Canadian Forces veteran Chris Upsdell of Red Deer was initially charged $380 for anesthetic he needed for a surgery. He had to make several phone calls before his insurer finally agreed to pay for the expense.

Veteran fights to get insurer to pay for anesthetic

Red Deer man was shocked when he was told he’d have to pay for the anaesthetic that would be used during his non-elective oral surgery.

A Red Deer man was shocked when he was told he’d have to pay for the anaesthetic that would be used during his non-elective oral surgery.

“It’s a bit ridiculous,” said Chris Upsdell, a veteran who served with the Canadian Forces for 17 years. Alberta Health “say they cover the surgery but they don’t.”

Upsdell, 43, was told that Alberta Health would cover the procedure but not the drugs that would put him out — a necessity for the soft tissue biopsy he had done on his lip last week.

“It’s like saying you’ll pay for the surgery but you don’t get any instruments; doctors got to use a chisel.

“I asked the doctor if I should I bring a bottle of whisky. He laughed but what’s a person to do if they can’t afford the anaesthetic?” The cost of the anaesthetic for the 15-minute surgery was $380, Upsdell said.

“I have bills just like everyone else. I have kids. I can’t pay that up front.”

According to Upsdell, Sun Life Financial, which handles insurance for the veterans who opt in on the plan, initially told him they couldn’t help him with the costs because the surgery was being covered by his provincial health care.

“They said they don’t cover surgeries that are covered by the province and that’s how it is but they did say they’d look into it,” said Upsdell.

On Thursday afternoon, Upsdell said he heard back from Sun Life with good news: they would step in to help cover what Alberta Heath didn’t, paying $342 of the total bill.

“I’m extremely pleased but I had to fight for it. What if this was happening to someone who didn’t know how to advocate for themselves?”

Upsdell served in Bosnia and numerous other areas across the globe before leaving the forces in 2006.

He’s now works in the non-profit industry, assisting unemployed and underemployed individuals, some with mental health issues.

“I kept thinking about the people I work with. Others in the situation would just pay it or low-income folk would just say ‘Well I guess I can’t have the surgery’ and wait until it becomes an emergency. That’s not OK.”

Upsdell said the surgery wasn’t exactly a matter of life or death but it was infected and he was told it could eventually spread to his brain.

“They didn’t make me pay upfront because I told them I was trying to get more information. So the surgeon’s office was great. I still think it’s a bit of a cop out on Alberta Health’s part because they say they’re covering the surgery but they’re not covering it fully.

“It just doesn’t sound right to me. I get colonostrophies because I also have colitis and it’s the same drug they give me when I get a colonostrophy and I don’t have to pay for that.”

Timothy Wilson, issues manager at Alberta Health, said the only time a patient would be charged for anaesthetic is when it’s for a service or procedure that is being administered by someone who is not a doctor, such as a dentist, or if the service the anaesthetic is begin administered for is not covered under the health care insurance plan, such as cosmetic surgery.

According to Jessica Johnson, assistant director of communications at Alberta Health, oral surgeons are not medical doctors.

“They are specialists in the field of dentistry and they bill under the Oral and Maxillofacial Schedule of Benefits (OMSB),” she said. “Mr. Upsdell’s procedure is covered under the OMSB as it was an insured procedure. Without knowing specifics about what kind of anesthetic he received, it’s hard to say for sure, but for this procedure, anesthetic was not an insured service as it was not administered by a physician (anesthetic it is not a benefit listed under the OMSB).”

She noted that a local anesthetic is “part and parcel of the procedure,” but that a general anesthetic would need to be administered by a physician, and as such is “compensated under the Schedule of Medical Benefits, covered under the Alberta Health Care Insurance Plan.”

That said, “if a patient opts for an anesthetic over and above the local anesthetic covered under this procedure, any extra costs become the patient’s responsibility,” she said.

rfrancoeur@bprda.wpengine.com

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