Dental implants
The Ministry of Health and Long-Term Care agreed to fund dental implants for a 55-year-old cancer patient who required extensive reconstructive facial surgery.
The Ministry of Health and Long-Term Care agreed to fund dental implants for a 55-year-old cancer patient who required extensive reconstructive facial surgery. The Ministry also acknowledged that there may be others in such exceptional circumstances and undertook to address the gap in the system to allow them access to funding for dental implants.
Case update - 2012-2013 Annual Report
In his 2009-2010 Annual Report, the Ombudsman highlighted the case of a cancer sufferer who was refused funding for four dental implants after surgery on his jaw and palate. Three years of co-operative work between Ombudsman and Ministry staff have resulted in a new program for patients in similar situations – all without need for a formal investigation.
The 55-year-old man suffered from squamous cell carcinoma and his treatment, beginning in 2006, had involved extensive surgery to remove cancerous tissue and bone from his face and mouth. He also underwent reconstructive surgeries and skin grafts, followed by chemotherapy and 28 radiation treatments.
By January 2007, he was unable to speak or eat properly because so much bone had been removed from the left side of his face. His physical and psychological condition deteriorated and his doctors determined that he needed a prosthesis and the insertion of four titanium screws (dental implants) into what remained of his jawbone.
He applied for Ontario Health Insurance Plan (OHIP) funding but was turned down on the basis that dental implants are not “insured devices” and are considered “cosmetic.” His subsequent appeal to the Health Services Appeal and Review Board was also turned down because, though acknowledged as medically necessary, the implants were not listed in the Schedule of Benefits for Dental Services.
The man complained to the Ombudsman in September 2009 and SORT conducted a preliminary investigation. OHIP officials took the position that dental implants are not insured, as they are generally used in cosmetic dentistry. However, after further discussion with Ombudsman staff, Ministry officials acknowledged the man’s case was exceptional, and in October 2009 agreed to fund the implants, which he received in summer 2010.
SORT continued to investigate the potential systemic implications of this issue. Some 22 complainants came forward between January 2009 and March 2013 who similarly needed dental implants for non-cosmetic, medically necessary purposes resulting from catastrophic events such as cancer.
Ombudsman staff remained in contact with Ministry officials, including the Deputy Minister, as a program to help these people was developed. The Ministry launched its new Oral and Maxillofacial Reconstruction Program on April 1, 2013. Under this $5-million annual program, the province will provide funding for implant-retained maxillofacial intraoral prostheses to restore oral function for patients who have no other treatment alternatives.