Medical Inadmissibility case for potential Permanent Reseident

[GlobalCitizen1984]

Dear Friends,

Due to the nature of my question, I hope you will not consider my request in a politically biased way.

So, here is my situation:

I work for a large multi national employer. I have active Ankylosing Spondylitis.
I discussed my case with a good medical immigration attorney in Canada and he said that I may be admissible because I have health plan and if I chose Ontario(He said other states are a possibility too, but he is not much aware of that).
The reason he said ontario was because in Ontario the health Plan is the first Payer. Is this correct? Where can I find the official information about this and other states?


I was told I may have to sign an agreement saying for 5 years I will not use Govt Health Care and would pay either with my health plan or out of pocket. I was also told certain procedures done in govt funded clinics cannot be paid by health plans or out of pocket. This is a very broad definition and the attorney said they do not have much further information about it. This is where I think a group like yours can help me?

I will ask very specific questions so as you know what I am seeking help of:

1. Scenario: I go to a rheumatologist. She charges me something. My plan pays 60% I pay 40%. Even if it is govt funded hospital/clinic. Is it possible?
2. Scenario2: medicines. Same thing as above. Say they are administered in a hospital.Like remicade... Can my plan pay 60% and rest I pay?
3. Scenario 3: big and expensive procedure: hopefully not: if it comes to that: Same question : can my plan pay 60% and rest I cover?
4. The rest of the 40%: is there a way for a permanent resident to get some financial help if it is out of my budget or I cannot afford it. I can always go back to my home country to get a very expensive procedure, which I have kept an option open for myself. But the healthcare will not be as good as in canada. So, I would rather explore an option of getting treatment in Canada instead of going back to my home country. I hope I do not need any such procedure for the five years for which the written agreement will be valid. But just in case.
5. The reason he said ontario was because in Ontario the health Plan is the first Payer. Is this correct? Where can I find the official information about this and other states?
6. Are there private clinics in Ontario? I talked to a native of Ontario and he said there are no private clinics at all.
7. What is the best option for me to apply for Permanent Residency? is it express entry for skilled foreign workers?
https://www.canada.ca/en/immigration-refugees-citizenship/corporate/publications-manuals/express-entry-system-immigrants.html




I hope someone will reply to me regarding this.

Sincerely,
John Doe

 

[zardoz]

Dear Friends,

Due to the nature of my question, I hope you will not consider my request in a politically biased way.

So, here is my situation:

I work for a large multi national employer. I have active Ankylosing Spondylitis.
I discussed my case with a good medical immigration attorney in Canada and he said that I may be admissible because I have health plan and if I chose Ontario(He said other states are a possibility too, but he is not much aware of that).
The reason he said ontario was because in Ontario the health Plan is the first Payer. Is this correct? Where can I find the official information about this and other states?


I was told I may have to sign an agreement saying for 5 years I will not use Govt Health Care and would pay either with my health plan or out of pocket. I was also told certain procedures done in govt funded clinics cannot be paid by health plans or out of pocket. This is a very broad definition and the attorney said they do not have much further information about it. This is where I think a group like yours can help me?

I will ask very specific questions so as you know what I am seeking help of:

1. Scenario: I go to a rheumatologist. She charges me something. My plan pays 60% I pay 40%. Even if it is govt funded hospital/clinic. Is it possible?
2. Scenario2: medicines. Same thing as above. Say they are administered in a hospital.Like remicade... Can my plan pay 60% and rest I pay?
3. Scenario 3: big and expensive procedure: hopefully not: if it comes to that: Same question : can my plan pay 60% and rest I cover?
4. The rest of the 40%: is there a way for a permanent resident to get some financial help if it is out of my budget or I cannot afford it. I can always go back to my home country to get a very expensive procedure, which I have kept an option open for myself. But the healthcare will not be as good as in canada. So, I would rather explore an option of getting treatment in Canada instead of going back to my home country. I hope I do not need any such procedure for the five years for which the written agreement will be valid. But just in case.
5. The reason he said ontario was because in Ontario the health Plan is the first Payer. Is this correct? Where can I find the official information about this and other states?
6. Are there private clinics in Ontario? I talked to a native of Ontario and he said there are no private clinics at all.
7. What is the best option for me to apply for Permanent Residency? is it express entry for skilled foreign workers?
https://www.canada.ca/en/immigration-refugees-citizenship/corporate/publications-manuals/express-entry-system-immigrants.html




I hope someone will reply to me regarding this.

Sincerely,
John Doe

Pretty much dismiss the idea of signing any form of "agreement" as it can't be legally enforced. I believe that you are going to find that overcoming a medical inadmissibility will actually be very difficult, if the "potential cost" to provincial healthcare exceeds the excessive demand limits now.

At the very least, you a) need to determine IF you are likely to be inadmissible and b) work with a lawyer that has a proven track record of overcoming it, especially with the new increased excessive demand limits.

 

[GlobalCitizen1984]

Hi Zardoz,

Thanks for replying. I wasn't expecting that I will get a traction on my thread so quickly and there are still nice people like you who try to help others.

So, you said:

Pretty much dismiss the idea of signing any form of "agreement" as it can't be legally enforced. - I am not sure. I did pay a consultation fee and discussed the case with a top medical inadmissibility immigration lawyer in Toronto who has a proven record. And he told me this. He is very well known lawyer.
So, I cannot comment on what you said.

I believe that you are going to find that overcoming a medical inadmissibility will actually be very difficult, if the "potential cost" to provincial healthcare exceeds the excessive demand limits now.-

At the very least, you
a) need to determine IF you are likely to be inadmissible- the lawyer said yes, I am inadmissible.
and
b) work with a lawyer that has a proven track record of overcoming it, especially with the new increased excessive demand limits.- yes I am doing that.

My questions were beyond that phase, if I may rephrase. after I get permanent residency and start getting treatment. I will not list my questions again, so as not to mess up the format, but I have bullet pointed my questions above. Can you please review them again?

Thanks for your time in replying.
Sincerely,
GlobalCitizen1984

 

[GlobalCitizen1984]

The reason I am asking is because the Lawyer said any procedure done in govt funded clinic cannot be paid by me. Not sure if he meant doctors also, or only procedures?
So, I will have to go to a private clinic or chose private clinic doctors. This may limit my choice of doctors( as I think due to the nature of healthcare system of Canada, most of the good/best doctors may be working in Govt funded clinics and hospitals) as no one pays from out of pocket in Canada.
Unlike USA.

 

[Medwizkid]

The issue is to be on treatment and be below the threshold. With the biologics such as remicade there are generics and modified low dosage regimes that may get you just below the threshold. You just have to prove it. Research the drugs in Canada for your condition find the one with the lowest cost and ask you Dr to out you in that and go foward. Remicade has a generic inflectra and there is an alternative dosage regime of 3mg/kg vs 5mg/kg which should cut the cost by almost 40%. Next ask you Dr for minimal follow up as possible once a year and labs as minimal as possible.

 

[GlobalCitizen1984]

The issue is to be on treatment and be below the threshold. With the biologics such as remicade there are generics and modified low dosage regimes that may get you just below the threshold. You just have to prove it. Research the drugs in Canada for your condition find the one with the lowest cost and ask you Dr to out you in that and go foward. Remicade has a generic inflectra and there is an alternative dosage regime of 3mg/kg vs 5mg/kg which should cut the cost by almost 40%. Next ask you Dr for minimal follow up as possible once a year and labs as minimal as possible.

I am thankful you took time to write. However, please see my questions again, my first post on this thread, and let me know if you have any information regarding the questions I asked.

Sincerely,
GlobalCitizen

 

[Medwizkid]

Dear Friends,

Due to the nature of my question, I hope you will not consider my request in a politically biased way.

So, here is my situation:

I work for a large multi national employer. I have active Ankylosing Spondylitis.
I discussed my case with a good medical immigration attorney in Canada and he said that I may be admissible because I have health plan and if I chose Ontario(He said other states are a possibility too, but he is not much aware of that).
The reason he said ontario was because in Ontario the health Plan is the first Payer. Is this correct? Where can I find the official information about this and other states?


I was told I may have to sign an agreement saying for 5 years I will not use Govt Health Care and would pay either with my health plan or out of pocket. I was also told certain procedures done in govt funded clinics cannot be paid by health plans or out of pocket. This is a very broad definition and the attorney said they do not have much further information about it. This is where I think a group like yours can help me?

I will ask very specific questions so as you know what I am seeking help of:

1. Scenario: I go to a rheumatologist. She charges me something. My plan pays 60% I pay 40%. Even if it is govt funded hospital/clinic. Is it possible? ->they consider the 100% cost not the part funded by the province. The ratio doesn't matter.
2. Scenario2: medicines. Same thing as above. Say they are administered in a hospital.Like remicade... Can my plan pay 60% and rest I pay?_> another issue is it an international plan or a canaCana plan .they consider the whole 100% in the calculation.
3. Scenario 3: big and expensive procedure: hopefully not: if it comes to that: Same question : can my plan pay 60% and rest I cover? -> Not sure
4. The rest of the 40%: is there a way for a permanent resident to get some financial help if it is out of my budget or I cannot afford it. I can always go back to my home country to get a very expensive procedure, which I have kept an option open for myself. But the healthcare will not be as good as in canada. So, I would rather explore an option of getting treatment in Canada instead of going back to my home country. I hope I do not need any such procedure for the five years for which the written agreement will be valid. But just in case.
5. The reason he said ontario was because in Ontario the health Plan is the first Payer. Is this correct? Where can I find the official information about this and other states?
6. Are there private clinics in Ontario? I talked to a native of Ontario and he said there are no private clinics at all. -> you can pay cash at any clinic. If you don't have a provincial card you can pay cash.
7. What is the best option for me to apply for Permanent Residency? is it express entry for skilled foreign workers?
https://www.canada.ca/en/immigration-refugees-citizenship/corporate/publications-manuals/express-entry-system-immigrants.html




I hope someone will reply to me regarding this.

Sincerely,
John Doe

 

[canuck78]

Dear Friends,

Due to the nature of my question, I hope you will not consider my request in a politically biased way.

So, here is my situation:

I work for a large multi national employer. I have active Ankylosing Spondylitis.
I discussed my case with a good medical immigration attorney in Canada and he said that I may be admissible because I have health plan and if I chose Ontario(He said other states are a possibility too, but he is not much aware of that).
The reason he said ontario was because in Ontario the health Plan is the first Payer. Is this correct? Where can I find the official information about this and other states?


I was told I may have to sign an agreement saying for 5 years I will not use Govt Health Care and would pay either with my health plan or out of pocket. I was also told certain procedures done in govt funded clinics cannot be paid by health plans or out of pocket. This is a very broad definition and the attorney said they do not have much further information about it. This is where I think a group like yours can help me?

I will ask very specific questions so as you know what I am seeking help of:

1. Scenario: I go to a rheumatologist. She charges me something. My plan pays 60% I pay 40%. Even if it is govt funded hospital/clinic. Is it possible?
2. Scenario2: medicines. Same thing as above. Say they are administered in a hospital.Like remicade... Can my plan pay 60% and rest I pay?
3. Scenario 3: big and expensive procedure: hopefully not: if it comes to that: Same question : can my plan pay 60% and rest I cover?
4. The rest of the 40%: is there a way for a permanent resident to get some financial help if it is out of my budget or I cannot afford it. I can always go back to my home country to get a very expensive procedure, which I have kept an option open for myself. But the healthcare will not be as good as in canada. So, I would rather explore an option of getting treatment in Canada instead of going back to my home country. I hope I do not need any such procedure for the five years for which the written agreement will be valid. But just in case.
5. The reason he said ontario was because in Ontario the health Plan is the first Payer. Is this correct? Where can I find the official information about this and other states?
6. Are there private clinics in Ontario? I talked to a native of Ontario and he said there are no private clinics at all.
7. What is the best option for me to apply for Permanent Residency? is it express entry for skilled foreign workers?
https://www.canada.ca/en/immigration-refugees-citizenship/corporate/publications-manuals/express-entry-system-immigrants.html




I hope someone will reply to me regarding this.

Sincerely,
John Doe

Either the lawyer is incompetent or you may have misunderstood.

I think the lawyer was saying one of the points you can state on your reply to procedural fairness letter is that you already have a job with extended benefits and will continue to have coverage to pay for your medication. This is a valid argument but it still means that you could easily need to access government drug benefit programs if your disease progresses or if you loose your job. Think the the lawyer may also be suggesting that you must pay for your medical for your PR application.

1. If you have OHIP you will not have to pay to see a rheumatologist.
2. You will have to pay for the remicade if you have extended benefits through work they should cover a percentage. If you don't have insurance it will fall on the government to cover all or a portion of your medication. That is why the government is concerned because biologicals are expensive.
3. If you also need to get an expensive procedure it would be covered by OHIP which is another reason the government will be concerned about your medical costs over the next 5-10 years.
4. Not sure what you are talking about first payer are you under 25?
5. Yes there are some private clinics but they are usually dermatologist, plastic surgeons and executive medical clinics. Most specialist only work in the public system unless a patient doesn't have OHIP and they pay cash.
7. You have to look at your profile and find out what immigration program you qualify for.

The big issue will be your cost of medication, guessing you need spinal surgery which is usually very expensive and you also may require mobility devices at some point.

 

[GlobalCitizen1984]

Either the lawyer is incompetent or you may have misunderstood.

I think the lawyer was saying one of the points you can state on your reply to procedural fairness letter is that you already have a job with extended benefits and will continue to have coverage to pay for your medication. This is a valid argument but it still means that you could easily need to access government drug benefit programs if your disease progresses or if you loose your job. Think the the lawyer may also be suggesting that you must pay for your medical for your PR application.

1. If you have OHIP you will not have to pay to see a rheumatologist.
2. You will have to pay for the remicade if you have extended benefits through work they should cover a percentage. If you don't have insurance it will fall on the government to cover all or a portion of your medication. That is why the government is concerned because biologicals are expensive.
3. If you also need to get an expensive procedure it would be covered by OHIP which is another reason the government will be concerned about your medical costs over the next 5-10 years.
4. Not sure what you are talking about first payer are you under 25?
5. Yes there are some private clinics but they are usually dermatologist, plastic surgeons and executive medical clinics. Most specialist only work in the public system unless a patient doesn't have OHIP and they pay cash.
7. You have to look at your profile and find out what immigration program you qualify for.

The big issue will be your cost of medication, guessing you need spinal surgery which is usually very expensive and you also may require mobility devices at some point.

Hi Canuck78,

Thanks! I will check with my rheumy if she knows someone in canada at doctor level. And can clarify the costs of medicines vs private and public rheumys in Canada. The thing which I remember is remicade is administered thru IV(so it has to be a clinic) whereas. Enbrel Biosimilar is a pen...
I will have to wait for information from my rheumy and hopefully I can switch to things as you suggested to keep my costs lower