Their daughter nearly drowned. Now they're going into debt paying for her care

It was in July 2022 that the McLaughlan family's lives changed forever.

The family was vacationing in New Brunswick when two-year-old Briar went out to play in the backyard.

About 20 minutes later she was found floating in the family pool, unconscious and not breathing. 

Despite receiving CPR, Briar suffered hypoxic-ischemic encephalopathy, brain damage caused by a lack of oxygen. Her prognosis wasn't good, and her parents were warned she probably wouldn't make it out of the hospital.

"They point-of-fact told us, 'We're going to do everything we can for her, but it's a very good chance she would never [leave] that room,'" said her father, Andrew McLaughlan, his voice cracking. 

"She proved them all wrong."

Defying the odds, Briar returned home to Kingston, Ont., after spending four months in children's hospitals in Halifax and Ottawa.

But now the family is in a battle with their new insurer, Canada Life, to get the same coverage they had for Briar's health care before the federal government switched providers this summer.

The McLaughlans are among the 1.7 million federal workers, retirees and dependents who saw their insurance provider switch from Sun Life to Canada Life on July 1, and with it changes to what services and drugs are covered, how they're approved and what happens when they need to talk to an agent.

The Treasury Board Secretariat (TBS), which oversees labour relations between the federal government and the public sector, said changes made to the Public Service Health Care Plan (PSHCP), including claim limits, coverage terms and eligibility, were approved in the fall of 2022 — independent of the switch to Canada Life. 

Those changes came into effect after Canada Life won a tender to administer the plan.

• This week CBC Ottawa will be sharing more stories of public servants affected by the switch to Canada Life. If you'd like to share your story send us an email.

Needs a wheelchair, fed through a tube

Briar's parents laugh as they describe her before the accident as "trouble" — mostly for her older siblings.

"She would open their door and go destroy the Lego that they had just built and just laugh," her mother, Jenn McLaughlan said.

The once vibrant, happy little girl with a mischievous streak now needs a wheelchair, is unable to speak, and requires a feeding tube and round-the-clock care.

"She depends on us for everything," said Andrew McLaughlan.

Briar's parents are hopeful she'll regain some of the abilities she lost, but her future is uncertain — along with the family's finances.

The McLaughlans are one of a few hundred people who've contacted CBC about the Public Service Health Care Plan's switch to Canada Life.

They have voiced frustrations about everything from spending hours waiting to speak to an agent — or not getting through at all — to incurring thousands of dollars of debt because claims Sun Life once covered are being denied or taking months to be reimbursed.

While the family is given a yearly stipend of $1,680 a year through Ontario's Assistive Devices Program for some of Briar's needs, they rely on their health care benefits for everything else.

The family spends around $2,000 a month on Briar's care. That includes $662 for a special formula, $355 for bags for that formula, $20 for gastrostomy tubes which are supposed to be changed weekly— although the family stretches each one an extra week to save as much as they can.

Under Sun Life, the McLaughlans were reimbursed for the cost of Briar's food, feeding equipment, wheelchair, medical bed, and a $28,000 airlift between Halifax and Ottawa.

"For me, [it was] wonderful," said Jenn McLaughlan. "We had our own case manager. If we had any questions, we called them directly. We didn't have to wait."

All that changed July 1.

'We've been totally blindsided'

The family was told by Canada Life that all consumable items related to Briar's care, aside from the formula itself — like those bags and tubes — are no longer covered.

"We've spent $5,000 towards Briar's care since July 1, that has not been reimbursed," said Andrew McLaughlan, who works for the Canadian Armed Forces. "Most of our claims have been denied."

That's a far cry from what they say they'd originally been told: that the coverage wouldn't change and was only going to improve.

"I feel like we've been totally blindsided by this," said Jenn McLaughlan. 

These are people's lives they're toying with.- Jenn McLaughlan

After the CBC contacted Canada Life, a representative called the McLaughlans to say the formula bags would now be covered.

The insurance company also told CBC it has created a team to review claims that may have been denied and decide whether they should be approved on compassionate care grounds.

It also said it aims to prioritize urgent claims or those filed by people facing financial hardship. 

In an email to CBC, the Treasury Board, which oversees the operations of the federal government, said it shares "the concerns and frustrations" of members who are still unable to get through to an agent or are experiencing long wait times.

"We understand the stress that this ongoing service issue is having on individuals and their families," a spokesperson wrote.

While the Treasury Board said replacement therapeutic nutrients are covered with a prescription, it didn't address whether related items like gastrostomy tubes and formula bags are also covered.

It did say members can appeal any claims that are denied.

Of the items that have been covered, the McLaughlans say they've had to wait months to get reimbursed. The family has had to go into debt.

"Our kids didn't ask to go through this. We didn't ask to go through this, and the kids are losing out on things because we have to wait longer for the reimbursement to come," Jenn McLaughlan said.

"These are people's lives they're toying with."

Every week, Briar continues to improve and shows us how incredibly strong that she is. And every week we're just so thankful that she's continued to fight.- Andrew McLaughlan

McLaughlan wants to know why they were told there wouldn't be any changes to what's covered.

The family also worries about their finances if they keep having to go into debt while waiting for Canada Life to process their claims.

"Do we have to make our older two children suffer so our youngest can have a semi-typical life?" said Andrew McLaughlan.

Despite the challenges, they say they're doing everything they can in the hope Briar may one day be able to lead a different life.

They're hopeful, considering the progress she's made in the last year alone. She's re-learned how to laugh and sing, and can dance around in a special standing frame.

"Every week Briar continues to improve and shows us how incredibly strong that she is," Andrew McLaughlan said.

"And every week we're just so thankful that she's continued to fight and wants to be here with us. Because we love her so much."