Minister vows changes on out-of-country health claims

Alberta Health Minister Ron Liepert supports the Alberta Ombudsman’s recommendations to improve quality and fairness of decisions made by the Out-of-Country Health Services Committee and Appeal Panel.

Alberta Health Minister Ron Liepert supports the Alberta Ombudsman’s recommendations to improve quality and fairness of decisions made by the Out-of-Country Health Services Committee and Appeal Panel.

The minister met with ombudsman Gord Button on July 20, after the minister missed a July 10 deadline to respond to Button’s report Prescriptions for Fairness.

“It was a very positive meeting,” said Glen Resler, director of corporate services with the ombudsman.

“For all the recommendations, there wasn’t any disagreement on any of them. Some will require regulatory changes and the minister has agreed to champion that process.”

Button’s report is based on an investigation announced last December after applicants were denied funding by the committee or panel without a clear explanation as to what evidence was considered and what criteria were used.

In many cases, the committee and panel determined services were available within Canada, but did not explain how they reached that conclusion, including what is considered a reasonable wait time for health services in question.

Resler didn’t know whether more Albertans would be compensated for out-of-country health care once the recommendations are implemented.

“That we can’t answer. But if they were rejected, they would know why it was rejected. Or if they’re told that the services are available locally, provincially or in Canada, they will get more specific information on where that can be obtained.”

Recommendations include:

• After a hearing has taken place, applicants should receive complete disclosure of the decision, including the findings of fact and how the evidence was weighed in the hearing.

• Physicians and dentists should complete and submit applications for funding on behalf of Albertans, with supporting documentation from specialists.

• Improving the accountability and transparency of the Out-of-Country Health Services Committee, the Out-of-Country Appeal Panel and the Department of Health and Wellness.

• Improving training for the review bodies.

• The appeal panel should re-hear four cases because of issues of administrative unfairness identified during individual investigations. This recommendation is not new. The ombudsman previously asked the appeal panel to re-hear these cases and those requests were denied.

Two of the four cases involve Red Deer residents — a mother who took her twin toddlers to Chicago for help with their severe sleeping disorder in 2005 and a woman who had lung cancer surgery at the Mayo Clinic in Minnesota in 2003.

The ombudsman has given Liepert until Sept. 3 to implement the recommendations or have a plan to implement them.

The appeal panel members met to discuss the recommendation to rehear the four cases on Wednesday. The ombudsman expects their decision in early August and he will respond to the decision later in the month.

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