Pregnant mom surprised to find out she's not eligible for Quebec health insurance
Health minister says RAMQ is 'not an open bar,' has right to check eligibility
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- Quebec Health Minister Gaetan Barrette responds.
Amira Tagoug has a doctor's appointment next week for a pregnancy check-up, but she doesn't know how she's going to pay for it without Quebec health insurance.
She has a Quebec health card, and it's not supposed to expire until 2018. It's useless right now, though.
That's because on April 27, she received a letter in the mail from Quebec's public health insurance agency (RAMQ), informing her that she is no longer eligible for public health insurance because she is not a resident of Quebec.
"An individual must be a resident of Quebec to be recognized as eligible for the health insurance plan, which is no longer your case," the letter states, in part.
It goes on to say that Tagoug will have to reimburse RAMQ for all medical expenses it covered since October 2014.
Tagoug, who is two months pregnant with her second child, received similar letters for her husband and her one-year-old son, who was born in Montreal.
She has no idea why the province thinks they're no longer residents. She and her husband moved to Quebec from Ontario in 2014. They live in Longueuil, Tagoug and her son are both Canadian citizens and her husband is a permanent resident with a job in Quebec.
Tagoug doesn't know how she'll pay for her baby's delivery if the province doesn't change its mind.
"I'm pregnant and I need my health card to see the doctor. I'm going to have lots of appointments ... That's really miserable for me," Tagoug said.
'RAMQ ... is not an open bar.'- Gaetan Barrette, Quebec Health Minister
RAMQ will not comment on specific cases.
RAMQ spokesperson Marc Lortie said the agency does regularly verify whether people who rely on the province's health insurance plan are indeed eligible.
Quebec Health Minister Gaetan Barrette would not comment on the specifics of this case.
In general, he said, RAMQ has the right to make sure people are eligible for coverage.
"There are rules and those rules are quite clear and most of the time, if not always, people will complain when they did not follow the rules and the proper steps in order to get their card," he said.
"The rules are there to be followed ... RAMQ in Quebec, and Quebec as a society, is not an open bar."
Patient rights lawyer says it's a common problem
Montreal lawyer Jean-Pierre Ménard, who specializes in patient rights and health care, said he sees cases like this all the time.
He said it's unfortunate, but Quebecers often have to resort to legal help if they want to resolve these issues quickly.
"It's sad," he said. "You can try to settle the issue by yourself ... but sometimes it can be helpful when we intervene."
Ménard explained cases like Tagoug's are often the result of some sort of bureaucratic mix-up, either the provincial agency didn't receive all the documents required, or it has something wrong.
He said usually, in his experience, the cases can be resolved quickly with legal counsel.
Bureaucratic red tape leaves family confused
Tagoug moved to Quebec from Ontario with her husband, Mahmoud Sfaia, in July 2014.
Her son, Abdelhafidh, was born at Saint-Luc Hospital in Montreal a couple of months later. The cost of the childbirth was covered by the Ontario government, because Tagoug hadn't been in the province long enough to be eligible for Quebec coverage.
Since then, Tagoug, her husband and her son have all received Quebec health cards.
Last year, Tagoug's health card expired without her realizing it. When she was notified that she'd have to pay $905 for medical fees she'd incurred while using an expired card, she wrote to RAMQ to explain the mistake.
The issue was resolved, and she received her new health card along with a letter in the mail in April saying the fees had been cancelled.
It was roughly one week later that Tagoug found out she wasn't eligible for health insurance.
She doesn't understand why RAMQ would accuse her of not living in Quebec, if it knows she had just incurred hundreds of dollars in medical expenses in the province.
"They said you're not living in Quebec. I said 'no, I am living in Quebec ... How am I using [the card] while I'm outside Quebec? That doesn't make any sense," she said.
90 day wait for file review
Tagoug and her husband plan to re-submit their proof of residency to RAMQ in the next few days, including proof that they rent an apartment in Longueuil and proof that her husband works in Quebec.
Once the agency receives their documents, Tagoug said it could take up to 90 days for their eligibility to be reconsidered.
In the meantime, they'll have to front the cost of all medical expenses, including a doctor's appointment scheduled for Tagoug next week. The family will be reimbursed if RAMQ reverses its decision.
"It's really bad. It's really miserable. I'm a Canadian citizen ... I don't know what's going to happen," Tagoug said.
Excerpt of a letter from RAMQ
