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Question: I live in British Columbia and I am moving to Ontario. Once I have my Ontario health card, will I be able to see my specialists in B.C.? In particular, I am presently able to see my psychiatrist (of 10+ years) over FaceTime (or Skype) when I am unable to make it to her office. Would I be able to continue seeing her over FaceTime? And would I be able to have appointments with her when I am visiting B.C.?
Answer: We tend of think of Medicare as a national program. But under our constitution, the delivery of health care is primarily a provincial responsibility – and each province provides medical services to its own residents.
“For people permanently moving to another province, one is expected to enroll in that province’s health care plan,” Stephen May, a spokesperson for the B.C. Ministry of Health, says in an email.
That essentially means you will be expected to switch to health-care providers in your new home province of Ontario.
However, you will have to live in Ontario for roughly three months before you are considered a permanent resident of the province and become eligible for Ontario Health Insurance Plan (OHIP) coverage.
In the transition period, B.C. will continue to pay your medical bills. So, during that time, you can continue to do FaceTime or Skype appointments with your psychiatrist back in B.C.
At the end of the three months, your B.C. coverage expires and you will come under the umbrella of OHIP.
The first thing you need to know is that the provincial plans are not identical. B.C. covers the cost of psychiatrist appointments conducted over the Internet. Ontario does not.
“Psychiatric services must be rendered in person with the patient in order to be insured, therefore the FaceTime/Skype service is not covered,” Joanne Woodward Fraser, a spokesperson for the Ontario Ministry of Health and Long-Term Care, explains in an email.
But if you go back to B.C. for a visit and have a face-to-face appointment with your psychiatrist, then OHIP will foot the bill. (Under inter-provincial cost-sharing agreements, your home province covers your medical bills if it’s medically necessary for you to see a doctor or be admitted to hospital while travelling within Canada.)
An occasional in-person appointment with your long-time psychiatrist might be nice, but it isn’t a practical solution for your ongoing care. You will need to find health care providers in Ontario. That makes sense for a number of reasons, says Dr. Paul Kurdyak, who is head of mental health and addiction research at the Institute for Clinical Evaluative Sciences in Toronto.
If there is a change in your mental health, and you need a higher level of care, “then you will want your psychiatrist to be able access regional resources,” on your behalf says Dr. Kurdyak, who is also an emergency-care psychiatrist at the Centre for Addiction and Mental Health.
He notes that mental health services and programs can vary greatly across the country.
“A psychiatrist in B.C. wouldn’t be able to do much to help you navigate the Ontario system,” he adds. That kind of detailed knowledge of local programs would normally come from someone who is working in the province.
And if you were ever hospitalized for your condition, then you would want someone to help coordinate your care so there is a smooth transition back to the community. In that case, you would also benefit from having a physician familiar with the local health care processes.
Of course, it would be comforting if we could maintain our ties to our long-time physicians when we move to another part of the country. After all, many people feel very attached to their doctors – especially those who see psychiatrists fairly frequently.
But it really is in your best interest to start fresh, and find a care-provider closer to your new home. Admittedly, it might not be easy. Dr. Kurdyak says psychiatrists tend to see the same group of patients on a fairly regular basis – and don’t often take on a lot of new patients. (Psychologists also provide therapy, but their services aren’t routinely covered by OHIP.)
So, it could take you a while to find a new psychiatrist. In the meantime, you may want to look for a family doctor who also has an interest in caring for patients with mental health issues.
And at least during your first three months in Ontario, being able to use the Internet to connect with your B.C. psychiatrist may help lessen the stress of the transition.
Paul Taylor, Sunnybrook’s Patient Navigation Advisor, provides advice and answers questions from patients and their families. His blog, Personal Health Navigator, is reprinted on Healthy Debate with the kind permission of Sunnybrook Health Sciences Centre. Follow Paul on Twitter @epaultaylor.