Question re Canadian Insurance Companies

Message

#1 Post by **amd** » Tue Sep 02, 2008 2:10 pm

Has anyone in Canada fought their private health insurance company and won coverage for their surgery? Mine covered $542 out of $3000. Just curious if anyone received full coverage and how they did it.

#2 Post by **StephCanuck** » Tue Sep 09, 2008 11:52 am

where do you live?
Im in Ontario and our coverage (OHIP) covered everything except orthodontics and I guess some of the post op checkups.

#3 Post by **amd** » Tue Sep 09, 2008 2:10 pm

I live in Toronto. Ohip only covered the actual hospital fees. My insurance covered the semi-private room and some of the anestia(sp) costs. That's it. I am out of pocket $3grand for the surgery and then add in another grand for xrays, and of course the braces themselves-$7,500.
We are with Empire Life. What company are you with? Did you have to have your surgeon submit anything specific to either the insurance co or OHIP?

#4 Post by **Laundraholic** » Wed Sep 10, 2008 5:22 am

I'm in Toronto, ON too.
My private (employer) insurance is covering 1/2 the braces. It covered the x-rays, the oral surgery consult, and I've covered for semi-private at the hospital.

As far as I know, OHIP is covering the hospital stay, anaesthesia, all of that stuff, but I'm responsible for the surgeon fee, which is around $3500 for both upper and lower.

I haven't even checked with my insurance yet if that is covered. I've waited for this for a while and honestly after reading so many (American) sites about the cost of surgery I was actually really happy to know the surgery here was only $3K.
I was realy scared going in, once I decided to go through with this, that the cost of the surgery was going to be so high that I wouldn't be able to go through with it (after taking 10 years to decide).

If it's covered, even partially, by my insurance (Manulife) then that's "gravy".
If not, then the amount is acceptable

#5 Post by **amd** » Wed Sep 10, 2008 6:24 am

Yeah I agree that the $3000 for the surgery really isn't bad. I was just curious as to why american insurance companies cover this type of surgery and canadian ones don't. I'm wondering if it's because OHIP pays such a large part. Apparently the bill for the hospital stay would have been close to $5000. I'm really grateful that I don't have to pay that directly.

#6 Post by **StephCanuck** » Mon Sep 15, 2008 2:24 pm

I have insurance from my mothers work benifits (covers family until they are 25 years and im 21) and My university coverage. As far as I know my OS submitted those 2 insurance forms and Ohip covered the majority of everything else ( besides ortho) though, my stay in the hospital was only overnight... But as said before, compared to other places, 3grand isnt too bad.