is a very important part of the country, as far as I’m concerned. We love to travel down there.”

The fight to overturn an Ontario Health Insurance Plan denial to help pay a $12,000 air ambulance bill will have to wait a few months for an outcome.

French River residents Dean and Erla Wenborne are asking the Ministry of Health and Long Term Care to reconsider not paying for the bill the couple incurred after Erla suffered a heart attack while out of province. 

“OHIP was very good for covering our other costs, and they did a beautiful job for my wife,” he was quick to point out.

She was taken to a hospital in Sydney, N.S., where she was stabilized and a temporary pacemaker was put in. However, the nearest hospital that could perform the followup tests and procedures was located in Halifax — a distance of almost 400 kilometres.

Medicare is the program that defines Canadians, she said, and it's based on medical needs, not the ability to pay for it. 

An air ambulance was called to transport Erla to Halifax, where she stayed about 36 hours, and then returned to Sydney by land ambulance for recovery.

Erla is recovering well, but there are some lingering effects from the heart attack, said her husband, Dean, 86, speaking on her behalf at hearing for the Health Services Appeal and Review Board.

While the couple are grateful for the care they received, they are fighting a $12,000 bill from the air ambulance service in Nova Scotia. Because they were in another province, the Ministry of Health denied their claim for coverage under the Ontario Health Insurance Plan (OHIP).

“It was a political decision to cover half the cost for the Alberta woman,” he said. 

“We know full well the limitations of this board, and that they can't override legislation, but we thought if we could get this issue in front of them, they could bring it to the government,” Dean said. “We're trying to illustrate that, if you travel outside of the province, there's a liability in front of you right away and you probably don't know about it. And, if you want to get insurance coverage specifically for ambulance alone, that type of policy doesn't exist.”

In his defence, Dean used the instance of an Alberta mother who, in 2015, went into early labour while visiting family in Timmins. She was flown by air ambulance to Health Sciences North, as the Timmins hospital wasn't equipped to deal with premature births before 32 weeks gestation.

In May 2018, the governments of Ontario and Alberta agreed to split the cost of the bill, even though out-of-province residents are required to pay the cost of an air ambulance in Ontario unless it's between two hospitals and they return to the first one within 24 hours.

“It was a political decision to cover half the cost for the Alberta woman,” he said. 

And, while he said he isn't optimistic, hopefully by bringing it to the review board will raise awareness of the fact Ontarians aren't covered for any ambulance services outside of their province, with a few very specific instances, like the one mentioned above.

“OHIP was very good for covering our other costs, and they did a beautiful job for my wife,” he was quick to point out.

The Ministry of Health and Long Term Care, represented by Susan Croft, Kathryn Fleming and Linda Lalani, said while the ministry concedes Erla was covered by OHIP and the transfer by air ambulance and land ambulance were medically necessary, neither of those ambulance services are certified under provincial legislation. In fact, no ambulance service — air or land — outside of Ontario is certified under the Ontario's Health Insurance Act.

While there are interprovincial agreements to cover medically necessary hospital costs , there is no such agreement regarding air ambulance services.

Dean questioned them on the Alberta mom's situation, however, no real clear answers were provided as they aren't able to speak about specific cases.

Nickel Belt MPP France Gélinas said the Wenbornes are the fifth family in her riding to come to her with the exact same situation.

“Nickel Belt isn't even that big,” she said. “If it happened to five people in Nickel Belt, I'm sure it's happening to many more, but no one is talking about it.”

“Name me one Canadian who knows that, if a medical emergency happens in another province and measures are taken to keep you alive, that you could end up with a bill for $12,000. No body knows that."

Medicare is the program that defines Canadians, she said, and it's based on medical needs, not the ability to pay for it. 

“Medicare has changed since the first interprovincial agreements were first put into place,” she said. “Air ambulance did not exist then. More and more hospitals now depend on inter-hospital transfer, and they use air ambulances. But, we have this archaic piece of legislation that doesn't even mention air ambulance, even though it's now part of life-saving hospital care.”

In the case of the mom from Alberta, when the pressure was applied to both governments, they conceded it was wrong, and agreed to pay, Gélinas said. 

“With a new government and a new minister of health, I don't want this issue to be put on the back burner. The ministers of health from all the provinces and territories have it within their power to change this with the stroke of a pen.

The review board will take a few months to make their decision. Failing a positive outcome for the Wenbornes, Dean said he will be negotiating with the ambulance service in Nova Scotia to decrease the bill, “but we shouldn't have to do that in the first place.”  


Posted in Ontario