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Insured in time

A cancer patient who had appealed OHIP’s decision to deny him coverage complained to us when he did not receive a response within the Ministry of Health’s posted deadline. He had been living overseas for several years and OHIP had denied him coverage because he lacked proof of residency in Ontario. …
A cancer patient who had appealed OHIP’s decision to deny him coverage complained to us when he did not receive a response within the Ministry of Health’s posted deadline.
/en/our-work/case-stories/insured-time

Worth the trip

A woman sought our help after her application for an overnight accommodation allowance was denied by the Northern Health Travel Grant because she did not meet the minimum distance requirement. She said her health needs required an overnight stay, and she had been granted many other travel …
A woman sought our help after her application for an overnight accommodation allowance was denied by the Northern Health Travel Grant because she did not meet the minimum distance requirement.
/en/our-work/case-stories/worth-trip

Uncovered

A concerned social worker at a psychiatric hospital asked us if we could help a patient whose OHIP coverage had been suddenly cancelled. We discovered that the man had immigrated to Canada more than 50 years ago, and was under the guardianship of Ontario’s Office of the Public Guardian and Trustee, …
A concerned social worker at a psychiatric hospital asked us if we could help a patient whose OHIP coverage had been suddenly cancelled.
/en/our-work/case-stories/uncovered

A second look

A transgender woman complained that the Ontario Health Insurance Plan (OHIP) had improperly refused her application for prior approval for breast reconstruction surgery. The woman explained that due to medical treatment she had undergone as an adolescent, she required additional reconstructive …
A transgender woman complained that the Ontario Health Insurance Plan (OHIP) had improperly refused her application for prior approval for breast reconstruction surgery.
/en/our-work/case-stories/second-look

Cost of living

After waiting many months for a response from Ministry officials about his experience, a man who had to relocate from Northern Ontario to Toronto for a lung transplant finally had his voice heard through our Office. Although he qualified for the Ministry’s Transplant Patient Expense Reimbursement …
After waiting many months for a response from Ministry officials about his experience, a man who had to relocate from Northern Ontario to Toronto for a lung transplant finally had his voice heard through our Office.
/en/our-work/case-stories/cost-living

Split difference

A divorced recipient of Trillium Drug Plan coverage complained to us that his access to the benefit was affected because his ex-wife would not provide a letter stating that he was no longer covered by her private insurance. Although such a letter is normally required under the program’s policies, …
A divorced recipient of Trillium Drug Plan coverage complained to us that his access to the benefit was affected because his ex-wife would not provide a letter stating that he was no longer covered by her private insurance.
/en/our-work/case-stories/split-difference

It’s in the (e)mail

A woman contacted our Office after learning her OHIP coverage had been suspended while she was studying outside of Ontario, despite the fact that she had emailed her renewal documents to OHIP several times. We asked that her file be reviewed by OHIP’s eligibility committee, which determined that …
A woman contacted our Office after learning her OHIP coverage had been suspended while she was studying outside of Ontario, despite the fact that she had emailed her renewal documents to OHIP several times.
/en/our-work/case-stories/its-email

The Right To Be Impatient

The to be Whether the Ministry of Health and Long-Term Care has failed to properly administer Newborn Screening in Ontario. O M B U D S M A N R E P O RT ANDRÉ MARIN | OMBUDSMAN OF ONTARIO | SEPTEMBER 2005 INVESTIGATIVE TEAM Director Special Ombudsman Response Team (SORT) Gareth Jones Investigators …
Investigation into whether the Ministry of Health and Long-Term Care has failed to properly administer newborn screening in Ontario.
/en/our-work/investigations/right-be-impatient

Testicular implants for boys: A Medical Necessity

The Ministry of Health and Long-Term care restored funding for testicular prosthesis surgery for boys under 18. Because the issue was resolved, no report was published. … Testicular implants for boys: A Medical …
The Ministry of Health and Long-Term care restored funding for testicular prosthesis surgery for boys under 18.
/en/our-work/investigations/testicular-implants-boys-medical-necessity

Out-of-country cancer care: The Out-of-Country Conundrum

The Ministry of Health overhauled its out-of-country care program and paid $75,000 to a chemotherapy patient who was wrongly denied coverage. No report was issued. Case update - 2007-2008 Annual report When Suzanne Aucoin came to the Ombudsman’s Office in 2007, she was fighting two battles: She was …
The Ministry of Health overhauled its out-of-country care program and paid $75,000 to a chemotherapy patient who was wrongly denied coverage.
/en/our-work/investigations/out-country-cancer-care-out-country-conundrum

OHIP: The Difference a Few Days Make

Coverage was granted to a 94-year-old man who moved back to Ontario from the U.S. and broke his hip 38 days before his Ontario health insurance eligibility was to take effect. No report issued. … OHIP: The Difference a Few Days …
Coverage was granted to a 94-year-old man who moved back to Ontario from the U.S. and broke his hip 38 days before his Ontario health insurance eligibility was to take effect.
/en/our-work/investigations/ohip-difference-few-days-make

Assistive Devices: Life and Breath

The Ministry of Health and Long-Term Care agreed to fund the home use of oxygen saturation monitors for children with life-threatening respiratory conditions, and to review the entire Assistive Devices Program. No report was issued.  Case update - Annual report 2007-2008 In February 2007, SORT was …
The Ministry of Health and Long-Term Care agreed to fund the home use of oxygen saturation monitors for children with life-threatening respiratory conditions, and to review the entire Assistive Devices Program.
/en/our-work/investigations/assistive-devices-life-and-breath

Positron Emission Tomography (PET) program

The Ministry of Health and Long-Term Care announced funding for Positron Emission Tomography scans for certain indications in the wake of this investigation of the Ministry's process for evaluating the technology, and practices in other provinces. Because the issue was resolved, no report was …
Investigation into the Ministry of Health and Long-Term Care’s administration of the Positron Emission Tomography (PET) program.
/en/our-work/investigations/positron-emission-tomography-pet-program

A Vast Injustice

Investigation into the Ministry of Health and Long-Term Care’s decision-making concerning the funding of Avastin for colorectal cancer patients OMBUDSMAN REPORT • André Marin, Ombudsman Of Ontario • September 2009 DIRECTOR, SPECIAL OMBUDSMAN RESPONSE TEAM (SORT) Gareth Jones LEAD INVESTIGATOR Mary …
Investigation into the Ministry of Health and Long-Term Care’s decision-making concerning the funding of Avastin for colorectal cancer patients.
/en/our-work/investigations/vast-injustice

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 also acknowledged that there may be others in such exceptional circumstances and undertook to address the gap in the system to …
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.
/en/our-work/investigations/dental-implants

Long-term care

The Ministry of Health and Long-Term Care incorporated the Ombudsman’s suggestions in its ongoing upgrade of its monitoring of long-term care facilities after he identified serious systemic problems. Since the Ministry’s efforts are “a work in progress,” in lieu of a report, the Ombudsman released …
The Ministry of Health and Long-Term Care incorporated the Ombudsman’s suggestions in its ongoing upgrade of its monitoring of long-term care facilities after he identified serious systemic problems.
/en/our-work/investigations/long-term-care

Going the distance

The owner of a home for adults with mental health issues contacted the Ombudsman, frustrated that he couldn’t get ODSP or Developmental Services Ontario (DSO) to provide funding to take one of his residents to her cancer treatments. The resident wasn’t capable of travelling to the treatments by …
The owner of a home for adults with mental health issues contacted the Ombudsman, frustrated that he couldn’t get ODSP or Developmental Services Ontario (DSO) to provide funding to take one of his residents to her cancer treatments.
/en/our-work/case-stories/going-distance

Pearly rights

A woman whose teeth had been damaged as a result of physical abuse by her partner years earlier contacted the Ombudsman for help in obtaining funds to have them fixed. In 2009, she had been awarded $20,000 in compensation for pain and suffering by the Criminal Injuries Compensation Board, which …
A woman whose teeth had been damaged as a result of physical abuse by her partner years earlier contacted the Ombudsman for help in obtaining funds to have them fixed.
/en/our-work/case-stories/pearly-rights

Handling with care

The aunt and uncle of a 16-year-old boy with Down Syndrome needed help finding the boy a place to live after his mother died of cancer. They were concerned that they would not be able to care for him because they lived 270 kilometres away, both worked odd hours, and, due to their age, wouldn’t be …
The aunt and uncle of a 16-year-old boy with Down Syndrome needed help finding the boy a place to live after his mother died of cancer. They were concerned that they would not be able to care for him because they lived 270 kilometres away, both worked odd hours, and, due to their age, wouldn’t be able to look after him on a long-term basis.
/en/our-work/case-stories/handling-care

Rehab reset

A mother complained to the Ombudsman after she was forced to pay $7,000 for a spot for her adult daughter in a residential treatment program for women with substance abuse issues. The daughter was just two days into the five-week program when a spot became available that was publicly funded through …
A mother complained to the Ombudsman after she was forced to pay $7,000 for a spot for her adult daughter in a residential treatment program for women with substance abuse issues.
/en/our-work/case-stories/rehab-reset