Saving Sight

**This featured case is one example of the concerns people have brought to us. Names have been changed to protect the identity of the people involved.

Cyril needed eye surgery to prevent blindness. This surgery was not available in Saskatchewan, so his eye specialist referred him to a surgeon in Ontario. Saskatchewan Health approved and paid for the surgery, but there were some additional costs for tests and a special device used during surgery. These were billed directly to Cyril, and the province reimbursed part of the money.

When he was pre-approved, Cyril understood that all the medical costs were going to be covered. Now that he had received most of the funding, he was grateful, but did not think the partial reimbursement was fair. He contacted our office.

Our investigation looked at the devices in question and the additional testing costs to determine whether he ought to have been fully reimbursed. For example, we found that for one device in particular, Cyril was only reimbursed about a third of the cost. In Saskatchewan, these devices cost much less than the ones used in the Ontario operation, so when the Ministry of Health was unable to obtain any further details about the reason for the higher cost, they reimbursed Cyril the amount it would have cost in Saskatchewan. Upon consulting his doctor, we found that the device used in the Ontario operation had been specially designed by the surgeon for that type of operation and were not available anywhere else.

We also found that, if the tests Cyril underwent had been performed in Saskatchewan in relation to an eye surgery, they would have been fully covered.

Based on our findings, we concluded that the Cyril ought to have been fully reimbursed and we recommended that the Ministry of Health reimburse him the remainder of the costs for the devices and tests related to his eye surgery.