Kelowna senior fights for better medical insurance coverage

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Kelowna senior fights for better medical insurance coverage
A Kelowna senior has finally received an increase to her allowable medical insurance coverage, eight months after being promised it – Jan 28, 2020

With almost one in three Canadians living with diabetes, the life-changing disease is fast becoming one of the biggest health epidemics of the 21st century.

But you don’t have to tell Ilona Enevoldson that.

“It’s a matter of life and death,” said Enevoldson.

Click to play video: 'Ask an Expert: Diabetes Awareness Month'
Ask an Expert: Diabetes Awareness Month

Last February, the 75-year-old Kelowna woman was diagnosed with pancreatic cancer.

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“They removed her pancreas, which put her into Type 1 diabetes overnight,” said Delia Enevoldson, Ilona’s daughter.

And because Ilona no longer has a pancreas, her blood glucose levels require constant, meticulous monitoring.

“We’re in big problems on either end of the spectrum, because you can potentially die from either one of those situations,” said Delia.

But for Ilona, she says pricking her fingers up to 10 times a day just isn’t manageable, so she opted for the FreeStyle Libre monitoring system.

FreeStyle Libre is an innovative glucose monitor that uses a sensor and a scanner. It allows diabetics to monitor their glucose levels for up to two weeks without having to prick their fingers with traditional lancets.

Click to play video: 'Innovative technology changing quality of life for people living with diabetes'
Innovative technology changing quality of life for people living with diabetes

“The product allows us to constantly monitor her blood sugar levels without any problems of pain,” said Delia.

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However, unlike in Ontario and Quebec, B.C.’s provincial government won’t cover the product’s annual $2,760 cost.

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It’s an amount that eats away at Ilona’s eligible insurance coverage of $2,000 dollars pretty quickly.

Click to play video: 'Calls for B.C. government to fund glucose monitor'
Calls for B.C. government to fund glucose monitor

The problem, according to the Enevoldson, is the drug identification number (DIN) that Sun Life assigned for the monitor falls under pharmaceutical drugs, and not under medical supplies, for which Ilona has $5,000 coverage.

“It’s a supply, it’s not a drug,” said Delia.

So Delia says she called Sun Life to see if they would increase the coverage for the product.

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“In June of last year, I was given an authorization to increase her drug coverage,” said Delia.

Delia says that she was told over the phone that her mother’s eligible coverage would be raised to $3,500 from $2,000 in order to help pay for the FreeStyle Libre.

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Making new diabetes technology more accessible

Since that time, however, Ilona’s eligible insurance coverage has not been increased and despite numerous attempts at contacting the company, nothing has been done.

“I have the direct numbers of the people I was in contact with but they are not contacting me back they are snowballing me,” Delia said.

For the Enevoldsons, it’s an extremely frustrating situation, one they say they feel Sun Life is trying to avoid covering for Ilona.

“Absolutely,” Delia said, who said she feels “angry” when asked how she feels about the situation,

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Click to play video: 'Diabetic drug coverage'
Diabetic drug coverage

Global Okanagan contacted Sun Life in order to get its side of the story, and late Tuesday, the insurer reportedly called Delia to apologize,

“They offered to reimburse me for the coverage that I was lacking [in] 2019 and to extend her coverage that was confirmed, the extension to $3,500 for 2020 and beyond that, possibly,” Delia said.

Delia and Iona say that without intervention, they don’t think that would have ever had happened.

“It shouldn’t have to go to this stage to get action, but I am really happy how they handled it,” Delia said.

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