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Rollercoaster of the CAMH experience & OHIP coverage

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I live in Ontario. We have a provincial insurance that covers doctor visits & surgeries (medical necessity, not cosmetic) Called OHIP (Ontario Health Insurance Plan). In order for Gender Reassignment Surgery to be covered under OHIP, you need to go through the Gender Identity Clinic (GIC) at Centre for Addiction and Mental Health (CAMH).

In order for ANYONE in Canada to have GRS covered by their provincial health plan, they have to go through the GIC at CAMH, and the only ONE centre in the country is in Toronto. Yes, that's right, all of Canada has only one building that you must go to, in order to get assessed by a psychologist and a psychiatrist two times (4 visits) in order to tell if you are stable enough to qualify for GRS. Needless to say, the wait time is upward to 19 months - just for that process.

I waited and went through this process. I didn't want to initially, because the CAMH program has horror stories of the way they treated patients, that asks invasive questions about your masturbation habits and kinks and other messed up stuff. My endocrinologist assured me that the GIC had an overhaul of doctors and the program standards had changed (which threw me off when I was asked these types of questions after all - which sent me into a two month depression spiral).

There really is no public available information about the whole process and what to expect. The impression I had, was that you go through the 4 visits for the assessments, then they have a meeting and decide if you are stable. Then if you're approved, you get your funding letter. Then you find a surgeon, wait on their wait list and get the surgery. It used to be that only one doctor in Montreal (Brassard - who has now retired from FTM surgery and passed on FTM to Belanger) is the only doctor that performed surgeries in all of Canada that was covered through all provincial health plans. I'm not sure when this changed, but Ontario had made it so you didn't have to travel to Montreal. You could go ANYWHERE to any doctor who accepts OHIP.

I was told on the phone that I had unofficially been approved a month before my final visits, I needed to attend the last set of appointments to finish the process. Excited, I called a lot of doctors (12) in Toronto, all of which told me that they do not accept OHIP coverage (but if they did, there would be a $7,400 privatization fee), or never returned my calls. I wanted to find a surgeon right away so I had a name to give CAMH, and was shocked that in the biggest city in Canada, zero doctors accept our provincial health plan benefits.

At my final appointment at CAMH (last summer), the doctor said something along the lines of, "so you're going to Montreal then?" and that's when I told him my disappointment  of not being able to find a surgeon in Toronto, and the fact that I felt like I wasted my time, and that transparency is a huge problem because there is such a lack of information on what to expect going through the GIC (I actually recorded this appointment on my iPhone because after the questions about how often I masturbate, what I think about when I do, what fetishes I had, positions in which I have sex, I wanted proof of their treatment. I do plan on putting the audio on soundcloud when I no longer need my funding).

So then, CAMH doctor told me that OHIP  has a list of out of country surgeons that they accept in the past, and if I find a doctor who isn't on the list, they need to make sure they can be approved. I asked if I could get this list, and no, I couldn't, it's not available. So I posed the question along the lines of, if OHIP has a pre-approved list of surgeons, why aren't they sharing it? CAMH didn't know. Long story short, I left super disappointed.

So after about 4 months of being depressed and calling more surgeons in my area (that I could find through Google), I called CAMH back and said, sure, send me to Montreal, even though in my heart I didn't want to travel that far, I don't have the money to travel that far, and don't feel right about not having a physical consult because pictures aren't sufficient. This was in March. I got my OHIP funding letter and a package from the doctor in Montreal. I haven't filled it out yet.

Last month, I *magically* heard about a doctor that *might* accept OHIP 20 minutes away. I had a consult with her, and she was disgusted with my story. She said she would submit the paperwork to OHIP so she could do the surgery. I told her that my worry was that OHIP would decline me because they already approved Montreal and I would have to wait until that letter expires, in two years. She looked me straight in the eye and said something like, "they're (OHIP) going to have to accept that this is unacceptable and the wait list is too long for that doctor in Montreal, nobody should have to go to Quebec for procedures." I don't remember her exact wording.

I got a call yesterday confirming that the paperwork has been sent off, and it could take 3-6 weeks for a decision.

For the first time in a year, I feel like I have a hope of actually getting surgery close to home, but I am still worried that it's not going to be for a while.

 


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4 Comments

Posted

Brigsby,

Wow, I would like to say that I can't believe that line of questioning (about masturbation, etc.), but sadly I can.  I could see some questioning of sexual interest and/or fantasies, but positions!?!?  Wow.

I was discussing that part of the procedure with my therapist the other day and the fact that you need letters from 2 people to be approved for surgery.  Neither of us knew if that meant I'd have to see a second psychologist (or something) for a few months.  When I see my endocrinologist next week I'm going to ask about surgeon referrals so that I can start talking to them about what exactly is required.

It sounds like at least in that area our 2 countries are similarly annoying (to say the least) about the process.  "Informed consent" should really be enough.  I'm a f*@#ing adult!!!

Anyway - good luck!

Christie

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Posted

What I think about this is it's outrageous anyone must go through what you have been through and still having to deal with. A country the size of Canada should have more than one facility to deal with potential transgender and that it should not take that long to get approval. My approval was within two visits of my first therapist and three visits for the second. Big difference is that I paid in cash for surgery out of my savings.

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Posted

Dr Brassard hasn't retired. That was his predecessor, Dr Menard who retired and left the clientele to Dr B. Dr Bélanger and Dr Brassard work together. 

It's a shame options for transitional surgeries are limited. I hoped there were more options too. The surgical work and immediate aftercare from Montreal was very good. Better than a lot of other places. Longer term after care (for non Quebecers ) has been difficult for some people.

i went to the US for a top surgery that OHiP wouldnt cover and basically lost all the money I spent on it after the surgery failed, and the Dr wouldnt provide what I felt was an a acceptable and fair revision process.  I went to a different surgeon in the US Nd had good results with the repair of the first one. We're a small and vulnerable minority, so sometimes we're sidelined or ripped off, and other times treated quite well. We just have to keep doing our best research and sharing what we learn with each other to protect ourselves.

Thank you for your article.

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Posted (edited)

Dear Tara,

Am very sorry about your failed surgery.  Beg everyone to check a surgeon's website for before/after pictures, patient references and consider THREE doctors (a second and third opinion), not just one, because often this kind of surgery is permanent.  A good bed side manner does not mean a good surgeon.  This is where dialogue with our brothers and sisters is ESSENTIAL!

Yours truly,

Monica

Edited by MonicaPz
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