Wednesday, March 07, 2007

Random Rules and Health Cards

I am only passingly familiar with the work of Franz Kafka, but from what I recall of the bits and pieces I have read, seen, or read about, a common theme (perhaps in general, or perhaps just in The Trial, I don't remember) is the protagonist being buffeted about by bureaucratic rules that they do not know and that noone will explain. It was really a fairly benign manifestation, but I think perhaps Kafka's ghost happened by and sprinkled a little fairy dust on me yesterday and today.

In Ontario, to get the health care benefits that you are entitled to as a resident of the province, you need to have a card bearing a unique number issued by the provincial government. At some point a decade ago or so they started a program under which all residents would have their old cards replaced with new ones. The old ones had just your name, the number and a signature, whereas the new ones had all of that plus your address and a photo. At some point during this transition it was decided that the whole business was costing too much, so they would terminate the program and just let anyone who still had the old cards keep them.

My partner and I both still had the old orange and white cards. When we were doing the million and three stressful things that needed to be done in 2004 before our move from Hamilton, Ontario, to Los Angeles, California, we had no idea that we needed to do anything with respect to our health cards. We did not even know that we needed to notify them of a change of address -- we had changed our driver's licence addresses, which are also issued by the province, and our health cards didn't even have addresses on them, so it didn't occur to us that we might need to.

So yesterday I went into the Ministry of Health office locally to get a new health card for L, our three-and-a-half year-old. The card we got shortly after his birth had expired awhile ago and we knew we needed to get a new one but just hadn't done it yet. I explained the situation and was informed that they had tried to mail us something about his card and it had been returned, so they had cancelled the card completely. I did not just need to renew it but to get an entirely new card. And to do that, I needed to have his birth certificate, which I had not brought, so I would have to come back another day.

Okay. Fine.

I also mentioned that the reason the mail was returned was because we lived outside the country for awhile. It was then that I learned that we should have filled out a change of address form, and I should bring that back whenever I came back to get a new card for L.

The change in demeanor of the person I was dealing with was quite noticeable over the course of our short interaction. When I was some guy there with a cute kid doing a routine piece of business, it was all warmth and smiles. It was still professional at the end, but as it became clear that I had failed to obey bureaucratic dictates that I did not know existed, and was therefore a Silly Person, the person dealing with me became somewhat more brusque and cold.

So today we went back. We dealt with someone else, who was warm from beginning to end, but not because I was in any way a less Silly Person today. Apparently we had even done potentially illegal things. Apparently -- and you are just supposed to know this by osmosis, I guess -- if you are intending to live outside the country for more than seven months but you intend to move back at some point, you are obliged to notify the Ministry so that they can change the status of your relationship to the provincial health insurance program without terminating your enrollment in it. If you don't tell them, you get booted off after seven months. I'm not clear where exactly the illegality comes in, but she did use that word a few times. Anyway, today when I submitted our change of address forms, I was informed that in fact we had to fill out different forms in order to be retroactively booted off the rolls and then readmitted with new numbers and new cards.

I'm still not clear on what all of this might have meant. It is a looooong time since I have been to the doctor and, despite our connection to medical institutions in this city via my partner's job, we still don't actually have a family doc. But does all of this mean that the provincial health insurance program would not have covered me if I had had some sort of accident in the year and a half that we have been living back in Ontario because I didn't fill out the right forms at the right times, even though I would've met all the conditions for coverage?

It's a scary thought.

Still better than some of the run-arounds we got from private sector insurance in LA, however.


debbie said...

I also had a hard time renewing my health card. I had just moved back to Toronto, and didn't have anything with my current address on it, so they didn't want to give me a new health card. And I was leaving the country very soon. I've lived in Ontario my entire life, and I had a brand new passport (amidst other forms of government issued ID) to prove my Ontario residency. I tried pointing out to the woman who was helping me that getting a passport is way harder than getting a health card, and that if my identity was actually in question, the fact that I had a passport was more of a problem than OHIP fraud. No dice. They made me drag my mother in to be my guarantor, which was more than a little humiliating.

Scott said...

Wow...what a pain...I can't believe they wouldn't accept your passport...that's ridiculous!

Whenever I encounter a relatively small but still infuriating thing like the experiences I described in the post, it renews my sympathy and respect for those people whose lives are much more closely defined by having to navigate big bureaucracies (that are often invested in being hostile to the people that depend on them) to get what they need to live...folks on social assistance, for instance, and a friend who had a long-running battle over disability benefits with a private insurance company, and so on...there must be better ways to do things.