Health-care plan switch to Canada Life leaves people frustrated, stressed

This week, CBC has been rolling out a series highlighting some of the people who say their health and finances have been severely affected by changes made to the Public Service Health Care Plan (PSHCP) that came into effect July 1, the same day Canada Life took over as the plan's administrator.

We've heard hundreds of stories from people frustrated with long wait times, failing to get through to an agent or being denied a claim without explanation.

Some of the people profiled this week have heard from Canada Life and been told their cases would be fast-tracked to resolve at least some of their concerns about coverage.

But CBC has heard from dozens more public servants and retirees. Here's a snapshot of some more families who say they have had to make difficult decisions about their health or finances.

Their stories have been edited for length and clarity.

Kari Hentzelt

Kari Hentzelt wrote to CBC this week.

"I am a chronically ill public servant in the midst of medical retirement. Every month I rely on medications for cardiac, neurological, musculoskeletal and pain reasons. Along with my husband's PSHCP and my own, we *were* adequately covered under Sun Life.

Since July 1, however, it has been nothing short of a nightmare.

I've been able to get through to a representative ONCE since July 1, after being on hold for ages.

I'm now almost two weeks late on my Emgality injection for migraines because they state that BC PharmaCare now covers it. I've talked to PharmaCare and they state my insurance should continue to cover it until my deductible is met.

Both myself and the drug company have sent them the special authority letter, as well as my pharmacy, but they still continue to deny this treatment to me.

Without it, I have approximately 15 to 20 migraines per month.

We are definitely not getting what we are paying for, and it's unacceptable."

Adam Shales

Griffin Shales' family contacted CBC over the summer about the changes to the PSHCP.

His father, Adam Shales, spoke to CBC this week about his nine-year-old son who relies on weekly intensive physiotherapy to counteract the debilitating nature of cerebral palsy.

Under the terms of the PSHCP, the family was covered at 80 per cent for claims up to $500 and claims over $1,000.

As of July 1, it's capped at $1,500 annually.

"It's a major source of stress," Shales told CBC.

"We don't have pots of money sitting around. So it's either we have to borrow for that or we have to reduce the amount of physio that he does, which then will have consequences and impacts on his body, his muscles, his range of motion and ultimately his quality of life."

Before the pandemic, Shales spent $15,000 to $20,000 a year on physiotherapy and were starting to ramp up his sessions again.

He said as his son gets older, it becomes even more difficult to help him with his exercises. Despite how much they work with him, they are no substitute for trained physiotherapists.

"For a government that's always promoting how they want to be more inclusive and diverse and persons with disabilities being one of the population segments that they want to increase representation, it doesn't really kind of walk the [walk]." 

Sabrina Hoque

Hoque also contacted CBC with worries about her three-year-old son's physiotherapy.

Ayden Clark was diagnosed with global developmental delay when he was three months old and receives weekly language therapy, occupational therapy and physiotherapy. He doesn't speak and can't walk or eat on his own.

"I'm determined I'm not going to change his care plan," she told CBC. "It's a stress and it's very frustrating."

Hoque spends about $400 per month for regular physiotherapy, plus another $1,650 for intensive physiotherapy every four months.

"So far, knock on wood, within the three years, there has been no regression and that's because we've kept a steady pace. We've been very determined. We've been on the ball with making sure that he gets weekly physiotherapy sessions," she added.

But she said the physiotherapy cap has had a dramatic effect on the family's lives.

"We're left hung to dry," she said.

"We're hitting a wall already with the nonexistent customer service. When we push through that wall and, yes, we connect with someone, to then be hit with another wall where there's no exception for families who are dealing with lifelong challenges."

Allison Abraham

Allison Abraham also wrote to CBC about concerns with her Crohn's medication not being properly covered.

"When the government switched to Canada Life, we were promised seamless transfer of insurance. It has been nothing but a pain though. 

One of my life saving drugs, Skyrizi, is about $20,000 per injection, which I get every eight weeks. Without this drug, I would be bedridden and dying. Unfortunately, since the insurance switch, I "do not" have coverage.

I have spent countless hours calling to make sure my coverage is active, but still can't process anything via their website or at the pharmacy. Thankfully, [the drug company] has offered me temporary relief in order to get me my medication. 

It is infuriating that I am having to rely on a service that people who actually don't have coverage use, because my insurance provider can't get it together.

I fear every time I order my medication that this will be the last time that it is covered."

Yvette Bosse

Yvette Bosse wrote in about equipment she relies on for her diabetes not being adequately covered.

"I am a single retired PSHCP member in distress caused by the contract awarded to Canada Life. I have multiple chronic health issues and am depressed with the way some of my life support therapy claims have been processed by Canada Life.

One example, I made a claim of $600 for an insulin pump supply in July 2023 and received an email confirmation my claim was processed in August 2023. No money was received.

Then I verified through my Canada Life account to find out I was only eligible to claim $8 of $600 and my refund was $6.40.

I have made many efforts to reach them since then. I have not received any responses.

I have another $600 to claim and will need to do another order soon. I am frustrated and stressed. Credit card bills are accumulating interest.

Canada Life issues are affecting me physically and mentally."

Brian Casey

Brian Casey wrote about being denied for claims he is making for a condition he's had for 15 years.

I require a catheter four times a day. First claim I sent in for $391 was denied.

The first reply was to apply to an Ontario program to cover the cost.

This program does not cover catheters. I have talked to two people at Canada life after making 25 calls.

No resolution.

This is total chaos.