Getting Boston's scleral lenses covered in Canada?

[Guest]

Hi all,

I've had success with getting my airfare covered by Manitoba Health... but so far, the PROSE lenses themselves are still left for me to pay.

I had thought I might have a lead on a doc who knew how to get them covered by Health Canada, but my own doc heard back from her and it turns out that she got it covered for her patients via B.C.'s provincial health dpt. Since I'm not in B.C., that won't help me

So... thought I'd ask if any Canadians here have had any luck getting the lenses themselves covered...

[Guest]

Found this on Health Canada's website... wondering if this might be an angle worth pursuing? http://www.hc-sc.gc.ca/dhp-mps/acces.../index-eng.php

Has anyone gone this route?

[Hopeful2]

Hi SAAG,

I recently spoke with someone from Canada who was one of the first Canadians to go to BFS. She told me that she has worked with Health Canada to ensure that all the fees are covered for Canadians.

I'll PM with details.

[spmcc]

RE: sclerals in Canada

Bummer! I think your doctor spoke to my doctor in BC and found out that bad news! I could have sworn, tho, that my doctor said "covered by Health Canada" and not "covered by BC MSP" (Medical Service Plan). Hmmm.

I didn't pull up the link you posted above, but I can't see how sclerals aren't just like crutches or wheelchairs which (I believe) are covered (by whomever)!

I also think that our provincial and/or federal health coverage is just like all insurance programs/services... they deny everything right off the bat. You have to go back to them, maybe multiple times, scream and yell and annoy them until they submit! I'm sure you know that a good doctor willing to fight, good documentation of your history, and research/medical literature to back up your claim are key.

The other option, since I've been hearing more and more about doctors in Canada fitting sclerals, is to bite the bullet and stay in Canada. There was a recent post about sclerals in Toronto. I also heard that a place in Halifax is using the same sclerals as BFS (same manufacturer). The only problem there is that I got that info prior to PROSE (and from my doctor in BC who seems to be able to get things). There's also a Dr. Lee in Vancouver who is fitting sclerals. I know of one person from DEZ who saw him.

Anyway, good luck with everything (and, fyi, I'm getting a PM ready to send to you, SAAG).

[canndym]

Hi I am from Saskatchewan and just started the process of being referred to the LA PROSE clinic and trying to get provincial coverage. I spoke to a lady from Alberta who had full coverage. She said she knows a few people in Ontario that have also been covered. So far speeking to BFS and LA clinic does not sound like anyone from Saskatchewan has been to either of those clinics. I spoke to a doctor on the provincial board and he was not optimistic but my speicialist is still trying for me. I have asked about the sclerals in Canada and my specialist felt most people find them painful and do not tolerate them well so I would be worried to try them with the scarring I have.
Does anyone have more information on scerals in Canada and if they are covered and better tolerated now?

[spmcc]

RE: Canada

Oh, that's another way to get the info you need, SAAG... call BFS and they can tell you if they've had others approved from your province. I remember (waaay back in 2009) that BFS confirmed with me that they had others from BC who were covered. I never asked specifically if it was through Health Canada or BC MSP... but maybe they would have that information if asked?? If you can find others, you could jump on the "precendent" bandwagon.

I looked at the link you posted and that's the same program my doctors used to get me Restasis starting in 2003 (long before approved in Canada). I was told by my doctor that if there's anything in the world, by prescription, that you need, your doctor can get it for you. Of course, there's paperwork... and your doctor must show that you need it... but you can get it covered. That's the rule.

[Guest]

Thank-you for the PM's everyone! My doc is totally willing to fill out any paperwork that I need... he's been fantastic. But he's never sent anyone to Boston before, so getting those lenses covered is new for him too. He had spoken to another Manitoba doctor who sent a patient to Boston, but that doc only knew about getting the airfare covered by Manitoba Health, and not about getting the lenses themselves covered.

I e-mailed new patient inquiries: (on BFS website)
Nancy Lemist
Email: nlemist@bostonsight.org
Phone: 781-726-7501

Hopefully I'll hear something back soon... was hoping they could tell me if anyone locally has gotten them covered, and if so, what the procedure is...

Wish this wasn't all so complicated... but it will be worth it if I can get the lenses covered since they are so expensive...

If we can figure this out and post the solution here, then at least future Canadians in our shoes that look here will have an easier time navigating this whole thing...

[canndym]

Hi
I think you will find the BFS very helpful. Nancy got back to me right away and answered all my questions. She also linked me to the person who does the coverage and that is where I found out about then never having anyone from Saskatchewan. Since I know I will forsure be paying the airfare myself I decided to go to LA clinic instead. There are annual follow ups so I thought this will be a big cost over time. The LA clinic has been really nice and helpful to deal with as well. The LA clinic said they have had Canadians come with coverage but anyone who goes and tries to get coverage afterwards has been denied she found. I know Saskatchewan will not cover anything that was not preapproved. I know the BFS and LA clinic also have financial help for those who qualify. I am not looking into that myself but it is an option for some people.

[Aaron77]

In Alberta your doctor must submit an out of country health services claim that has to be aprroved by a panel. He is saying that once they see the word lasik in my history that they will reject it - I've passed the paperwork on to his office but am not sure yet what has been done with it. Alberta health care has told me that they will only pay for the consult if a pproved and that I will have to pay for the lenses. At this point in time I've decided to go to Boston whether or not anything is covered, to get a significant improvement in my quality of life at this point in time seems like it would be worth the cost - but of course it is somewhat of a gamble as I can't be sure this venture will be a success.

[Hopeful2]

I would think that Health Canada would still cover you even if you had lasik. Who is to say that you would not have developed dry eye anyway. Besides lasik dry eye is only supposed to last for 6 months. You (and the rest of us lasik victims) would have a very good argument in suggesting that this dry eye, wether lasik induced or not, is still dry eye and requires treatment. I would be absolutely shocked if Health Canada refused to treat us. There are at least four of us who will be checking out Boston. Actually I believe we now total five (given info from other DEZ members). Brennan is looking for another follow up to the 16 x 9 documentary which aired this Spring, concerning the dangers of Lasik. . . difficulty in getting Health Canada coverage might just be the story they are looking for. Actually, maybe just the fact that we are looking for this service might be enough to attract public attention and government action. I wonder how many other Canadians are out there suffering from post lasik dry eye???

Be prepared to spend up to two weeks being fitted. Accommodation is $35 / night with breakfast included. On the plus side, BFS has the PROSE (scleral lens) manufacturing machine right on the premises. . . this cuts down on turn around time. . . and increases the likelihood of a comfortable fit. When the lens fits nicely. . . dry eye sensation disappears : )

Another thought entirely, if we ( post lasik dry eye victims) are as rare as the lasik industry claims we are, shouldn't the industry set up some kind of insurance fund to help look after our needs?

I think there are a few issues here. . . Health Canada coverage. . . Global tv follow up program. . . industry insurance fund. . . Health Canada insurance fund ( after all they have approved the Lasik procedure).

Please share your thoughts on any of the issues mentioned here.

[Guest]

Update: Spoke with Nancy from BFS... she put me through to Donna from billing - she's been able to get the consult and fitting covered, but has never seen the lenses themselves covered by Health Canada.

This is really interesting to me... we always think that everything medically necessary is covered for us here in Cda, but apparently not... I'm lucky that I can afford to buy the lenses myself... but this is really crummy for anyone who can't... doesn't seem right, especially considering the fact that these lenses can make the difference between being really disabled/chronic pain from dry eye or whatever and leading a more normal life. Apparently people may be able to get funding from the Lions eye bank???? but since they are a charity, it is based on financial need...

Anyone else find out anything different?

[Hopeful2]

Thanks for the update SAAG. What is the cost breakdown? Are consult and fitting half the cost (i.e. $5000)? I'm surprised that Health Canada does not cover the cost of the lenses.

There is a form somewhere, a PDF file that addresses the Province of Ontario covering the cost of the PROSE lens. I would think that if Ontario covers the cost, then the other provinces would as well. . . I can't find it right now but will post it when I find it.

[Guest]

Yes, she did mention something about OHIP? I assume that's Ontario's health dpt?... If I understood correctly, it sounded like OHIP would pay for the lenses themselves... but double check that...

My letter from Manitoba Health specifically states that the cost of the PROSE lenses will be my responsibility....

[Hopeful2]

Assistive devices Ontario covers prosthetic scleral shells. I have a phone call to them. . .Hopefully will get good news.

https://ozone.scholarsportal.info/bi...9/1/257852.pdf

[Guest]

Update: - I just spoke with Christine at Health Canada - that coverage for medical devices only applies if the device is going to be used/fitted in Canada... so if one is going to the U.S. to have the device fitted etc., then Health Canada does not cover it.