When Nan Normand’s husband had quintuple bypass surgery, it cost them $1,500. It wasn’t the operation that was pricey, but the travel. The couple went from Kenora, a small city near the Ontario-Manitoba border, to Hamilton for the surgery. The trek included flights and a multiple-night stay.
Normand was unlucky: Manitoba had temporarily stopped accepting most Ontario heart patients, so they couldn’t go to the much closer Winnipeg, and they were delayed by about three days by an ice storm once they hit Hamilton.
But the Normands aren’t the only ones paying significant out-of-pocket costs for health care. Patients in parts of Northern Ontario often travel upwards of 100 kilometres for surgery, procedures like chemotherapy or to see specialists.
The Northern Health Travel Grant helps offset some of the costs that come with that, with the goal of increasing access to care for people in those areas. Yet it doesn’t cover everything. Normand and her husband received $2,625 from the program, about $1,500 of which was for her husband, with the rest for her costs as his companion. Despite staying in a $40-a-night medical hostel, “our true expenses were approximately $1,500 over that,” she says. “The only way we were able to do it is because we’re middle income and we have credit cards.”
Increasing access to services
Normand is one of the over 200,000 Ontarians who apply for assistance every year. The program, which costs the province $53 million a year, is available to people living in 10 districts, including Kenora, Manitoulin, Parry Sound, Sudbury and Thunder Bay. The average reimbursement is $272.
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The grant helps residents from those areas who are referred to specialists or need services that aren’t available locally. They have to go to the closest option, which might mean Manitoba for some. They are reimbursed 41 cents per kilometre after the first 100 kilometres for travel, and an extra $100 for accommodation if the closest option is more than 200 kilometres away. One companion can also apply for a grant.
Other provinces have similar programs, including Manitoba, Newfoundland and the Northwest Territories. In B.C., the Travel Assistance Program offers discounted rates at hotels and subsidized transportation. Others places, including Alberta, don’t offer any reimbursement.
Ontario’s program started in 1985 as a set rate based on the distance from the patient’s residence to the treatment centre or specialist. Since then, it has seen a number of changes: In 1991, concerned that the grant was encouraging patients to travel south instead of seeing northern specialists, the Ministry of Health and Long-Term Care reduced the minimum one-way distance to 100 kilometres in Northern Ontario or Manitoba, and 200 kilometres in the rest of Ontario. And in 1994, it was modified so patients had to see the closest specialist. In 2007, the government increased the mileage allowance to 41 cents per kilometre, up from 34.25 cents. They also added $100 for accommodation for each trip.
The grant made headlines in 2000, when a group of patients filed a complaint with the Ontario Human Rights Commission (it was settled or withdrawn beforehand, never being heard by the tribunal, but that year, the minister of Health and Long-Term Care promised to review both programs). They argued it was unfair that Cancer Care Ontario covered food, hotel and transportation costs for patients from Southern Ontario, while the Northern Health Travel Grant only covered a portion. The Cancer Care program was much smaller, only covering patients who were referred away from their home centre for radiation treatment.
Is it time to raise the rates?
Though the grant reimburses some of the costs, it’s not meant to cover everything. There’s no payback for meals, and the $100 accommodation allowance is a flat rate, whether you stay one night or a week.
“It’s not based on any rational formula that I can see,” says Carolyn Hudson, a friend of Normand who also lives in Kenora and has used the grant. “Give me a mileage plus accommodation that actually covers it, that isn’t just a figure someone in Toronto has picked out of the air.”
People who can’t afford the travel skip services, ask their doctors if there for other options, or hold barbecues or dances to raise the money. France Gelinas, MPP and the NDP Health and Long-Term Care critic, says she hears of fundraisers for families who can’t afford their part of travel expenses at least once a month.
“The goal of it is good, it helps a bit, but it still leaves serious barriers to access for many families,” says Gelinas, who believes the payback amounts are now out of date. “If the goal of the program was to address some of the barriers to access, then over time some of those barriers have grown back.”
There’s also the issue of how long it takes to get paid back. The government announced it would try and make payments faster in 2007, and it says it now takes four to six weeks for people to be reimbursed.
But Michael Mantha, MPP for Algoma-Manitoulin, says it often takes longer, and that the turnaround time is creating difficulties for people
It sometimes takes as long as six months for people to be reimbursed, he says. “When you’re on a fixed income or a very low income [and these funds are delayed], it’s very difficult to make ends meet,” he says. He’s thinks it’s particularly difficult for patients who undergo regular treatment, like chemotherapy, and have to re-apply for the grant every time.
The ministry says cases are processed within the six-week timeframe, with the exception of “a small number of circumstances where an application was not completed properly or where eligibility comes into question.” Phil Graham, director in Primary Health Care at the Ministry of Health and Long-Term Care, also points out that non-profit organizations like the Canadian Cancer Society, the Kidney Foundation and Ontario Works front travel grant money to needy recipients, then collect the funds from the government afterwards.
The Ontario Ombudsman receives about 11 complaints a year about the travel grant; in 2013/14, they had seven. They’re mostly around people who have been denied coverage, says Linda Williamson, director of communications for the Ombudsman. A recent example was a woman who had to travel 193 km for a colonoscopy and couldn’t get the accommodation allowance because she was under the 200 km minimum. “We spoke to the ministry about this, and said that they needed to be more flexible about what was covered,” says Williamson.
The ministry is now developing an independent Medical Appeals Review Committee that will look at denied applications upon request. (Right now, an internal review committee does this and makes sure the policy wasn’t misinterpreted and the person wasn’t wrongfully denied reimbursement.) That new committee will look for cases that warrent exceptions, so people will have another option than the Ombudsman.
Replacing travel with telemedicine
One option for patients who have to travel long distances is to try telemedicine instead.
The Ontario Telemedicine Network has encouraged doctors and patients to do just that. A marketing campaign is underway that promotes telemedicine to care providers, with a focus on follow-up visits. The Ontario Medical Association and the Ministry of Health and Long-Term Care have worked with the telemedicine network to help increase awareness of the option.
“A lot of travel grants are provided for the purposes of follow up care,” says Rob Williams, chief medical officer for the network. “And there’s usually minimal to no physical examination.” If a physical exam is needed, a nurse in the patient’s town can provide it and report back to the specialist during the appointment.
Initial consultations, pre-surgical assessments and pre-op assessments also work well virtually, says Williams.
Telemedicine means patients who would normally use the grant save time and cut down on their expenses, says Williams, whose patients have told him the grant covers at best 20% to 25% of the cost to them. “From a clinical perspective, they’re getting equal value and equal clinical attention, so it’s probably the same, just a lot more convenient.”
A special agreement in place with Manitoba ensures patients can access the same specialists they would regularly see, even if they’re in places like Winnipeg, through telemedicine.
Part of what needs to be done, says Gelinas, is for doctors in Southern Ontario to be more aware of the lengths patients from parts of Northern Ontario must go to for their appointments, so the doctors can think about other options like virtual consultations.
Williams agrees. Physicians in the north are “quite aware of the travel burden,” he says. “But in southern Ontario, there still is work to be done.”
The comments section is closed.
I am getting ready to travel from Kenora to London Ontario for surgery. Distance of 3444 km return. My husband will be travelling with me as mu companion. We will be required to be there the night before my surgery and will have to stay at least 4 nights maybe more in London. The basic allowance of 100.00 per day does not cover hotel costs not to mention meals for two people three times a day. The 41cents per km will help with the travel expense to and from London but it will cost us money out of our pockets due to the fact Manitoba will not accept Ontario Patients in a timely fashion to have emergency surgery done to avoid a possible death without surgery. We all live in Canada yet there seems to be a very large device between Manitoba health and Ontario health, why?
My doctor’s receptionist will not fill in the Northern doctor’s portion until I return it with the specialist’s info completed.
This makes no sense to me as 1. the northern doctor must refer me to the specialist
2. I must make an extra trip to my primary physician to return the form
Parking fees at the specialist’s office are often very pricey, but not covered
I think it is time for the rate to be reviewed and become more in line to the $.59 paid to government workers.
In addition it takes too long to get reimbursed right now I am waiting 10 weeks
Well 3 months wait for our 3 visits to Hamilton. This getting stupid now.
Single people who have lost their spouse have their income drastically decreased with the loss of a major pension. These people really suffer as they are old and have no to supplement their income. They should have special consideration.
Having surgery in Ottawa. The problem is that a few days before the surgery I have to have CT. Staying with someone about 2 hours away from Ottawa. So have to make multiple trips back and forth but Grant only covers the major trip. Because I am traveling in Eastern Ontario and I am a Northern, Was told there is no grant for eastern ontario travel. But I am still a northerner that has to make a couple of smaller trips that are not covered.
when you travel from sheguiandah on. to Toronto, the cost of a room is $120.00 min. +room tax ,city tax, most charge for parking, food is 20% higher. Total for two days =$360.00
We live in Elliot Lake and remain totally perplexed by the unreasonable inflexibility of the NHTG system.
For example, part of my prostate cancer treatment involved daily Mon-Fri radiation treatment at Heath Sciences North in Sudbury for eight weeks. Because I was not deemed to qualify for the then $100 daily accommodation allowance I was expected to drive a daily round trip of 4-5 hours, receiving $90.20 each day; $451 a week.
If the accommodation allowance was available and paid I would have only needed only $590.20 a week in total.
Needless to say the stress of driving about 10,000 km for radion alone does irreparable health damage to a 77 year old!
It’s better than nothing. Stop complaining before we end up with 0$ along with the other 90% of the planet,
If you do not have a family doctor in Northern Ontario or cannot see a doctor in a timely manner in Northern Ontario, which is so often the case, and you see a doctor in Southern Ontario who makes a referral to a specialist, you are ineligible for the travel grant because the referring physician is from Southern Ontario. I feel this is an unjust situation and it is the situation that I have found myself in. I went to the Emergency Room to ask them to please fill out the travel grant for me so I could get a small amount of compensation, and they 1) rudely scolded me for going to the emergency room for a non-emergency issue, even though my family doctor cannot see me for three weeks and the only walk-in clinic in the city turned me away because they had already seen 24 people, and 2) refused to sign the form because they were not the referring physician. How do they expect your referring physician to always be from the North when you have so few options for receiving care in the North and they scold you every time you go to the Emergency Room for a non-emergency issue? Aside from having limited options for care in the North, I am very uncomfortable seeking services in my city because I am treated poorly, not given adequate assistance, there is a serious lack of pain management services, my privacy is not respected, and I give out information to health care providers only for that information to be used against me in the future leading to a serious lack of trust. Please change the process so that it is no longer necessary for the referring physician to be from Northern Ontario. My sister still had to drive me five hours to my appointment in Southern Ontario if it is a referring physician from Northern Ontario or not because I live in Northern Ontario.
Another important thing to mention is that even when it is in the patient’s best interest for the patient to be referred to someone in Southern Ontario, the Northern Ontario physician feels strong pressure to keep the business in Northern Ontario, so will likely not refer to someone in the South, and thus the patient suffers unnecessarily.
10 yrs since mileage chg increased…why..with the cost of gas? $100 for hotel room in Toronto area…none avail for that price that you would want to stay in..most people who travel to Toronto area will need to stay more than one night…why not per night allowance of $100. No meal allowances! As with everything else…all considerations for south are priority…for the north…not so much! Give your head a shake!
I have a tooth which broke away from a large filling and it broke up in the gum. Our local dentist took and xray and it showed that my root on that tooth is bent and the sinus cavity has fallen down to rest on the root of that tooth. She has referred me to an Oral Surgeon in Thunder Bay (a 4 1/2 hour drive away). He is doing a consultation and the surgery all on one day as I am traveling so far.
My issues are that even though I am on a blood thinner he is not doing surgery at the hospital for lack of an operating room. Also, the travel grant will not cover this trip at all. I will need to travel up the day prior to seeing him because otherwise it would mean I need to drive on winter roads in the dark and I am a nervous winter driver. I need to stay in Thunder Bay 24 hours after surgery to be sure I do not have hemorrhaging at the surgery site while on the Trans Canada miles from a hospital. I cannot understand why this trip is not covered as it is not something which my local dentist is qualified to do and I am being forced to stay for 2 nights out of town, have meals away from home and pay fuel and wear and tear on my vehicle too.
Are these not things which the travel grant has been set up for?
The Travel Grant is unbalanced for those from NW ontario requiring surgery just as the Cancer Travel grant was unbalanced in favour of those from Southern Ont. Both groups are from the same Province, and pay the same taxes, but those in NWO suffer from a two-tier system!
The grant doesn’t even begin to cover the expenses when it only allows for a one night stay in sOnt. regardless of the number of nights spent away. The $100 allowance is also ridiculous when you are being seen in TO or London where
there are simply NO rooms in that price range. Travel from nOnt. to sOnt. for surgery requires patients to see specialists
pre and post operation which means a minimum of 3 nights……how is $100 fair? … and one is not allowed even a basic meal allowance?, …also hard on the patients who probably would prefer to be anywhere else but where they are. It is like they are being punished for needing medical care. As the companion to a travelling patient I found it very stressful trying to keep costs down and yet make her trip as comfortable as possible. I think this program needs a serious overhaul……you either scrap it altogether and just admit the government is not in the business of helping people access
specialties in medicine, or cover in full the expenses that are incurred.
The program could be tweaked very easily but not a priority for the liberal govt..totally concentrated on s ont and gta. Their money is to be spent there and only there. Don’t stop addressing it with them…they may change it or we may change the govt!
I have to travel from Kenora, Ontario to Winnipeg to see an allergy or heart specialist/and or go for special procedures. My husband has to accompany me. We have to stay overnight. I look for deals online for hotels but still,with taxes and fees, the $100 hotel doesn’t cover it. I usually pay about $140 – $155 for this and as I said, I book online in advance to get deals. Also, why is there a deductible for the mileage. Believe me, provincial and federal government employees don’t have to have deductibles when doing government business. Also, government employees don’t have to have a $100 limit on their hotel allowance and pay out of pocket for anything more when doing government business. (note…..at times there are those people that have to stay more than one day and are only allowed the $100….it is the entire limit for the grant even if their stay is longer. What are they supposed to do? Sleep on the street?) This is so unfair. We are retired and have a set income. It’s difficult to pay for these expenses. It just seems the government has lots of money to pay for the things it wants, ie. the $10 million payout to Omar Khadar, but little to help those in need that are sick and vulnerable. We are at the mercy of those we elect. These travel grants need to be upgraded and reflect prices accurately. Thanks for listening.
patient companion had to stay almost two weeks with 82 year old patient room will be approx $1000.00 travel grant covers $100. not very good. Seniors don’t have the money to pay these expenses.
Atikokan to Thunder Bay is 203 km one way the bus only runs once a week and only one way so you would have to stay in a Motel for a week on top of that they don’t pay for the first 100 km and the most you can revive is 130.00 for travel . There is a shuttle service KellyCoach who offers same day return trips but northern travel don’t give enough to use their service so kinda stuck in a rock and hard place gov should pay more
My mother is a 78 year old legally blind senior who requires major surgery on her sighted eye. The surgery will render her blind for several days post-surgery and she is required to stay in Ottawa two days pre-surgery and 10 days post-surgery. We must drive a distance of 482km there and back and although we appreciate the mileage assistance, having only $100 in assistance for accommodations and no assistance for meals when required to stay to see the doctor every second day for follow-up post-surgery is not much assistance at all.As her companion, to assist and care for her in the days after the surgery where my mother will be unable to see or care for herself also leaves me unable to attend work – this is a 12 day stay after all. It is unacceptable. My mother is a senior on a fixed income of OAS and CPP and when a family member must take a leave of absence and must pay accommodation costs such as these – it puts additional strain on families already going through stressful health issues. My mother is facing potentially losing her sight completely when she wakes up. The other stress can be eliminated by a financial assessment or scale being put in place to at least assist the low income families in these circumstances. It’s unacceptable that a human being must go through this when they are suffering.
I need to travel from Marathon, Ontario to Thunder Bay Regional Hospital for Surgery’s. First you need to go the day before for the Pre Op, stay the night for Surgery the next day, even though it’s day surgery they want you to stay that night and they send a nurse to your motel, for your pain medication & dressing changes. So you have no choice but to stay two nights in a motel & one of the nights they use like a hospital room, but the travel grant only pays $100.00 for accommodations. So you end up paying out of your pocket. They should at least pay all of the accommadations. It’s not our fault that they built a Regional Hospital that can not accommadate the Region.
If your spouse is flown from northern community to southern Ontario for surgery, why won’t the cost of hotels and meals be covered. Telemedicine wouldn’t work. And the Federal/Provincial mileage rate is .56 in 2016. Why is the mileage rate .41? Are patients and taxpayers being punished?
I was sent for emergency surgery on a Wednesday. but once arriving at they hospitAL and waiting hours to find outy surgery would need to be rescheduled to friday-overnight stay-released Saturday. My issue-unable to drive do a friend drove. Missed now 4 days of work & we found family to stay with because we couldn’t stay that long at a hotel-too expensive. We need better health care. Sudbury needs specialist!
I traveled by car from Parry Sound district to London for surgery performed on Sept. 17, 2015. For various reasons my application for travel assistance was not completed and mailed until the first week of September of this year. Although the application itself was fine, I was denied because no one acknowledged it until September 20th – 3 days late for the twelve month cutoff of Sept.17/2016. The 17th was a Sat. and the mail was not opened until the following Tuesday. Does the mail always get opened the same day it’s received or does it sit on someone’s desk for a few days? The letter denying the claim was dated Oct.5 which suggests that there may be some backlog in processing claims. For a Ministry that claims to be committed to helping people, perhaps a tiny bit of flexibility would be appropriate.
My wife and I had to go $750 out of pocket (after travel grant paid us $237.90) for her to have surgery in Thunder Bay.
I also had to deal with the headache of getting the $100 accommodation reimbursed, because the motel we stayed at issued the receipt in my name. The Ministry refused to pay the accommodation allowance, because my wife’s (the patient) name wasn’t on the hotel receipt.
I’d say the experience has been a shocker, but I’m never shocked when I’m dealing with the Ontario government.
Appeal this.. the hotel will issue the required receipt because they are aware of these silly rules the govt has and the govt will reconsider the app and pay. They dont make the rules completely clear. If you require help call your MPP’s off. The are very helpful.
Patients that qualify for the travel grant have difficulty finding a room within the $100 limit and furthermore if extended treatment is needed they find themselves financially burdened with the extra cost
My dad was to have a “routine” heart procedure and almost died. He then caught a hospital infection and was delirious. As POA I had to stay for 18 days with only $100 towards hotel was covered.
The Northern Health Travel Grant system is too inflexible.
For example, those in Elliot Lake do not qualify for the accommodation allowance when travelling to medical appointments in Sudbury but if the appointment is very slightly further in Sault Ste Marie then they qualify for accommodation.
Qualification takes no account of what the appointment is for. Someone going to Sudbury for day surgery must drive him/her self home or pay hotel accommodation themselves. Crazy!
Even more ridiculous, someone who has appointments on two consecutive days and does not qualify for accommodation must repeat the (175km exch way) trip each day!
My husband recently under went a quadruple bypass in Hamilton. I had to drive 4 hours to Thunder Bay to be with him when he flew to Hamilton. I had to stay in a hotel in Thunder Bay because he didn’t fly out until the next day. I had to pay for hotels in Hamilton for 8 nights, take a $100 cab ride to Pearson to get us home, paid $900.00 in airline tickets, spent $25 on a cab from the Thunder Bay Airport and then stayed another night at a hotel for $145.00 at the doctors request before diving another 4 hours home.
All totaled, we are out of pocket $1980.00…we get refunded $1221.00!! That covers the airfare, $100 for accommodations and $.41 a kilometer for the travel. That leaves a balance of $728.00 that we have to suck up because we live in a small northwestern community. Pile of crap!!
My wife and I (both seniors) live in Windsor.
In 2013 she was diagnosed with a rare form of cancer–a soft tissue Sarcoma.
Our local Cancer clinic immediately referred her to Princess Margaret hospital in Toronto—our local hospital has no experience nor resources to treat Sarcomas. We had no other choice.
We had to take Via over 35 times and literally live in Toronto hotels (400 km away) throughout 2013 and 2014, for consultations, various examinations, various tests, radiation, very extensive surgery, and various follow up visits. Going by car is out of the question due to weather, physical limitations, higher cost, etc.
More visits and more surgery are slated for 2015.
Our total expenses so far are over $23,000.
About a quarter of our expenses have been recovered though medical expense credits on our income taxes, but the remaining amount is not.
We don’t qualify for Northern Health Care assistance, and are quickly eating up our savings.
Any advice would be appreciated
Having to travel from Thunder Bay to Toronto for treatment as my unborn son has been diagnosed with a condition known as CDH and no one in Thunder Bay can assist. Each trip is a minimum of 3 days and we soon find out if I’ll have to remain in Toronto for the remaining 10-12 weeks of my pregnancy… Medical rate at a hotel within 20mins of hospital is 139$…the northern travel grant is a help for flights but how am I supposed to afford this upcoming hotel bill? Especially since I’m not working anymore :(
It should be looked… The accommodation portion should be more than 100 per trip
I find it very unfair and unaffordable, my dr has sent me out of town to see a specialist, I have been since told I have to go back 4 more times. I understand I will have help with the travel but once I get there it is going to cost me over a hundred dollars to and from airport. I have no income what so ever as I have been off due to neck and back issues and spending this is taking away from other things of importance. I would not think twice about hoping on a bus or subway but I have a very hard time sitting, standing for any length of time, if I could I would not need these visits. I really wish there was at least some help with transportation.
As mentioned in the last section of the article, telehealth has been shown to be an effective means of delivering care to rural and remote populations. Patients can not only avoid the costs associated with travel but also access care in a more timely manner. According to a Praxia/Gartner study commissioned by Canada Health Infoway in 2011, patients reported avoiding between $400 and more than $1,000 per return trip by using telehealth. Furthermore, a number of medical disciplines reported more timely care in a variety of care settings. For example, wait times for dermatology were reported to be reduced to no more than 10 days, and frequently only two days; wait times for ophthalmology were observed to decrease from about 25 days to less than two days. The full study can be accessed here:
https://www.infoway-inforoute.ca/index.php/progress-in-canada/benefits-realization#telehealth
How is telehealth going to administer my treatment? I attend a pain clinic in Toronto. There is a difference between not knowing if I have the flu or a cold and calling telehealth and getting treated for chronic pain, chronic headache, and receiving IV treatments for pain. Your comment is irrelevant.
%featured%My husband and I have to live in Toronto because he needs a lung transplant. Because we have to be within 2.5 hours from the only hospital in Ontario that does the procedure we have had to relocate from Sault Ste. Marie. %featured%Through Trillium we get $650 per month as a relocation allowance. Others on the transplant list from the Maritimes get between $1500 and $1650 per month for relocation. It costs us who live in Northern Ontario a lot more to live here than it does for them. After 13 months on the waiting list we have spent more than $ 15 000 of our own money to live here. We are grateful for the chance my husband has at a new life but it is a very unfair situation in a country where medicare is supposed to be universal.
A patient cannot claim expense without return airfare ticket completed.
For example, someone from N. On. who is needs to be in Toronto for a lung transplant, (which can be a 1-3 year process) gets the same amount as a one day visit AND no refund until patient completes trip, in other words, returns home.
%featured%The travel grant is good in northern Ontario , it does assist to see a real specialist in southern Ontario, but the question is why isn’t Health Care the same in Toronto, London or Timmins.%featured%
The Health Care experience in Sarnia is no where at the level of London. London Health Care is supreme to Sarnia
Anyone who has had any experiences with the Sudbury Hospital will tell you.. Going down South for medical care is the only option we have, if you want to live. And the Doctors down south will tell you how pathetic our health care in Sudbury really is. So %featured%in my opinion, the travel grant should be enough to cover ALL expenses. Not just part.%featured%If we had great health care and the same services as the south People wouldn’t have to travel.
I had 5 bypasses in 2000 and still going strong. I am a tradesman and just submitting my retirement papers now, you must have had a bad experience, but don’t take it out on all of Sudbury. In fact Sudbury has a reputation for their knowledge and care of heart patients.
My husband just had a heart attack and he had great care in Sudbury
What I don’t understand is that my expenses including an overnight stay in Toronto (hotel cost $150.00 a night near the hospital) were denied because I should have taken a bus to my 7 a.m. appointment from Sudbury and come home the same day instead of travelling the night before and staying in a hotel. With all the red tape and then being denied I haven’t even bothered to apply again. I now have specialist appointments every 2 weeks in Toronto.