A Costly Guess

Ministry of Health and Long-Term Care

Date: 2008

Guess

A patient diagnosed with prostate cancer was turned down by the Ontario Health Insurance Program (OHIP) for a surgical procedure that he and his physician believed to be available only in the United States.

After spending $40,000 on the U.S. surgery, however, the man learned that it had in fact been available in Ontario, but OHIP officials had failed to inform him of this.

The Ombudsman’s investigation found that OHIP’s letter of denial was too vague for either the patient or his physician to understand; it certainly did not make it clear that the man could have had the surgery at home.

Presented with the Ombudsman’s findings, the Ministry of Health and Long-Term Care agreed to reimburse the man for $30,000.

 

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