Health Canada’s program for First Nation and Inuit medical benefits hurts clients and private clinics, a local clinic manager alleges.
The government’s health program for First Nation and Inuit people has cracked down on approving travel for dental appointments, said Darrin Sinclair, manager of the Riverstone and Chilkoot dental clinics.
Health Canada recently sent letters to Whitehorse clinics reminding them of their policy for approving travel spending for people coming from the communities for health services.
Sinclair is spending more of his time writing letters to approve travel for his clients, and the quality of service has suffered, he said.
“We had a gentleman here just very recently who was diagnosed with multiple forms of cancer, needed chemotherapy to live, like he has months to live without it,” Sinclair said.
“But he had such massive infection that his doctor wanted his teeth out. They were pretty much rotten, so he wanted that out so the chemotherapy would be more effective.”
After manoeuvring to squeeze the man into the operating room between appointments that had already been scheduled, Sinclair found out the day before the planned surgery that the man’s travel had been denied.
“So I’ve got to write this letter to say that we’ve got to do this to save the man’s life? You would think that the fact that this man needs to go into the hospital under general anesthesia for dental work would be fact alone.”
The man’s nurse in Carcross complained that, since she received the letter from Health Canada about their travel policy, she has spent two-thirds of her time requesting travel for her clients, according to Sinclair.
“So now we’ve got a nurse who is becoming an administrator instead of being a nurse.”
The requests are being denied more frequently, especially in the case of routine appointments.
“If it’s just a cleaning and just a checkup, i.e., prevention, half of the time they won’t pay. It has to be for something major,” said Sinclair.
“Well, how do I know you need a filling unless we do an exam on you? Basically, what they’re saying is it’s got to hurt before you can come in, which is not an effective way to service a whole segment of the population.”
Health Canada’s policy explains that travel expenses for routine care will be considered when “dental visits to the client’s home community are not scheduled for at least six months; co-ordination with other medical appointments has been attempted and is not possible; and, Health Canada has verified appointments with the dental office prior to approval.”
First Nation and Inuit clients can access care through private clinics, or they can go to Health Canada’s own dental clinic, reserved for aboriginal people with status, in the Elijah Smith Building.
This clinic competes directly with private dentists, and a loophole has allowed some clients to abuse the system, said Sinclair.
Clients with First Nation or Inuit status do not pay up front when they visit the clinic.
If the client has secondary insurance, Health Canada will ask that the portion payable by insurance be paid directly to them.
However, a couple of insurance companies have refused to reimburse Health Canada directly, and instead sent cheques to the clients.
“If I go there, and I get $1,000 worth of dental work done and I get reimbursed $500 from my private insurance, and there’s no recourse, then I just keep going back, and they write me a stern letter but they can’t kick me out,” said Sinclair.
Health Canada confirmed in an email that it had a problem being reimbursed directly from some insurance providers. In these cases, the clients would be notified in writing of their outstanding balance, and service could be refused to them in non-emergency situations.
They are working with the insurance companies to insure a long-term solution. In the meantime, “The Whitehorse Dental Clinic no longer submits dental claims to private insurance companies who refuse to reimburse Health Canada directly,” the email stated.
That means that, for now, Health Canada is eating the costs of these services even though part of it could be paid through insurance.
They also said that the problem was not on a large scale, and was limited to a few cases.
The clinic began operating in 2005 because the private market was not meeting the needs of First Nation and Inuit clients, according to Health Canada.
The First Nations and Inuit Dental Clinic does not infringe on the business of private clinics, according to Health Canada, because clients are free to choose where to go for their services.
Furthermore, any private dentist can apply to work at the clinic through a competitive “request for proposal” process.
The department is currently looking to hire a new dentist on a three-year contract. The tender’s value is estimated to be between $500,000 to $1,000,000.
The restrictions placed on dentists who work at the publicly funded clinic mean that it is far from an open process, said Sinclair.
“To say that there’s no competition (with the private sector) as a result is blatantly wrong. And in fact I’m pretty sure it’s a lie. You’d have to have your head pretty far up your ass to think that that’s the truth.”
Contact Jacqueline Ronson at
jronson@yukon-news.com