Monday, July 13, 2009

Ontario Assistive Devices Program (OADP)

Beginning September 2008, the Ontario government provides funding for the purchase of insulin pumps and insulin pump supplies for adults with Type 1 diabetes.

This bit of information may very well likely have already been posted by someone else from Ontario long ago, but it is something I just found out about two months ago when I had my endocrinologist appointment. My doctor told me about the new coverage through the Ontario Assistive Devices Program (OADP). It was great news for me, because our health insurance through my husband's previous employer is on the brink of cancellation. Like so many others, he was laid off back in November. His employer extended our health insurance coverage for 9 months or until he found new employment, whichever came first. He has finally found new employment, but insurance with them doesn't begin until his probationary period ends in September.

So during my appointment, my endo gave me the form for the program; I filled in my part, and left the form with him to fill in his and submit. I finally received a letter in the mail last week from OADP telling me that coverage is approved and that I will receive my first cheque in the mail sometime in the next 3 to 4 weeks.

So, great news right? The government covers my supplies and we don't have to worry about insurance coverage anymore (at least for pump supplies; we still need coverage for test strips, insulin, etc).

The problem is that I have some receipts that are in insurance limbo right now. I applied for OADP coverage slightly late because I didn't know it existed until two months ago. Without knowing that I was eligible for OADP, I had been purchasing my pump supplies as normal - I bought what I needed each month and saved the invoices, then about every four to six months I submit them all at once to my insurance company for reimbursement.

I'd been wondering why it was taking so long for my last claim to be processed, and today I got my answer. I received a letter from my insurance company stating that because OADP now covers insulin pump supplies, the last claim I had submitted to my insurance company for pump supplies from October 2008 through April 2009 was DENIED.

Six months of supplies at approx. $250 per month is $1,500. $1,500 which I may never see again because I should have applied for OADP coverage sooner.

I'm mad, but I suppose it is my own fault for not keeping myself informed. I knew that OADP coverage for insulin pump therapy had been granted in December 2006 to children age 18 and under with Type 1 diabetes. However, short of checking the Ministry of Health website on a regular basis, I'm not sure how I would have found out about adult coverage any sooner than I did. The government doesn't exactly freely advertise when they are giving away money. I suppose this is a lesson learned the hard way to keep abreast of developments in the diabetes world.

If you live in Ontario and, like me, have also been caught in OADP/insurance limbo, let me know. I'm not sure if we can resolve anything together, but it would be nice to know I'm not the only ignorant one. :)


Anonymous said...

Hi Lori,

My wife is just going through the process of getting registered for ADP for her pumping supplies, and we got caught in the same situation as you with our insurance provider denying a claim. I found out about the program when I called the insurance folks for an explanation!! But both the our insurance provider and the ADP diabetes "team" said that insurance carriers were required to pay for all claims made before you were registered in the program. Our carrier said all they needed was proof of registration in the program and they would pay for all the supplies purchased before the enrollment date. Now that you have your letter (proof) you may want to talk to your insurance provider or the ADP folks. Everything I've heard says you should be getting that $1500 back. Good luck!

LORI said...

Thanks for the info! My husband re-sent the claim with the letter from ADP, but our policy is now cancelled (my husband lost his job last year, and although they extended his benefits, they finally ran out last week). We're still waiting to hear from them, hopefully we'll get some money back.