Some people worry that changes to physiotherapy and drug coverage will leave them with big bills to pay
Louise Sullivan puts a brace on her husband’s knee and holds his arm while he hobbles from the living room to the kitchen and back.
Michael Fairhead looks and sounds tired. She is, too.
The Ottawa couple, who are both in their mid-sixties and used to work for the federal government, used to live an active life and travel the world before Fairhead had a stroke eight years ago and lost most of the use of his right side.
But Sullivan thinks that what little mobility he still has would not have been possible without years of intensive physiotherapy, which she says will now be much less necessary because of what the Canadian government did.A number of changes have been made to the largest health insurance plan in the country.PSHCP, or the Public Service Health Care Plan.
“If he doesn’t get the physical therapy, his body will waste away,” she said.
“What I’m really worried about is that he won’t be able to do anything on his own, and then I’ll have to do all the things that he can do now.”
On July 1, Sullivan and Fairhead were among the 1.7 million federal workers, retirees, and dependents whose insurance provider changed from Sun Life to Canada Life. This meant changes to what services and drugs are covered, how they are approved, and what happens when they need to talk to an agent.
The Treasury Board Secretariat (TBS), which handles labor relations between the federal government and the public sector, said that changes to the PSHCP, including claim limits, coverage terms, and eligibility, were approved in the fall of 2022, regardless of the switch to Canada Life.
After Canada Life won a bid to run the plan, these changes went into effect.
Still, dozens of members have told CBC News that they are upset with both the government and the insurance company.
Fairhead’s physiotherapy used to be covered pretty much as much as possible.
Under the old terms, 80% of claims up to $500 and 100% of claims over $1,000 were covered for the couple.
Now, it can’t go over $1,500 per year.
Sullivan says that the cost of his physiotherapy last year was more than $14,000.
In response to the new limit, Sullivan said she had to make the hard decision to cut his physiotherapy from three times a week to no more than once a week.
She plans to help him exercise as much as she can, but she knows that she won’t be able to make up for what he’s missing.
“That’s my biggest fear: that he’ll be so stiff and sore that he won’t even want to get out of bed, and that would break my heart,” she said.
Drug coverage confusio
In addition to setting limits on coverage, the new plan says that people must choose generic drugs.
Beverley Cormier, who is 59 years old, has rheumatoid arthritis. She recently switched to a new medicine to help with flare-ups. Under her husband’s plan, Sun Life paid for 80% of the first month. However, when the next 30 days were due, she found out from the drug’s maker, Pfizer, that Canada Life had turned it down.
“It’s hard to explain to people how one day you feel great and the next day you can barely move, and how this medicine made such a big difference in such a short time,” she said, her voice breaking.
The price of that medicine is $1,700 per month.
I’ve used up all of my credit cards to pay for the small amount of medicine I have right now.– Susan Judges, plan member
Before the plan changed, Cormier had only been taking the medicine for a month.
Her veteran husband, Norm Cormier, who worked for the military for 27 years, thought about finding another job after he retired.
After being turned down twice for the medicine, it was even more frustrating to not be able to reach a Canada Life representative.
After CBC asked Treasury Board President Mona Fortier’s office about the drug, Canada Life has since covered it.The TBS told CBC that the medicine needs to be approved first.
“When it’s your medicine and you’re in pain, all you want is for someone to tell you something,” said Beverley Cormier.
She did suffer.
Because it took so long to get the medication approved, she went 10 days without it. This caused a severe flare-up that made it hard for her to move.
Susan Judges, who is 52, can also use the plan because her veteran husband qualifies. Before problems with her plan were fixed earlier this month, she had to pay hundreds of dollars out of pocket for medications.
Even though I called the company four or five times a day and sent emails since the switchover, it took weeks before someone got back to me.
“I feel like we fell through the cracks,” she said to CBC.
Still, it will be weeks before she gets the $300 back because of ongoing problems with their enrollment. In the meantime, she has to choose between buying food or medicine.
Judges said, “I’ve used up all of my credit cards to pay for the little medicine I do have right now.”
Roy Goodall has heard a lot of people’s worries and frustrations over the last few weeks.
“It’s a terrible situation,” said the head of the National Association of Federal Retirees.”I don’t feel sorry for the people who have to deal with this.”
He said that the association plans to talk to the government about the limit on physio coverage when coverage is looked at again in two years.
In the meantime, he’s heard from people who are upset that they can’t reach an agent and have to do most of their enrollment or claims online, even though they don’t know much about technology.
“I know that a lot of people are upset, angry, and frustrated that they can’t get in touch with anyone.”
There are real people behind all of these numbers and decisions, and I think it’s terrible that their lives are being affected so deeply.– Louise Sullivan is a former federal worker who has left her job.
Canada Life said it appreciates people’s patience as it tries to deal with longer wait times to talk to an agent.
It said that more people were calling because they needed help signing up for the plan, but that it is working with the government to help members get to their benefits faster and is adding call center capacity to cut down on wait times.
The company also told members to give their new Canada Life benefit card information to pharmacies so that fewer claims would be turned down.
TBS says the changes will make it easier for more members to get in
TBS said it is still putting pressure on Canada Life to come up with ways to handle the number of calls it gets now.
It said that prescription drug coverage is still reimbursed at 80%, but that a new $8 cap on pharmacy dispensing fees and a requirement that people choose generic drugs means expanded benefits in other areas, such as mental health, mobility devices, and laser eye surgery.
It used the same reasoning for the physiotherapy part of the plan. By setting an annual limit of $1,500, TBS was able to get rid of a barrier that had made some lower-cost claims ineligible before.
TBS also said that it had tried to get in touch with plan members before the change, including through the Annual Pensioners Statement and social media.
Sullivan knows that the change would probably give more people access, but she feels that seniors with long-term health problems are being left behind.
“Most people don’t care about this, but we are getting older as a whole. Older people’s bones break more often, and 10 sessions won’t help you get better, she said.
“There are real people behind all of these numbers and decisions, and I think it’s terrible that their lives are being affected so deeply.”
Both the Conservative and NDP health critics were contacted by CBC.
The NDP MP for Hamilton-Centre and deputy labour critic, Matthew Green, called the move “alarming” and “unconscionable.”
Green said that he was worried about families with fixed incomes.
He said, “This seems like a bait-and-switch by the federal government.”