Paula required oral surgery to repair an overbite but the procedure she needed was not covered by the provincial Medical Services Plan (MSP). She had contacted the Ministry of Health and was advised that the decision to not to cover the costs associated with her condition aligned with its policy and that the ministry would not be able to assist further.

Paula disagreed with this decision as the oral surgery she required was a result of a surgeon’s errors. Frustrated, she contacted our office for assistance.

We reviewed the ministry’s coverage schedules and applicable policies and confirmed that Paula’s condition was not covered, and the decision not to extend coverage was fair. However, the ministry accepted that the woman’s initial surgical consultation was eligible for MSP coverage as it followed an insured surgical procedure. As such, the ministry wrote to Paula’s dental surgeon and requested that he reimburse her $250. The ministry also wrote a letter to Paula advising her of its decision and that it had directed her surgeon to repay her.