After waiting more than three years on the wait list for shoulder surgery, Paul Prudames decided to travel to Alberta to have the procedure done sooner to relieve his intense pain.
“I had bone on bone and terrible arthritis and this had been going on for years,” said Prudames, of Orillia, Ont. “I was going downhill fast so I had to do something. Either live like that or get something done."
In October 2022, Prudames had the surgery completed at Canadian Surgery Solutions in Calgary, Alta., and was charged $28,000 as a non-Albertan resident. He thought that the majority of the procedure’s cost would be covered by the Ontario Health Insurance Plan (OHIP).
Prudames has been trying to get the money repaid by OHIP ever since. While OHIP told him he would be getting a percentage of the cost for the procedure, he was shocked when the amount he received was only $1,821.
"I thought down the road I would get reimbursed because they couldn't do the operation here. I really thought I was going to be reimbursed by OHIP,” said Prudames.
In a letter, Prudames was told, “OHIP ministry staff have reviewed this application and have determined the requested facility is not a publicly funded hospital. Any facility charges are the responsibility of the patient.”
The Ontario government announced Wednesday it's expanding the number of private clinics in the province to try and clear a backlog of surgeries.
Ontario Health Minister Sylvia Jones said patients using them won’t have to pay for the procedures.
"We can reduce wait times by doing more surgeries in state-of-the-art convenient and safe facilities which will always be paid for by your OHIP card, never your credit card," said Jones.
That news won’t help Prudames who is adamant the entire cost of his surgery should be covered since he couldn’t have it done in Ontario
“I’ve been working my whole life paying into OHIP, but when I had to use it, it wasn't there for me,” said Prudames.
When CTV News Toronto reached out to OHIP regarding Prudames’s case, Ontario’s Ministry of Health said it couldn't comment on proceedings under appeal.
Prudames now lives almost completely pain free and is hopeful he'll get more money back from OHIP to help cover his $28,000 bill.
Ontarians are also crossing the border to go to the United States to have surgeries done and they're paying out of pocket for the procedures. If you have an operation done outside of Ontario, in most cases you should expect you'll have to pay for it.
