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June 25, 2019

25 June, 2019

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.

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June 25, 2019

25 June, 2019

Uncovered

A concerned social worker at a psychiatric hospital asked us if we could help a patient whose OHIP coverage had been suddenly cancelled.

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June 26, 2018

26 June, 2018

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.

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June 26, 2018

26 June, 2018

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.

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June 26, 2018

26 June, 2018

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.

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June 27, 2017

27 June, 2017

Delay headache

A woman whose migraine medication is covered through the Exceptional Access Program contacted us because she was worried about how long it was taking the program to approve a renewal of her prescription.

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June 27, 2017

27 June, 2017

Got him covered

A man who had lost all of his identification a few years earlier sought our help because he was unable to get health coverage through OHIP.

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November 8, 2016

8 November, 2016

Welcome home

A senior contacted our Office after restrictions were placed on his visits with his wife at her long-term care home, after he raised concerns with a nurse about his wife’s care.

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November 8, 2016

8 November, 2016

Fire protection

A man whose home and important documents were destroyed by fire complained that he was having trouble renewing his Ontario health card.

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November 8, 2016

8 November, 2016

Retroactive relief

After the Trillium Drug Program denied a woman drug benefits that she had previously received, our staff raised the case with a senior analyst at the Ministry, who found the information she had submitted about her private insurer’s drug coverage had been inconsistent.

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November 8, 2016

8 November, 2016

Finding compassion

A woman complained to our Office on behalf of her 34-year-old daughter, who requires a specially-made drug at a cost of $200 per month.

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November 8, 2016

8 November, 2016

Timely medicine

A mother whose son has a developmental disability and is medically fragile complained that her son’s medication costs were no longer being covered since he had been placed in a group home funded by the Ministry of Community and Social Services.

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July 28, 2015

28 July, 2015

A sign of relief

A mother was concerned about the lack of support and funding for her 19-year-old son, who has autism and aggressive behavioural issues. He had recently been taken to hospital by police after an incident when he became agitated and violent.

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July 28, 2015

28 July, 2015

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 able to look after him on a long-term basis.

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July 28, 2015

28 July, 2015

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.

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July 28, 2015

28 July, 2015

Good medicine

A woman who was experiencing a third occurrence of HER2-positive breast cancer was denied funding by the Ministry for the chemotherapy drug Kadcyla, although it was prescribed by her oncologist. The Ministry would fund the drug for women experiencing a second occurrence of the disease, but not a third – despite scientific evidence that women with third and even fourth occurrences did benefit from the drug.

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July 28, 2015

28 July, 2015

Lost in the mail

A 62-year-old woman with Crohn’s disease required infusions every eight weeks at a cost of $4,542.76 per treatment. The woman’s private insurance covered 80% of the costs, while the Trillium Drug Program reimbursed her for the remainder, but she was reaching the lifetime maximum for her private insurance coverage and it was about to end.

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July 28, 2015

28 July, 2015

Failure to communicate

After the removal of a benign brain tumour, a woman in her 20s suffered a stroke that left her unsteady on her feet, needing assistance to use the bathroom, and with speech difficulties. She had to be hospitalized several times and was placed in the complex care unit of a local hospital for four months.

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July 28, 2015

28 July, 2015

No time to lose

An inmate was told after a colonoscopy that he likely had bowel cancer and would need surgery immediately – within a week. However, the jail’s doctor told him the facility had no paperwork from the specialist, and it would be up to four weeks before he could even get an appointment for surgery.

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July 28, 2015

28 July, 2015

Excruciating wait

An inmate had been waiting for months to have a wisdom tooth extracted and was in severe pain, to the point where he had fainted and had to be sent to hospital.

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July 28, 2015

28 July, 2015

New drug, new hope

After a woman was denied funding for a drug to treat neuropathic pain, her husband came to the Ombudsman for help. The woman has a rare neurological disease and her condition, which is considered palliative, means she has considerable muscle and nerve pain. One of the drugs that helped her pain, Sativex, was only approved for patients with multiple sclerosis, or palliative cancer patients with refractory pain.

 

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July 28, 2015

28 July, 2015

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.

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July 28, 2015

28 July, 2015

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.

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