Extended Health Insurance Lobby
Extended Insurance Advocacy Efforts
Although dealing with the lack of insurance coverage of occupational therapy services has always been a priority, CAOT is making a concerted effort in 2011 to get changes to extended health benefit plans to ensure that occupational therapy services and occupational therapists are covered. Advocacy efforts are targeting insurance companies to change their product offerings to include occupational therapists, working with a key employer, the Government of Canada, to include in their health benefits for the public service access to occupational therapists, influencing key decision makers such as unions to influence the make-up of health benefit plans and developing a call to action entitled “Ask for It”, to create a demand for access to occupational therapy by the general public and potential clients.
Reports on Advocacy Efforts:
In November, 2011:
CAOT continues to actively advocate for extended insurance coverage by meeting with Manulife Financial, a provider of health benefit packages. What they told the Association:
As a service provider, Manulife will offer coverage of occupational therapy services if asked in one of the following ways:
- As a recognized health profession as part of Manulife’s list of paramedical professionals;
- As part of an employer benefit plan, with fixed spending limits per profession; and
- As part of health care spending accounts, where a maximum limit is allowed to spent as the client wants on whatever services they want.
One of the reasons that occupational therapists are not on the list of authorized health professions is that many of the lists were set up before the profession was fully regulated across Canada and have yet to be updated.
Coverage of occupational therapy services are sometimes paid out as part of non-occupational therapy claims such as the need for a medical device or part of rehabilitation.
In October, 2011:
Occupational therapy services provide real benefits to many Canadians. When these services are offered through hospitals, health authorities and community health centers, occupational therapy services are covered by government health plans. Access to the profession outside of the above mentioned environments must be paid directly by the client either through an extended health insurance plan or from their own resources.
On behalf of its membership, the Canadian Association of Occupational Therapists (CAOT) has undertaken an intense campaign to increase coverage of occupational therapy services through extended insurance plans.
Target Audiences for Advocacy Efforts:
Insurance companies / Health insurance providers:
Blue Cross family of companies
Life and disability insurance providers
Health insurance plan administrators
Health benefits providers:
Major employers: Federal government, provincial/territorial governments, Regional Health Authorities, private industry, unions, Universities
Health service users:
Occupational therapy clients
Dealing with the coverage or lack of coverage of occupational therapy services
CAOT or CAOT representatives have met with Insurance companies:
Blue Cross Medavie
Pacific Blue Cross
CAOT has met with health benefits providers:
Public Service Union of Canada
Custom and Immigration Union
Border Services Union
Privy Council of Canada
Increase the demand for occupational therapy services:
- CAOT developed a communication strategy to increase overall knowledge of what occupational therapy is by explaining the solutions occupational therapists bring to issues and concerns of general public, employers/unions and decision makers. OT solutions that work campaign tell what occupational therapists do.
- CAOT created and launched an “Ask for it” campaign to engage occupational therapists, OT students and the general public to ask for coverage of occupational therapy services.
What we learned
- Many insurance companies do offer coverage of occupational therapists services. The companies who to date have told CAOT they cover OT services include: Medavie Blue Cross, Saskatchewan Blue Cross, Industrielle Alliance
- Many purchasers of insurance packages do not select occupational therapy service coverage
- Too often the lack of demand determines whether occupational therapy services are covered by health plan providers.
- All insurance companies we spoke to use occupational therapists to shorten the payouts on disability claims.
- If insurance companies can be convinced that offering occupational therapy services would reduce payouts for prescription drugs, they would promote OT services themselves.
- Queens University has recently added the coverage of occupational therapy to their health benefit packages.
- Currently over 10 million Canadians have access to occupational therapy services through their insurance plans.
- Even if insurance companies offer access to occupational therapy, there is no guarantee that benefit providers will include access in their service offerings.
In September, 2011:
- Met with Medavie Blue Cross, one of six Blue Cross organizations, who serve Ontario, Quebec and the Atlantic provinces. The insurer advised CAOT that they provide coverage of occupational therapy services to eight million Canadians who purchase health benefit services from them. This company provides services to such organizations and companies as RCMP, Veterans Affairs Canada, Canadian Forces, Loblaw’s, Boeing Canada, Hydro-Québec, and through their Interim Federal Health Program 175,000 refugees and immigrants. CAOT will continue on with its discussion with this company to see how we can work with them to promote greater access to occupational therapy.
- Has sent follow-up letters to any of the insurance companies that have yet to respond to CAOT April requests for meeting.
In July, 2011:
CAOT has continued its efforts for the extended health insurance lobby by:
- Preparing for two upcoming meetings with insurance companies to advocate for coverage. CAOT representatives will be meeting with Pacific Blue Cross and Medavie/Blue Cross (serving Ontario, Quebec and the Atlantic Provinces)
- Receiving a reply from Saskatchewan Blue Cross. They agree that occupational therapy can play a fundamental role in improving the health and wellness of patients. However occupational therapy is currently not one of their standard benefits under their group plan offerings. They do have some employers who have specifically asked that occupational therapy services are covered. As well, they provide coverage for occupational therapy services under their Health Spending Account Plans.
In June, 2011:
Advocating for Extended Insurance Coverage for Occupational Therapists continued by:
- CAOT staff meeting with Libby Davies, health critic for the NDP, to discuss in detail the issue of insurance coverage. Ms. Davies, a former union occupational health and safety officer, suggested that CAOT promote the value of coverage for occupational therapy services with all union officials in Canada. CAOT will act upon this suggestion.
- Receiving a response from Industrielle Alliance, a health insurance provider, headquartered in Quebec. They indicated that occupational therapists are authorized health professionals in their standard contract. While some of their customers may restrict certain therapists, the reimbursement of occupational therapists fees in Quebec and all across Canada is included in all their groups.
In May 2011:
Letters asking for meetings on increasing access to occupational therapists were sent out to all major insurance plan providers across Canada. CAOT is now coordinating a meeting with Pacific Blue Cross.
CAOT is preparing for a meeting on the insurance lobby with the Clerk of the Privy Council. His office is in charge of all the public service and will be challenged by the Government’s plan to reduce the costs associated with a very large workforce.
In April 2011:
On the topic of increasing access to occupational therapy through extended health benefits, CAOT President Sue Baptiste and Executive Director Claudia Von Zweck wrote to senior managers in the Public Service of Canada and to Public Service Unions leadership. They made the case for including access to occupational therapy as part of the health benefit plan for federal government workers.
CAOT initiated a discussion with other G7 coalition members to take a strategic look at the influence the group of seven health professional associations brings to the health policy agenda surrounding health human resources, health promotion and injury prevention and third party billing (extended health benefits). A strategic planning meeting will be held on June 28 to investigate the possibility of group action in particular on increasing health insurance coverage of our health professionals.
In March 2011:
CAOT researched two reports presented to the Prime Minister by the Clerk of the Privy Council on the state of the public service. The information garnered from the reports will be used to promote increased access to occupational therapists as part of extended insurance plans.
CAOT contacted a new assistant deputy minister at Treasury Board to again promote the access to occupational therapists through the federal government benefit plan.
In February 2011:
On the insurance lobby, CAOT is actively developing strategies to extend funding for occupational therapy services. We have received valuable input from NLSOT and OSOT
In January 2011:
CAOT is in the process of putting together a campaign targeting providers of health benefit plans to ensure access to occupational therapists. Part of our efforts includes finding partners who can also carry the message. This past week, we met with the Canadian Association of Family Resources Programs. They will be looking at their benefit plan to see if they offer access to occupational therapists. A positive first step!