ST. CATHARINES — A Pelham woman who crossed the border to obtain an MRI weeks earlier than her tentative appointment in Canada was scheduled, will not be reimbursed by OHIP — even though she was hospitalized immediately due to the scan results.
The MRI in Buffalo revealed the woman had had a right hemispheric stroke.
She was stabilized at St. Catharines General Hospital with medication until she underwent surgery days later.
Her appeal of OHIP’s decision not to reimburse her for the MRI she obtained in the U.S. was denied by the Health Services Appeal and Review Board July 19.
The board’s decision, which does not name the woman, said she began to experience “pins and needles,” “numbness” and “weakness” in her left hand in early March 2009.
It said she saw her family doctor a number of times and in April 2009, began the process to obtain an MRI test in Ontario through that doctor. She also saw a neurologist in St. Catharines and by May 14, 2009 the request for an MRI had been submitted but no appointment date was set.
Over the weekend of May 16, 2009, the woman began to feel worse and the fingers on her left hand curled and were immobile. On May 19, 2009 she arranged to see the neurologist the next day, but didn’t get a diagnosis. The receptionist at the neurologist’s office told her it would take six to eight weeks to obtain an MRI.
The board said the woman felt something was seriously wrong and made her own appointment for an MRI at Seaton Imaging, in Buffalo on May 20, 2009.
That same day she underwent the MRI, the results were sent to her St. Catharines neurologist, who contacted the woman and arranged for her to be seen immediately at St. Catharines General Hospital.
A vascular surgeon told her the MRI revealed the stroke. She was hospitalized and on May 27, 2009 — weeks before she would have received her MRI in Ontario — she underwent a right carotid artery endarterectomy - the removal of material inside the artery - to prevent future strokes.
The woman submitted an OHIP claim for the MRI in August 2009, but was denied funding and appealed. The board decision does not say how much money the woman paid for the procedure.
The website BuffaloMRI.com includes a range of prices for various procedures, including $465 to $565 for a basic MRI.
The board said out-of-country health insurance is paid by OHIP when a person has an emergency condition while outside Canada that is acute, unexpected and requires immediate medical treatment. It’s also covered if prior approval by OHIP has been obtained.
The woman argued through representatives that although her symptoms arose in Canada, the extent of her condition wasn’t known until the May 20, 2009 MRI results.
As a result, she claimed, the condition arose outside of Canada and was unexpected.
She also argued her medical circumstance was an emergency — she was hospitalized the same day as the MRI with surgery days later — and prior approval for the out- of- country MRI could not be applied for or obtained.
But the board sided with OHIP.
It said although the woman was “quite reasonably concerned for her health” and frustrated with the waiting time for an MRI in Ontario, there was no medical evidence that she faced an immediate risk of stroke that prohibited her from seeking prior approval for the MRI.
That’s because once the degree of the blockage was known from the MRI on May 20, 2009, the woman didn’t have surgery right away due to risk. Instead, she was stabilized with medication in hospital until her surgery on May 27.
“The appeal board has no jurisdiction to order OHIP, for compassionate or other reasons, to make a payment that is not permitted under the Act or Regulations,” the board said.