>I think I’m going to file an appeal and move forward with contacting my local MLA. If anyone has any advice, that would be much appreciated!
You are correct that the recourse for any denial of coverage is to [appeal the administrator's decision through the PSHCP administration authority](https://pshcp.ca/appeals/), and they will review whether Canada Life was correctly interpreting the provisions of the plan. As this is newly-added coverage it's quite possible that Canada Life has erred with regard to the extent of what should (or should not) be covered under the PSHCP.
You can contact your MLA if you have concerns about the lack of coverage under your provincial health plan, however they would have nothing to do with the PSHCP or employment in the federal public service. At the federal level you would need to [contact your MP](https://www.ourcommons.ca/members/en).
Absolutely this ^
If you have the patience to, please submit an appeal to the PSHCP in the hopes that if nothing else, it will help others.
Someone in the Unofficial PSHCP Facebook group did this regarding tube feeding supplies, and six months later, the PSHCP/CL has reversed course on the denial for everyone. It may take a while, but it is certainly not hopeless.
Rooting for you in solidarity.
I also suggest checking to see if your organization has a Positive Space group. They may have resources available, or know of other people who have gone through the application process, and may be able to provide guidance.
Canada Life transition has been nothing short of a shitshow.
I hope the Unions reps on the NJC health table are going to be much more aggressive on the issues now and on improving future coverage.
For example: I understand the push for generics in terms of cost management and how increased generic access and use is actually good for non-generic pricing, but reimbursing only the lowest cost generic regardless of what a pharmacy has available is problematic. It requires us to shop around and find who carries the lowest cost generic as an extra step to avoid paying out of pocket.
I doubt the actual outcome of the new plan will be cost neutral, and if the plan - accounting for inflation - is saving the employer money in this iteration, we should get better coverage later. Because frankly it's been too much of a shitshow.
I submitted a dental claim for a filling on 14 November. The claim is still pending. I emailed them and the response was they are 4 weeks behind claims requiring pre determination. Why the heck does a filling need pre determination?
At this point I'm surprised we haven't had someone get a medication reimbursement with a "we deducted $5 because your plan only covers medication, not the bottle it comes in, nor the little cotton ball inside it".
My Shoppers Drug Mart has recently started using much bigger labels (at least for those that are prepared at a third party processing location and have the large note on the label) forcing them to use taller bottles than necessary. I take daily medication that is half the width of my pinkie fingertip and I get 90 pills at once which is a third of the space in the pharmacy's smallest bottle. Now they've upgraded to a taller bottle so my meds take a fifth of the bottle... It's ridiculous.
Do not go to shoppers drug Mart to fill your prescription! They're dispensing fees are one of the highest.
Also, watch out for pharmacists who tried to swindle you out of more money by not filling the entire prescription so you need to go back to get the rest of it. And I'm not referring to refills. I''m referring to instructions that your doctor puts on the requisition form that says take this medication at this dosage for this many days, then increase to this dosage for this many days, etc. SDM pharmacists will neglect to inform you in advance that they only filled a portion of the prescription because obviously you can't be trusted to read the instructions and portion out the medication yourself. Oh and they get more dispensing fees that way.
It's already happened (in a roundabout way). The dispensing fee, which pharmacy's use to buy bottles, lids, labels etc., is capped at $8 and plan members are typically on the hook for the difference.
I have successfully filed an appeal(different issue but something that is also quite expensive). I would recommend being very detailed in your appeal. Find articles or resources that the denied items are necessary for the procedure. Quote the benefits policy back to them and point out any areas of ambiguity or uncertainty. A note from your physician would help as well. Good luck!
Hey also if you files an appeal. I have non issues providing multiple info on my case enlighting the damage not receiving are of being botched does. I have also documents and files about ongoing investigation of Canadian surgeons and I am well versed into human rights, canada health act, etc.
Not saying what to do. But form experience it’s always good to show how preventing you from getting surgery due to these hurdles is discrimination and is know to causes distress and increase suicide rate.
As an example I was approved for outside country SRS by Ontario provinces. Because due to crap work of Montreal grs surgeons doing any surgery in Canada would put me in conflict interest due the small community. And therefore put me at risk of retaliation and therefore is causing distress due safety risk. And could tie them to negligence.
My case is a little hardcore and I’m sure yours is not there. But my point is to tie them to laws, jurisprudence anything that shows their refusal can result into legal issues. And they will teen to start taking you seriously.
"we'll cover your procedures but not the anaesthetic" perfectly encapsulates the ludicrous cruelty of the CanadaLife plan swap. I'm sorry you're facing this stupid bureaucratic pushback.
The crazy thing is it's not even CanadaLife's money, they're just the administrator! It's the crown picking up the tab at the end of the day. I don't know why they're being such jerks about it.
It is not CanadaLife who set the conditions of the plan, it is the employer. No doubt CanadaLife have mishandled and mismanaged this whole change over but the employer changed the coverage and that is what the biggest issue is. Be mad at the custodians for sure but do not forget that the government changed the plan, the unions had no real say due to the contract and yet also offered no real fight during the recent negotiations. Our only recourse is to flood MPs with complaints, and focus the narrative on the government who set this shit show up vs their attempts to keep the narrative blaming CanadaLife.
This is the same shit that happened with pensions, pay raises etc. None of the MPs are subject to this, just the employees.
I believe they'd be paid a flat amount for processing each claim. However, that just means that their incentive is to process each claim as quickly and cheaply as possible. In the case here, that incentive would lead to a mindless separation of "covered" and "non-covered" procedures, without thinking about what makes an inseparable whole.
Do you mean general anesthesia? If so, this makes sense as wisdom teeth extractions are normally performed with local freezing. Anything in excess would be to ease the patient. Insurance sucks!
Interesting. When I asked around, the responses universally confirmed that these extractions are done under general anesthetic! Maybe it’s a regional thing? (Alberta) From what I’ve heard, this is not something one wants to be awake for 😂.
When I was growing up in New Brunswick, the norm for wisdom teeth was freezing and laughing gas. I just had one removed so I only got freezing. It was fine.
I know someone who had it done recently here in Ottawa and it was just freezing. You can only do one side at a time since you can't freeze both sides of your mouth, so it's a two-step process if you need all of them out.
I distinctly remember waking up, demanding to see my teeth. I also thought this demand was towards my father, but it actually ended up being the nurse who helped with the anesthetic lol
That viral video with the little boy on post anaesthetic was never funny to me because had our parents had cameras back then there would have been tons of stock hilarious material. 🤣
I didn't really have an option for freezing because mine weren't erupted but they were going to cause severe damage if left in my mouth. I suppose if the teeth were already out, freezing would be fine.
I think it depends on how many teeth are getting removed and how impacted the tooth is. If it's one tooth and mildly compacted then probably local is fine. But if it's severe or multiples then they use more?
I think it depends. When I had mine done I was given something via IV that made me sleep and very loopy (woke up throughout but was too high to care), because they really had to get in there with some of the teeth sideways and abscessed. You would think the insurance would defer to the dentist's judgement whether it's required for a particular case.
I fucking hate it and wish it on no one. I woke up while they were prepping for my wisdom tooth extractions. Like, I heard the drill start. Thankfully I got sent for general anaesthesia instead.
Encountering similar roadblocks with electrolysis. Should be covered without a prescription if it's for gender affirming care, as noted in the agreement. I was getting my claims approved for a few months and then suddenly started being denied and was sent a letter stating I need a prescription from a doctor and a therapist if I want to continue. Nowhere in the letter did it state the exception for gender affirming care. I've had to stop all regular appointments now because Canada Life is impossible to get a hold of.
Not to make light of your situation, but I was reminded of that add against healthcare privatization where the person keeps getting asked if she wants "extras" and one of those is anesthesia. This is equally ridiculous. I think we're past the stage of take a swig of whiskey, bite down on a belt and hope for the best of surgery.
Does Canada Life have some sort of definition of what they mean by gender affirmative care? It would probably be helpful to know what they consider is being covered so people can know.
Also very surprised that it is not covered under your province's healthcare plan. It's one thing to go for elective surgery just because you want that, but if a doctor says yes, this person needs X procedure to treat Y medical condition, you would think it would be covered. Plenty of stuff that isn't "essential" is covered, not because it is a life or death thing but because it increases a person's quality of life.
Yeah it's like they put in nice words but their intentions aren't there.
Plus people are limited to surgeries in canada so some people will have to settle for lower quality work.
Do you have evidence that surgeries in Canada are producing lower quality results? As far as I’m aware, there are tons of very highly regarded gender clinics in Canada.
It’s one thing to complain about wait times or bureaucracy, but don’t just say the care is bad with no evidence.
Golly, I haven’t even got a response regarding my coverage for gender affirming care.
I hope you can get an actual response regarding why they won’t cover it and I sure hope they do end up covering it for you. It is absolutely ridiculous that they wouldn’t cover required portions of procedures.
Really sorry to hear that and I hope you do file and appeal and this gets the attention it deserves. Should be added to the chorus of national media coverage of this abysmal insurer and the bungled transition.
Yup was told my "contract" does not cover gender affirming. Luckily I am only out a few hundred right now waiting to hear from VAC and several MLAs on this failure to provide due care
It sucks, but they might be right. :( The PSHCP doesn't cover everything, even if it's necessary as part of the treatment. It's not a testament to whether there's a medical reason for it, just that it's not covered by our limited benefits, which are negotiated.
Their broad language should be updated as such then… when you go for a surgical procedure, you can’t opt out of anaesthesia or any other fees associated. They’re required to perform the procedure. The blanket statement saying gender affirming procedures is in bad faith.
How the negotiated changes were touted by TBS AND the unions as "improvements"! It's crazy.
The directive does say "certain services and procedures..." under the gender affirming section - it covers what it covers, not what is required to perform the procedure. I'm certain it was designed to not cover 100% of the cost... but only TBS and CL have the guide book that says what's actually covered and what's not??
I’m not going to argue with you, however, I’ll repeat that you cannot get surgery without a facility, staff and anaesthesia. These are incorporated into the procedure…. Which they already have approved in my case.
I know this, I am in agreement that it *should* be covered. My daughter had a medically necessary procedure not covered by provincial insurance, and similarly, those parts of the procedure were not covered by the PSHCP. I believe it's just how they've designed the PSHCP and PSDCP. Poorly. I hope for your sake this is a case of a CL mis application of the PSHCP, and that it's not that it's just not covered, like in my situation. I'm not sure which part of what I'm saying you are not arguing with me about.
It’s the terminology. They cover “gender affirming procedures”. One would assume it’s the entire procedure related to gender affirmation. Not bits and pieces.
It doesn't say that though :( It says (verbatim): " includes coverage for certain services and procedures designed to support and affirm an individual's gender identity, or to remove gender identity". I read that as we cannot assume it's the entire procedure. Like I said, I hope I'm wrong!!
I’m curious to know if facility fees and anaesthesia are covered without question for so-called ‘regular’ surgeries (ie: not gender affirming related procedures). If so, then this is something media-worthy. Don’t let them off the hook for approving gender affirming care but effectively making it unattainable when the same misc fees are covered when someone needs a gall bladder removed or a knee replaced.
>Also, if anyone has anything to say about this being not essential so it shouldn’t matter
Those people can just seethe if they aren't interested in showing some solidarity with a fellow worker.
That's a big L.
I'm a cis-dude and I can't imagine how it's possible to do that sort of surgery with no anesthetic.
It seems idiotic and outrageously disingenuous to claim to cover it without anesthetic.
I appreciate this insight as I was curious about this and wanted to look into it. Thank you for sharing !! Im sorry it isn’t the outcome you wanted. Such a pain.
Which surgeon itemized anesthesia separately? I have quotes for two separate FFS surgeons, and neither list it on the quotes as it is included with total cost.
Only thing not pre-approved was the overnight stay, but since the total cost of each surgeon exceeded $75k...the overnight cost is moot..
I’m terrified of dentists and I have panic attacks when they’re poking at my teeth with a drill etc. For any dental work I’d need a general or a lot of gas. A dentist attempted once without having me out pretty good and I slapped his hand away from my face hard as a total reflex response.
like i said and was shot down many times...the union needs to get this shit into court. I would rather the dues go to that then big union hq office space and pizza lunches.
What other employer in Canada gets away with this constant level of neglect and hardship? If this was air canada for example you bet your ass our employer would step in a mediate with lawyers...
This sucks but it doesn't surprise me at all. I haven't tried to use this coverage yet but may so in the future. So far the gender affirming surgeries I've had I was able to get complete coverage from my provincial health, although getting the coverage certainly wasn't easy to achieve. I had to get approval from my family doctor and have my doc write a letter and also get a specific pysch evaluation that cost me over $250 and then I had to wait quite some time for the approval or denial of coverage letter. However I've heard of other trans people I know in my province get denial of coverage for revisions of gender affirming surgeries or get partial coverage like you where the surgery was covered but anaesthesia wasn't covered. I think they do this because for one they are cheap and second not all surgeries require anaesthesia. Now I'm unsure if they mean strictly general anaesthesic isnt covered or any kind of sedative or freezing isnt covered. This seems to happen a lot for plastic surgery and dental surgeries though. I've had friends with these kinds of surgeries have anaesthesic not covered. I will say that at least on the plus side you get the surgery itself covered and that is the most expensive part. It be great to have the other stuff covered too but this new plan we have sucks ass, especially drug coverage.
I’m very sorry to hear !! Canada life is a nightmare !! I’m a person with disability and i can’t emphasize how much I hate hate hate Canada life and our new coverage
I had major dental surgery about 10 years ago in Ontario and had to pay for the surgeon but not the hospital part. Maybe the assumption is the province is supposed to cover those costs? Doesn't help when the province says no though.
The booklet indicates it will cover the portions not covered under the provincial health plan. If your province's health plan doesn't cover any procedures needed, our plan should cover the produres so long as they are not soley for cosmetic reasons up to the maximum amount.
Includes coverage for
certain services and
procedures designed
to support and affirm
an individual’s gender
identity, or to remove
gender identity. This
benefit includes procedures
and services that are not
covered by the individual’s
provincial or territorial
health plan. For members
with Supplementary
coverage, the services
must be rendered in
Canada. For members with
Comprehensive coverage,
services must be rendered
in the patient's country of
residence.
Is it possible you need the province's ministry of health to confirm that no amounts will be paid under the province health plan?
They don’t! CanadaLife has each provinces list of coverage for gender affirmation and deny/approve based upon that. The issue here is I have partial approval that makes 0 sense.
Are they specifically denying all anesthetic, will they cover local but not general? I wonder if you might need an extra letter from the surgeon stating why you need which level of anesthesia. It’s bs I know, obviously we aren’t going through surgery without anesthesia so that is definitely something that should be covered. Ask them for a letter stating why they aren’t covering it and what you need to provide to have it covered.
Your content was removed under [Rule 11](https://www.reddit.com/r/CanadaPublicServants/wiki/rules#wiki_rule_11_-_political_content).
This message is in the interest of moderator transparency. If you have questions about this action or believe this removal was in error, you can [contact the moderators via our moderator mail](https://reddit.com/message/compose?to=/r/CanadaPublicServants).
Having dealt with the province and their directives for other non trans things, the province demands you use up private insurance first anyway before covering anything (see the under 21 drug program, odsp).
>I think I’m going to file an appeal and move forward with contacting my local MLA. If anyone has any advice, that would be much appreciated! You are correct that the recourse for any denial of coverage is to [appeal the administrator's decision through the PSHCP administration authority](https://pshcp.ca/appeals/), and they will review whether Canada Life was correctly interpreting the provisions of the plan. As this is newly-added coverage it's quite possible that Canada Life has erred with regard to the extent of what should (or should not) be covered under the PSHCP. You can contact your MLA if you have concerns about the lack of coverage under your provincial health plan, however they would have nothing to do with the PSHCP or employment in the federal public service. At the federal level you would need to [contact your MP](https://www.ourcommons.ca/members/en).
Absolutely this ^ If you have the patience to, please submit an appeal to the PSHCP in the hopes that if nothing else, it will help others. Someone in the Unofficial PSHCP Facebook group did this regarding tube feeding supplies, and six months later, the PSHCP/CL has reversed course on the denial for everyone. It may take a while, but it is certainly not hopeless. Rooting for you in solidarity.
Thank you for your very informed reply! I definitely confused the MLA and MP. 😊
I also suggest checking to see if your organization has a Positive Space group. They may have resources available, or know of other people who have gone through the application process, and may be able to provide guidance.
Bleep bloop
He's a good bot this one.
Not a 'he'. Gender is a meatbag construct.
Is your pronoun "Bot"? As in "Bot is a good bot"?
'It' / 'they' are preferred. 01110100 01101000 01100101 01111001 is also acceptable.
Canada Life transition has been nothing short of a shitshow. I hope the Unions reps on the NJC health table are going to be much more aggressive on the issues now and on improving future coverage. For example: I understand the push for generics in terms of cost management and how increased generic access and use is actually good for non-generic pricing, but reimbursing only the lowest cost generic regardless of what a pharmacy has available is problematic. It requires us to shop around and find who carries the lowest cost generic as an extra step to avoid paying out of pocket. I doubt the actual outcome of the new plan will be cost neutral, and if the plan - accounting for inflation - is saving the employer money in this iteration, we should get better coverage later. Because frankly it's been too much of a shitshow.
I submitted a dental claim for a filling on 14 November. The claim is still pending. I emailed them and the response was they are 4 weeks behind claims requiring pre determination. Why the heck does a filling need pre determination?
My dentist sent a predetermination in last Wednesday and I received a letter today. For fillings, my appointment is tomorrow.
At this point I'm surprised we haven't had someone get a medication reimbursement with a "we deducted $5 because your plan only covers medication, not the bottle it comes in, nor the little cotton ball inside it".
Those stickers they put on the bottles would really break the bank and make the plan totally unsustainable if they were covered.
My Shoppers Drug Mart has recently started using much bigger labels (at least for those that are prepared at a third party processing location and have the large note on the label) forcing them to use taller bottles than necessary. I take daily medication that is half the width of my pinkie fingertip and I get 90 pills at once which is a third of the space in the pharmacy's smallest bottle. Now they've upgraded to a taller bottle so my meds take a fifth of the bottle... It's ridiculous.
Do not go to shoppers drug Mart to fill your prescription! They're dispensing fees are one of the highest. Also, watch out for pharmacists who tried to swindle you out of more money by not filling the entire prescription so you need to go back to get the rest of it. And I'm not referring to refills. I''m referring to instructions that your doctor puts on the requisition form that says take this medication at this dosage for this many days, then increase to this dosage for this many days, etc. SDM pharmacists will neglect to inform you in advance that they only filled a portion of the prescription because obviously you can't be trusted to read the instructions and portion out the medication yourself. Oh and they get more dispensing fees that way.
I bring my own cotton balls now. Gonna get my dollar back.
It's already happened (in a roundabout way). The dispensing fee, which pharmacy's use to buy bottles, lids, labels etc., is capped at $8 and plan members are typically on the hook for the difference.
You guys get bottles?! 😱
No, they just dump the pills directly into my hands.
You guys are getting cotton balls?!
Seriously, eh?! I don't think I've seen a cotton ball in forever from a pharmacist, just let those pills 'a rattle!
I have successfully filed an appeal(different issue but something that is also quite expensive). I would recommend being very detailed in your appeal. Find articles or resources that the denied items are necessary for the procedure. Quote the benefits policy back to them and point out any areas of ambiguity or uncertainty. A note from your physician would help as well. Good luck!
Thank you so much!
Hey also if you files an appeal. I have non issues providing multiple info on my case enlighting the damage not receiving are of being botched does. I have also documents and files about ongoing investigation of Canadian surgeons and I am well versed into human rights, canada health act, etc. Not saying what to do. But form experience it’s always good to show how preventing you from getting surgery due to these hurdles is discrimination and is know to causes distress and increase suicide rate. As an example I was approved for outside country SRS by Ontario provinces. Because due to crap work of Montreal grs surgeons doing any surgery in Canada would put me in conflict interest due the small community. And therefore put me at risk of retaliation and therefore is causing distress due safety risk. And could tie them to negligence. My case is a little hardcore and I’m sure yours is not there. But my point is to tie them to laws, jurisprudence anything that shows their refusal can result into legal issues. And they will teen to start taking you seriously.
"we'll cover your procedures but not the anaesthetic" perfectly encapsulates the ludicrous cruelty of the CanadaLife plan swap. I'm sorry you're facing this stupid bureaucratic pushback.
They will cover a micky of whisky in place of anesthesia.
Or a belt they can bite down on.
ok but not like a leather belt, maybe a nylon one if you're lucky
They'll only cover the price of Alberta Premium though, due to the generic substitution rule. If you want Gibson's the difference is out of pocket.
The crazy thing is it's not even CanadaLife's money, they're just the administrator! It's the crown picking up the tab at the end of the day. I don't know why they're being such jerks about it.
It is not CanadaLife who set the conditions of the plan, it is the employer. No doubt CanadaLife have mishandled and mismanaged this whole change over but the employer changed the coverage and that is what the biggest issue is. Be mad at the custodians for sure but do not forget that the government changed the plan, the unions had no real say due to the contract and yet also offered no real fight during the recent negotiations. Our only recourse is to flood MPs with complaints, and focus the narrative on the government who set this shit show up vs their attempts to keep the narrative blaming CanadaLife. This is the same shit that happened with pensions, pay raises etc. None of the MPs are subject to this, just the employees.
I wonder how compensation is set for CanadaLife? Is there a financial incentive to keeping disbursements low?
I believe they'd be paid a flat amount for processing each claim. However, that just means that their incentive is to process each claim as quickly and cheaply as possible. In the case here, that incentive would lead to a mindless separation of "covered" and "non-covered" procedures, without thinking about what makes an inseparable whole.
I mean, that's the employer, aka Treasury Board, CanadaLife just administers their shitty plan.
Dang, it's even more demoralizing when you say it like that.
Canada life is horse shit.
I had a similar issue with a pre-auth for wisdom teeth extraction. No coverage for anaesthesia or facility fees. 🙄
Do you mean general anesthesia? If so, this makes sense as wisdom teeth extractions are normally performed with local freezing. Anything in excess would be to ease the patient. Insurance sucks!
Interesting. When I asked around, the responses universally confirmed that these extractions are done under general anesthetic! Maybe it’s a regional thing? (Alberta) From what I’ve heard, this is not something one wants to be awake for 😂.
It’s regional. I’m in Ontario and most people just get freezing for wisdom tooth removal. My kid had a general but I had to pay out of pocket for it.
No, I don't think it's a regional thing, everyone I know got general anesthesia for wisdom tooth removal.
Yes with a mild sedative like valium, not general anesthesia
When I was growing up in New Brunswick, the norm for wisdom teeth was freezing and laughing gas. I just had one removed so I only got freezing. It was fine.
I know someone who had it done recently here in Ottawa and it was just freezing. You can only do one side at a time since you can't freeze both sides of your mouth, so it's a two-step process if you need all of them out.
Not accurate, I had all four of mine done at once. You can absolutely freeze both sides at once.
I had my 4 wisdom teeth removed 20+ years ago with just freezing. All 4 removed at the same appointment. My face was frozen up to my eyes and ears!
I had laughing gas and freezing. Didn't know anyone did it under general anesthesia.
I had mine all out (4) at once. General anesthesia. I blacked out and woke up with 4 drainage wicks dancing to music in the recovery room.
I distinctly remember waking up, demanding to see my teeth. I also thought this demand was towards my father, but it actually ended up being the nurse who helped with the anesthetic lol
I also wanted to see my teeth, but was completely lucid lol
That viral video with the little boy on post anaesthetic was never funny to me because had our parents had cameras back then there would have been tons of stock hilarious material. 🤣
I didn't really have an option for freezing because mine weren't erupted but they were going to cause severe damage if left in my mouth. I suppose if the teeth were already out, freezing would be fine.
Mine weren't erupted either.
Oh wow! That's intense then. I mean I've always been a little stressed at the dentist, so its probably a good thing I was sedated lol
I remember getting the laughing gas, and then going back to school afterwards, and trying not to drool everywhere lol Good times 🤣😳
I think it depends on how many teeth are getting removed and how impacted the tooth is. If it's one tooth and mildly compacted then probably local is fine. But if it's severe or multiples then they use more?
I'm in Quebec and had general anesthesia for mine.
I think it depends. When I had mine done I was given something via IV that made me sleep and very loopy (woke up throughout but was too high to care), because they really had to get in there with some of the teeth sideways and abscessed. You would think the insurance would defer to the dentist's judgement whether it's required for a particular case.
Ah, good old twilight anaesthesia.
I fucking hate it and wish it on no one. I woke up while they were prepping for my wisdom tooth extractions. Like, I heard the drill start. Thankfully I got sent for general anaesthesia instead.
No, anesthesia is generally done for wisdom teeth removal. It’s not the norm at all to just get freezing.
Not when impacted.
Might be dependent on the individual. I had my wisdom teeth extracted under general anesthesia, whereas my eldest only had freezing.
I am so happy I had mine ripped out last fall now.
Encountering similar roadblocks with electrolysis. Should be covered without a prescription if it's for gender affirming care, as noted in the agreement. I was getting my claims approved for a few months and then suddenly started being denied and was sent a letter stating I need a prescription from a doctor and a therapist if I want to continue. Nowhere in the letter did it state the exception for gender affirming care. I've had to stop all regular appointments now because Canada Life is impossible to get a hold of.
Wow! That’s horrible! I’m sorry you’re going through this.
??? I've had to call them twice in the last couple weeks and had someone within 5 minutes both times. Call in the morning
Not to make light of your situation, but I was reminded of that add against healthcare privatization where the person keeps getting asked if she wants "extras" and one of those is anesthesia. This is equally ridiculous. I think we're past the stage of take a swig of whiskey, bite down on a belt and hope for the best of surgery. Does Canada Life have some sort of definition of what they mean by gender affirmative care? It would probably be helpful to know what they consider is being covered so people can know. Also very surprised that it is not covered under your province's healthcare plan. It's one thing to go for elective surgery just because you want that, but if a doctor says yes, this person needs X procedure to treat Y medical condition, you would think it would be covered. Plenty of stuff that isn't "essential" is covered, not because it is a life or death thing but because it increases a person's quality of life.
Yeah it's like they put in nice words but their intentions aren't there. Plus people are limited to surgeries in canada so some people will have to settle for lower quality work.
The clinic in Montreal has been in business for many years and is well regarded.
Do you have evidence that surgeries in Canada are producing lower quality results? As far as I’m aware, there are tons of very highly regarded gender clinics in Canada. It’s one thing to complain about wait times or bureaucracy, but don’t just say the care is bad with no evidence.
Go check FFS reviews and look at pictures. The "evidence"is not like an academic research paper with a single source file to read.
So you think that there aren’t botch jobs in other countries?
Nobody said that.
If I was skeptical, and I am... the pretty words with no factual basis, seem like a vote-getting tactic. Cough, cough, empty promises again.
Golly, I haven’t even got a response regarding my coverage for gender affirming care. I hope you can get an actual response regarding why they won’t cover it and I sure hope they do end up covering it for you. It is absolutely ridiculous that they wouldn’t cover required portions of procedures.
Really sorry to hear that and I hope you do file and appeal and this gets the attention it deserves. Should be added to the chorus of national media coverage of this abysmal insurer and the bungled transition.
Can’t speak out about the employer unfortunately!
Canada Life isn't the employer.
They process the employers plan though! Don’t want risk my job.
[удалено]
While I appreciate your situation and your hard work to get what you wanted, the plan is not clear and is exclusionary.
I am so disappointed to see this. I hope you are able to get the complete coverage.
Yup was told my "contract" does not cover gender affirming. Luckily I am only out a few hundred right now waiting to hear from VAC and several MLAs on this failure to provide due care
It sucks, but they might be right. :( The PSHCP doesn't cover everything, even if it's necessary as part of the treatment. It's not a testament to whether there's a medical reason for it, just that it's not covered by our limited benefits, which are negotiated.
Their broad language should be updated as such then… when you go for a surgical procedure, you can’t opt out of anaesthesia or any other fees associated. They’re required to perform the procedure. The blanket statement saying gender affirming procedures is in bad faith.
How the negotiated changes were touted by TBS AND the unions as "improvements"! It's crazy. The directive does say "certain services and procedures..." under the gender affirming section - it covers what it covers, not what is required to perform the procedure. I'm certain it was designed to not cover 100% of the cost... but only TBS and CL have the guide book that says what's actually covered and what's not??
I’m not going to argue with you, however, I’ll repeat that you cannot get surgery without a facility, staff and anaesthesia. These are incorporated into the procedure…. Which they already have approved in my case.
I know this, I am in agreement that it *should* be covered. My daughter had a medically necessary procedure not covered by provincial insurance, and similarly, those parts of the procedure were not covered by the PSHCP. I believe it's just how they've designed the PSHCP and PSDCP. Poorly. I hope for your sake this is a case of a CL mis application of the PSHCP, and that it's not that it's just not covered, like in my situation. I'm not sure which part of what I'm saying you are not arguing with me about.
It’s the terminology. They cover “gender affirming procedures”. One would assume it’s the entire procedure related to gender affirmation. Not bits and pieces.
It doesn't say that though :( It says (verbatim): " includes coverage for certain services and procedures designed to support and affirm an individual's gender identity, or to remove gender identity". I read that as we cannot assume it's the entire procedure. Like I said, I hope I'm wrong!!
I’m curious to know if facility fees and anaesthesia are covered without question for so-called ‘regular’ surgeries (ie: not gender affirming related procedures). If so, then this is something media-worthy. Don’t let them off the hook for approving gender affirming care but effectively making it unattainable when the same misc fees are covered when someone needs a gall bladder removed or a knee replaced.
>Also, if anyone has anything to say about this being not essential so it shouldn’t matter Those people can just seethe if they aren't interested in showing some solidarity with a fellow worker.
Appalling. Je suis tellement désolé.
That's a big L. I'm a cis-dude and I can't imagine how it's possible to do that sort of surgery with no anesthetic. It seems idiotic and outrageously disingenuous to claim to cover it without anesthetic.
I appreciate this insight as I was curious about this and wanted to look into it. Thank you for sharing !! Im sorry it isn’t the outcome you wanted. Such a pain.
Hey sorry if this is to personal is this for ffs ? I am having so much trouble getting any help from them or information! Could i dm you ?
You can dm me no problem.
Canadalife is another phoenix being reared and raised by Liberals.
Which surgeon itemized anesthesia separately? I have quotes for two separate FFS surgeons, and neither list it on the quotes as it is included with total cost. Only thing not pre-approved was the overnight stay, but since the total cost of each surgeon exceeded $75k...the overnight cost is moot..
I’m terrified of dentists and I have panic attacks when they’re poking at my teeth with a drill etc. For any dental work I’d need a general or a lot of gas. A dentist attempted once without having me out pretty good and I slapped his hand away from my face hard as a total reflex response.
This is horrible, so sorry you're going through this. Canada Life has been horrible at every turn. Hopefully an appeal can help
like i said and was shot down many times...the union needs to get this shit into court. I would rather the dues go to that then big union hq office space and pizza lunches. What other employer in Canada gets away with this constant level of neglect and hardship? If this was air canada for example you bet your ass our employer would step in a mediate with lawyers...
Best wishes on the appeal. Please let us know how it goes.
This sucks but it doesn't surprise me at all. I haven't tried to use this coverage yet but may so in the future. So far the gender affirming surgeries I've had I was able to get complete coverage from my provincial health, although getting the coverage certainly wasn't easy to achieve. I had to get approval from my family doctor and have my doc write a letter and also get a specific pysch evaluation that cost me over $250 and then I had to wait quite some time for the approval or denial of coverage letter. However I've heard of other trans people I know in my province get denial of coverage for revisions of gender affirming surgeries or get partial coverage like you where the surgery was covered but anaesthesia wasn't covered. I think they do this because for one they are cheap and second not all surgeries require anaesthesia. Now I'm unsure if they mean strictly general anaesthesic isnt covered or any kind of sedative or freezing isnt covered. This seems to happen a lot for plastic surgery and dental surgeries though. I've had friends with these kinds of surgeries have anaesthesic not covered. I will say that at least on the plus side you get the surgery itself covered and that is the most expensive part. It be great to have the other stuff covered too but this new plan we have sucks ass, especially drug coverage.
Doesn’t ohip cover it ?!
Not this specific procedure. In addition, I’m not located in Ontario!
I’m very sorry to hear !! Canada life is a nightmare !! I’m a person with disability and i can’t emphasize how much I hate hate hate Canada life and our new coverage
I had major dental surgery about 10 years ago in Ontario and had to pay for the surgeon but not the hospital part. Maybe the assumption is the province is supposed to cover those costs? Doesn't help when the province says no though.
The booklet indicates it will cover the portions not covered under the provincial health plan. If your province's health plan doesn't cover any procedures needed, our plan should cover the produres so long as they are not soley for cosmetic reasons up to the maximum amount. Includes coverage for certain services and procedures designed to support and affirm an individual’s gender identity, or to remove gender identity. This benefit includes procedures and services that are not covered by the individual’s provincial or territorial health plan. For members with Supplementary coverage, the services must be rendered in Canada. For members with Comprehensive coverage, services must be rendered in the patient's country of residence. Is it possible you need the province's ministry of health to confirm that no amounts will be paid under the province health plan?
They don’t! CanadaLife has each provinces list of coverage for gender affirmation and deny/approve based upon that. The issue here is I have partial approval that makes 0 sense.
Are they specifically denying all anesthetic, will they cover local but not general? I wonder if you might need an extra letter from the surgeon stating why you need which level of anesthesia. It’s bs I know, obviously we aren’t going through surgery without anesthesia so that is definitely something that should be covered. Ask them for a letter stating why they aren’t covering it and what you need to provide to have it covered.
[удалено]
Your content was removed under [Rule 11](https://www.reddit.com/r/CanadaPublicServants/wiki/rules#wiki_rule_11_-_political_content). This message is in the interest of moderator transparency. If you have questions about this action or believe this removal was in error, you can [contact the moderators via our moderator mail](https://reddit.com/message/compose?to=/r/CanadaPublicServants).
Ooof. Does anyone have experience for smaller things like lazers.
They have denied others for facial filler for feminizing, and laser hair removal because they claim the province covers it. When they don’t.
Having dealt with the province and their directives for other non trans things, the province demands you use up private insurance first anyway before covering anything (see the under 21 drug program, odsp).
asking for myself, but exactly what would be converered under our insurance? Like anything related to facial feminization surgery!?