Regulation prevents the province from covering the expense
A senior from Manitoba is down $5,000 after the province refused to reimburse him for bionic knee braces that he needs to deal with a debilitating knee condition.
Wes Vanstone, a 78-year-old man who has been curling, dancing, and farming all his life, had to give up all three when he developed patellofemoral arthritis, reported CBC News. To deal with the condition, which causes intense pain when he moves his legs, Vanstone tried a number of different knee braces before finally getting a prescription for bionic braces from his doctor.
“It takes 100 per cent of the brace to lift me, 'cause I've got no assistance from my kneecaps,” he told CBC News. “It's got to be done with a mechanical device.”
Since last summer, Vanstone has been able to sit, stand, and move around painlessly because of the spring-loaded braces. Without them, he cannot go from a standing to a sitting position without experiencing an audible, tear-inducing cracking of the knees.
Because the province had covered the costs of other kinds of braces, he assumed he could purchase the bionic ones and get reimbursed. But this time, Manitoba Health denied reimbursement — a decision which he appealed. The appeal board found that the braces were not listed on the medical devices schedule indicated under the Health Services Insurance Act.
“This schedule has not been updated in the last 15 to 20 years,” the decision said. “The board has sympathy for the apellant's plight in that the orthotic he purchased is simply too new to have made the tariff.”
Vanstone is scheduled to undergo knee replacement surgery this summer. But he’s anxious, saying that the braces are the only solution that has worked. And he’s getting another “beefed up” set in July, which he will pay for out of his own pocket.
Manitoba allows people to apply for special consideration on newer medical technology, as long as they can provide a detailed rationale for why they need it. But when asked by CBC News, Manitoba Health could not confirm if that process was different from the appeal Vanstone had submitted.
“Perhaps in the future, the tariffs found in the POMD regulation, and similar regulations enacted under the act, will be updated … to include provisions that allow for expenses for new services and devices more previously in existence or considered to be reimbursed if they are medically required,” wrote the acting chairperson of the Manitoba Health Appeal Board in her decision.
