Migrants without status who receive a $40,000 bill for their baby in intensive care, doctors who pay out of their own pocket for medication for children not covered by RAMQ, community organizations at the end of their tether who must resolve the problems of health insurance for their vulnerable customers.
Two years after its entry into force, Bill 83 (PL 83), supposed to extend the coverage of the Régie de l’assurance santé du Québec (RAMQ) to all children from families with precarious migratory status, is far from having resolved everything, deplores Médecins du monde (MdM). With its partners in the field, the organization is reporting more and more problems related to the application of the Act.
MdM documented the case of a mother without immigration status and victim of domestic violence who presented to the emergency room with her newborn who had apparently just been shaken by his father. As the child and parents did not have medical coverage, the hospital accounting department demanded that the care be paid in advance.
However, the mother did not have this money, relate MdM documents that were able to consult The duty. The bill was still issued, but thanks to the intervention of a volunteer, the mother did not have to pay it in advance to have her baby treated.
“We wonder whether access to scan for the baby was delayed due to the absence of a health insurance card,” the organization indicates in its report. He adds that according to him, without the intervention of this MdM volunteer, the mother “would surely have left [les lieux] », thinking that she did not have the right to care for her child.
Billing continues
This case is far from isolated, notes Chloé Cébron, senior advisor in analysis and advocacy for Médecins du monde. “We often get called by people [organismes] of the health network who ask us what to do, who do not understand why families received bills from the hospital where their child was treated. »
Élizabeth Sigouin, lawyer at the organization La maison bleue, discusses the case of a family who was given a bill for nearly $40,000 because the newborn had to spend four days in intensive care. Even if he will eventually be entitled to a sun card, the child born here could not be covered by his parents’ health insurance since they, without valid immigration status, did not have any.
“Parents are already panicking because their baby is not doing well, of course it adds stress to receive a bill for tens of thousands of dollars,” she says. “So much the better because the dad came to see me and I was able to reassure him. But some people may be paying the bill when they shouldn’t. »
Some doctors even go so far as to pay out of their own pocket so that a child who has problems obtaining a RAMQ card can quickly obtain medication. “They know that if the child does not take treatment, it will degenerate into a serious chronic illness and cause even more costs for our health system,” reports Patricia Li, pediatrician at the Montreal Children’s Hospital.
“No bill, ever”
Lawyer Élizabeth Sigouin sees on a daily basis the burden that this new law represents for all those involved in organizations that help these migrant families with precarious status. “What we want is: “no bill, never” when it comes to children. I don’t know why hospitals don’t apply the presumption of coverage,” she continues.
What we want is: “no bill, ever” when it comes to children. I don’t know why hospitals don’t apply the presumption of coverage.
Non-compliance with the presumption of eligibility for RAMQ, although provided for in the Act, is precisely one of the main problems emerging from a recent survey carried out by MdM among partner organizations. Registration delays would also have particularly serious consequences for families and barriers to access to care would persist even after registration.
Doctors of the World have received reports of situations of absurd imbroglios, where RAMQ and hospitals passed the buck. For example, it has happened that the accounting department of the hospital, which invoiced the costs generated by the birth of a child, referred the parents to the RAMQ for the cancellation of the invoice… but that the RAMQ sent them back again to the hospital, alleging that the billing problem is not his.
“If the child is born and the parents have no medical coverage, it’s always complicated,” confirms My Lan Graziani, a family doctor who also provides obstetric care at St. Mary’s Hospital Center. “Everyone is wondering who should pay for the child. »
According to the DD Li, the word, about the Law, has never passed in the health network. ” The Ministry [de la Santé et des Services sociaux] and the RAMQ have not issued a clear and binding directive to ensure that PL 83 is properly implemented, so it is we who must resolve the problems of its application. »
” It’s necessary that it moves “
Chloé Cébron, from MdM, deplores that the bill, although satisfactory on paper, does not give the expected results on the ground. ” It’s necessary that it moves ! It is becoming urgent. It is not normal for families to be left on the side of the road. »
She recalls that following the adoption of the bill in September 2021, barely two follow-up meetings with the Ministry of Health took place. During the last one, about a year ago, the office of the minister, Christian Dubé, informed Médecins du monde that a working group would be set up with the main partners.
“We never had any news,” notes Mme Cébron, while nevertheless welcoming the efforts of certain actors in the network such as the RAMQ. “The minister had leadership on the file and we thank him, but it is not enough. You have to go all the way. »
Joined by The duty, Minister Dubé’s office seems to be in complete agreement. “Let’s be clear, the Law must be applied everywhere,” he replied. “If this is not the case, we will do all the necessary checks to make it happen. »
The cabinet recalls that 18,928 children have been covered by RAMQ since the implementation of the bill. “It’s major!” » However, it is difficult to quantify the total number of children without coverage, some of them having parents without status who are impossible to count.