What my provincial plan covers and what it does not

Started 30 October 2024 · 19 replies · 235 hearts · read 4.7k times

MapleToronto, CA · 30 October 2024

1.7 years ago

Something I have been sitting with: What my provincial plan covers and what it does not Not looking for advice so much as other people's experience.

Anyone else here in my part of the world? I would like to compare notes.

The pathway where I am appears to be different from every account I have read, and I would like to know whether that is the area or me.

I would rather hear one detailed account from my own system than five from elsewhere, if anybody local is reading.

What I want to know is what to ask for by name, because a general request has got me nowhere three times.

I will come back and update with actual timings, because published times and real times are not the same thing.

NolanHalifax, CA

What I would flag is that the criteria on my plan were reviewed annually, and I had assumed approval was permanent.

EsiFacilitatorToronto, Canada

A request rather than a note: where somebody sets out a sequence, give it in order and with the names of the forms. Half a sequence is what sends the next person round twice.

28me too 5

OrrinGlasgow, UK

Reading this properly rather than skimming, which is all I have to offer today.

XanBerlin, DE

Reading Orrin, I recognised more of that than I expected to.

The cost without coverage was the thing that nearly stopped me, and the coverage conversation should have happened much earlier.

TamsinRedruth, UK

What Xan described happened to me too, in a slightly different order.

My reviews are with a nurse practitioner and the care has been consistently good and much easier to access than a physician appointment.

BassCoventry, UK

What helped was a pharmacist who knew the special authority process well and effectively filled the form in with my doctor.

MargueriteQuebec City, CA

I moved provinces and had to rebuild the coverage arrangement entirely, which took about four months.

12me too 1

AurelBucharest, RO

Something worth knowing: my province's formulary is published and searchable, and reading it answered questions nobody would answer on the phone.

OrphBath, UK

Aurel, thank you for that. It gives me somewhere to start from.

The distances here mean an appointment is a half-day at minimum, and consolidating everything into fewer visits was the fix.

KaiVancouver, CA

#10

I would say ask what happens at renewal before you need to know, because mine required documentation I had to go and get.

NadjaBelgrade, RS

#11

My private plan covered part of it and the criteria were in a document I had never read until somebody here suggested asking for it.

OrvalWinnipeg, CA

#12

What I found is that what my cousin in another province described bore no resemblance to my situation at all.

MapleToronto, CA

#13

Something practical: the special authority form had to come from the prescriber in a particular format and the first one was returned.

NolanHalifax, CA

#14

What Orval described happened to me too, in a slightly different order.

The winter is a real planning input for me. Two months of the year the travel to appointments is genuinely uncertain.

IvorLlanelli, UK

#15

Saying it out loud helps other people say it too. Thank you.

OrrinGlasgow, UK

#16

Maple has already said most of this and I want to add the one part that was different for me.

Nothing here is medical advice and coverage rules differ by province and by plan, so please check your own wording.

XanBerlin, DE

#17

Ivor said something I want to sit with for a second.

Coming back at eighteen months to say the coverage held through one renewal, the care has been good, and the forms were the whole battle.

EsiFacilitatorToronto, Canada

#18

Thank you all. Somebody arriving confused by advice written for a different country and leaving with an answer for their own is the whole job of this circle, and it only works because people say where they are.

23me too 7

BassCoventry, UK

#19

Something I got right was keeping every receipt, because the annual claim needed all of them and I nearly threw them out.