325 replies to this topic

[LBO]

I'm not sure if anyone out there from a province other than Ontario is aware but I believe if you work for the public service and you are not from Ontario, the health care plan will cover your IVF if you have blocked tubes. I live in ON and I don't have blocked tubes but I wrote to Sun Life because I know there is a clause that states they will cover any procedure covered by another province. I thought since Quebec will cover it they would for me but because Ontario decided they would cover it for blocked tubes they won't cover it for any other issue but if your province doesn't cover any IVF procedures, Sun Life should reimburse you.

Sorry if this is not the right place or you already know this but I received the letter yesterday and thought if it helped even one person then it was worth a mention. If you want a copy of the letter, let me know and I will scan it for you.

[DiXie]

darn, I wish I could block my tubes somehow lol

Good info! I'll pass it on as needed

[Sandibeach]

I got that letter as well last year, but I figured with Quebec's new funding, we should be covered. I'm planning on trying a 4th attempt next spring and I will submit my expense to Sunlife and if they refuse, I will challenge it. Yes, Ontario covers it but only under certain conditions and since Quebec has no conditions, just a limit, they should reimburse us. If there are enough of us fighthing this, we should be able to get something. It's worth a try, we have nothing to loose. My only problem is I plan on going back to Montreal and I'm afraid with the free IVF, I might have to wait this time. I'm gonna call Dr. Mahutte in January 2011 to put my name on a waiting list to start in May... he is so awesome, I don't want to go elsewhere and my dr. in Ottawa moved to Calgary, so I'm really out of luck. He was the only one I trusted at OFC.

Ladybug - Are you going to try to fight with Sunlife?

[LBO]

Dixie - that thought crossed my mind too. I feel terrible even thinking that but I think it's just out of frustration.

Sandibeach - You were actually the one that prompted me to write to Sunlife. I'm not sure how detailed your letter is but they basically stated that since OHIP covered the procedure (even though not for everyone) they wouldn't but if they didn't cover any of it, they would. That's how we understood it so it looks like the Ontario government screwed us every way possible. I'm going to fight it I think. We're too late this round since we paid in June so they'd probably say that it had to be dated after Quebec started paying but I think I'll try if there is a next time (hoping there isn't). I'm just so frustrated that they choose to only cover one cause and now because of that, the rest of us won't get anything. Perhaps I'll transfer to New Brunswick or something!

[Sandibeach]

The little buggers... in my opinion, that's not the same thing... yeah, so if you lived in Alberta or BC or pretty much any other province, you'd get it paid because of Quebec, but basically Ontario would be the only province it wouldn't be paid for since we have some IVF coverage here... I'd definately fight it, but you are right, if you just finished one, they'll give you the run around since it's not yet free in Quebec.

My little guy is 4 months old, so I'm not ready to try again, but when I do and if this isn't sorted out yet, they will definately hear from me. We need to get hold of the actual regulations/documentation they use - not the PS manual. It's all a matter of interpretation and Sunlife interprets based on their understanding. THe final say is Treasury BOard, cause all Sunlife does is adminster the program based on TB's mandate and if you appeal something it will eventually make it's way to them. I used to be a tax auditor - so I know something about appeals and you need to take it to the top. For $10k, it's worth the effort. For your next IVF, I'm wishing you all the luck that it works, and also I'll help you with the appeal if you want to fight this. You'll be there before I will. I won't be trying again till May 2011. I figure who ever sets the standards, it will follow easily for the rest of us.

[LBO]

Yep, because OHIP covers something, the rest of us are screwed but if we were anywhere else we could claim it. Pathetic. Thanks for the offer to help with the appeal and I may take you up on that. I'm actually just starting another cycle next week (Finally) so I'm hoping this works given our last two cancelled ones. We'll have to keep each other posted, I'm not going to let them exclude us because if it.

[nlt]

Does anyone know if the PSHCP covers IVF drugs?

[Sandibeach]

Yes they do cover 80% of all drug costs and there is no maximum amount. I've claimed 3 IVF attempts with them and have been reimbursed 100%. DH is also with Public Service, so I claim the other 20% on his insurance. It seems to take a little longer than normal, but I've never had any problems.

[nlt]

Yes they do cover 80% of all drug costs and there is no maximum amount. I've claimed 3 IVF attempts with them and have been reimbursed 100%. DH is also with Public Service, so I claim the other 20% on his insurance. It seems to take a little longer than normal, but I've never had any problems.

Thanks! I'm in ON and Sunlife has already refused my IVF claim but luckily DH is with a crown corp that covers IVF so I just have to resubmit to his plan. We're very lucky as between my blocked tubes being covered by OHIP, and both our workplace health plans, our out of pocket expenses are very minimal. I figure we can do 3 more rounds before having to pay for it ourselves but honestly I don't think I'm emotionally up for more than one more, so we'll see. I had forgotten how emotionally exhausting this all is. NLT

[collieflower]

I am considering IVF and am a PS employee living in Ontario (with no blocked tubes).

Ladybug-would you mind sharing the letter you wrote to SunLife? I will be attempting to claim my expenses, which of course they will deny. I think it's worth it to continue pressuring though.

[Sandibeach]

I will also pursue the issue when I do an attempt early 2011. Did you do your IVF after the coverage went into effect in Quebec? If so, I think you have a really good case and you should appeal any decision that doesn't support the reimbursement of your expenses. Good luck. Please keep us in the loop of what happens!!

[JoSaa02]

Hi i was reading this thread and was wondering if anyone out there could help me on this topic. I am from Alberta and have both my tubes blocked and just under went surgery to clear them and it didnt work so they are still blocked. Now i was told that my only option was IVF and i was wondering if anyone knew if it was funded even tho i live in Alberta and if it is funded to i have to go out of the province for the procedure? Thanks so much

[Sandibeach]

It's not funded in Alberta, only Ontario. You'd have to be a resident of Ontario and get OHIP to have it covered. But if you work for the feds, they will reimburse you where ever you get the procedure done.

[LBO]

collieflower - I don't mind at all sharing my letter. I'll scan it and send it to you. I had everything organized in a binder but for some reason that's not in there so once I find it I'll send it along. I read it again and the last page outlines what Ontario considers necessary to cover and it says that we can't use another province's criteria. My problem is I think it's really unfair that because some politician thinks it's only necessary for blocked tubes the rest of us suffer since we live here. I'll be appealing their denial when it comes to it. We're getting ready for number 4 so I'll be submitting a claim to SunLife.

[Sandibeach]

their argument doesn't hold...cause before free IVF in quebec, if you had blocked tubes and lived in another province, sunlife would reimburse you.. but only if you met the blocked tubes diagnosis... so why wouldn't the opposite be true - quebec has it free 3 times for the life of a patient, then we should be able to claim it.. i'm doing a forth IVF next year and I will also appeal it. Somewhere on this forum, there's info on a DND military guy who lived in BC at the time who claimed an IVF for this wife and in appeals won - she did not have blocked tubes, but argued on other grounds... not sure why it didnt' set a precident to change the rules with sunlife.. but worth searching to see what was said.. good luck and keep us posted!!

[LBO]

I'm ready for a fight and it's good to know they were covering it for tubal issues. I'm just so sick of researching and fighting to get anything for this cause. I'm kind of feeling a little defeated lately.

[honeybee2]

As a federal employee just getting started on this process, I have been communicating with Sunlife about covering IVF. Although I'm not sure "communicating" is the right word - I ask them whether they will cover IVF now that Quebec does, and they send me a form email telling me I need to send them medical proof of complete bilateral tube blockage. I tell them I don't have complete tubal blockage, and has their policy changed now that Quebec is covering IVF? They tell me I need to send them medical proof of complete bilateral tube blockage. Three times this happened! I don't think they actually read the emails, they just see "IVF" and send that form email.

So I called the toll free number and explained what I was trying to ask, and they said I'd have to send an appeal to the Administration Authority asking them to change the coverage requirements. I have done this and am waiting to hear back - apparently they send an acknowledgement of all appeals as soon as they receive them.

I'm just wondering if anyone else has tried this yet - maybe there's already another appeal in the system that would get an answer quicker? Because I want to get started with IVF but I'm afraid that the decision might not be retroactive. It should be retroactive to the date Quebec started covering, but who knows.

[hazypeanut]

Hey there, we too are with sunlife, my husband is DND.. so we had no choice as to where we live.. we just sent in our claim for "lab fees" to sunlife... along with a printout from their website stating that "lab fees" should be covered.. so we will see what happenes when they receive the letter.. please keep me updates on ur outcome as well!! its true if there is enough of us maybe a change will be made! GOOD LUCK!

As a federal employee just getting started on this process, I have been communicating with Sunlife about covering IVF. Although I'm not sure "communicating" is the right word - I ask them whether they will cover IVF now that Quebec does, and they send me a form email telling me I need to send them medical proof of complete bilateral tube blockage. I tell them I don't have complete tubal blockage, and has their policy changed now that Quebec is covering IVF? They tell me I need to send them medical proof of complete bilateral tube blockage. Three times this happened! I don't think they actually read the emails, they just see "IVF" and send that form email.

So I called the toll free number and explained what I was trying to ask, and they said I'd have to send an appeal to the Administration Authority asking them to change the coverage requirements. I have done this and am waiting to hear back - apparently they send an acknowledgement of all appeals as soon as they receive them.

I'm just wondering if anyone else has tried this yet - maybe there's already another appeal in the system that would get an answer quicker? Because I want to get started with IVF but I'm afraid that the decision might not be retroactive. It should be retroactive to the date Quebec started covering, but who knows.

[hazypeanut]

Hey there, we too are with sunlife, my husband is DND.. so we had no choice as to where we live.. we just sent in our claim for "lab fees" to sunlife... along with a printout from their website stating that "lab fees" should be covered.. so we will see what happenes when they receive the letter.. please keep me updates on ur outcome as well!! its true if there is enough of us maybe a change will be made! GOOD LUCK!

As a federal employee just getting started on this process, I have been communicating with Sunlife about covering IVF. Although I'm not sure "communicating" is the right word - I ask them whether they will cover IVF now that Quebec does, and they send me a form email telling me I need to send them medical proof of complete bilateral tube blockage. I tell them I don't have complete tubal blockage, and has their policy changed now that Quebec is covering IVF? They tell me I need to send them medical proof of complete bilateral tube blockage. Three times this happened! I don't think they actually read the emails, they just see "IVF" and send that form email.

So I called the toll free number and explained what I was trying to ask, and they said I'd have to send an appeal to the Administration Authority asking them to change the coverage requirements. I have done this and am waiting to hear back - apparently they send an acknowledgement of all appeals as soon as they receive them.

I'm just wondering if anyone else has tried this yet - maybe there's already another appeal in the system that would get an answer quicker? Because I want to get started with IVF but I'm afraid that the decision might not be retroactive. It should be retroactive to the date Quebec started covering, but who knows.

[hazypeanut]

Sent it our claim for the IVF cycle to Sunlife... just waiting to hear back, and see how mad they get! lol

[honeybee2]

Well, I got an acknowledgement from the PSHCP Administration Authority that they received my letter asking for expanded coverage for IVF now that Quebec is covering it. They said they are reviewing it and will contact me if they have any questions. There was no indication of how long their review might take.

In the meantime I have called my RE and said we're ready to get started with IVF. I don't want to wait forever for a decision from PSHCP. My sister works in insurance policy and says that it should be covered, so hopefully that's the answer they come back with. And hopefully sooner rather than later...

[Sandibeach]

Awesome news Honeybee... please keep us informed. I'm doing another cycle next summer and would really not want to fight to get reimbursement if I don't have too. I've already paid for 3 IVF and 2 IUI attempts from my own monies... my bank account could use a break, especially that I will be on leave without pay to stay home with DS.

HB- Either way, I would continue with your IVF treatment... because if you will get it covered, it will be backdated since Quebec has had it free since Aug 5th... The drugs are already covered, so once you've paid for your IVF, send int he claim immediately... no need to wait till the cycle is done. This is great news!!!

[baby2come]

Hi there,

When we did IVF 2 years ago I called Sunlife and they told me that my employeer has not chosen to add this to their policy. I called my employer and they said they would not add it to the company policy as it is very expensive in the benefits. Do you know if I can still challenge this? Sunlife only covered the synarel and prometrium that I took. I didn't think to submit lab fees though. Any insight?

Thanks! This is great....hopefully 1 day we'll all be covered!

[Sandibeach]

this thread is in regards to sunlife coverage for fed govt employees only...not sure hoe other employers work

[Sandibeach]

My husband found the fed health care plan directive:

Here's the link to it: http://www.njc-cnm.g...ge=3&vid=9&pv=1

What I interpret from this, is since IVF coverage in Quebec is new, the last paragraph would apply and it will ultimately be up to the Trustee's to make a decision on this. So here's to hoping that the claims that you ladies have submitted will start the ball rolling and the trustees looking at eligibility and that it will be accepted!! I certainly hope so!!!! Please keep us informed on how it goes!!!

"Eligible expenses are the reasonable and customary charges for:

physician's services and laboratory services where such services are not eligible for reimbursement under the participant's provincial/territorial health insurance plan, but where such services would be eligible for reimbursement under one or more other provincial/territorial health insurance plans.
Laboratory services include those services which when ordered by and performed under the direction of a physician provide information used in the diagnosis or treatment of disease or injury. Services include, but are not limited to, blood or other body fluid analysis, clinical pathology, radiological procedures, ultrasounds, etc.

Where only one province/territory provides reimbursement for a particular service, and that province/territory discontinues the coverage, the issue shall be subject to review by the Trustees as to whether coverage will also be discontinued under the Plan. Claims for such services, following cessation of provincial/territorial coverage, shall be held by the Administrator pending the decision of the Trustees.

Where a province/territory begins reimbursement for a particular service, claims for the service shall be held by the Administrator pending a review by the Trustees as to whether the service should be covered in the other provinces and territories."