Travel costs for medical care covered afterall

Authority Ministry of Social Development and Social Innovation
Details

Rosa lives in a rural community and called us after the ministry refused to assist her with travel costs to see her eye prosthesis specialist in Vancouver. Rosa explained that she has two prosthetic eyes and that every three years she has to see her eye prosthetic specialist to ensure that the prostheses are properly fitted and to address any medical issues arising from the prostheses. She noted that there are no specialists in her region of the province.

Rosa receives disability assistance. She said that for the past ten years the ministry had provided funds for travel to her medical specialist appointments in Vancouver. However, this time she was told the ministry would not help her.

When a person is on disability assistance, he or she has access to extended health benefits, including medical transportation costs. We wondered what had changed to cause the ministry to refuse Rosa’s medical transportation request, given that there was a history of the ministry providing assistance, there appeared to be a legitimate medical need and nothing seemed to have changed based on the information available.

We contacted the ministry supervisor responsible for assessing medical transportation requests in the region. We said we were investigating to ensure the ministry followed a reasonable process for assessing Rosa’s request for a medical transportation supplement, including whether the ministry took all of the relevant information into consideration.

The supervisor told us that the ministry did not as a rule approve medical transportation for travel to appointments to this type of specialist and that they had assessed the appointment as cosmetic rather than medical. We reviewed the information that Rosa had shared with us and shared previously with the ministry regarding the medical nature of the appointment with the supervisor. He agreed to review the decision making process in Rosa’s case.

When we followed up, the supervisor told us that he didn’t find sufficient information on the ministry’s record and therefore had asked his staff to call the specialist and get additional information about the purpose of Rosa’s appointment. He told us that the ministry had learned that because there are changes to bone and tissue in these kinds of cases, and medical problems can arise as a result, it is necessary to refit the prostheses every three to five years. He said that based on the information the specialist provided, the ministry changed its decision and approved Rosa’s request for medical transportation assistance.

We called Rosa and informed her that the ministry had changed its decision and her medical transportation request was approved.

Category Health
Type Case Summary
Fiscal Year 2013
Location The Interior