P.E.I. man in battle with insurance company over pricey MS drug
A P.E.I. man is in a battle with his insurance company over coverage for an expensive drug for Multiple Sclerosis. The company says he failed to disclose a pre-existing medical condition, but he says that's not so.
Jonathan Ramsay, 34, who lives in Crapaud, was diagnosed with MS in September 2015 — a month after he and his partner applied for family coverage with Sun Life Financial.
Ramsay says the symptoms struck very quickly, leading him to his family doctor, a neurologist, and eventually an MRI.
"I was just overly tired with minimal effort and I was basically dragging my leg as if it was a 20-pound weight around my ankle," he said.
"I just knew there was something wrong ... my whole left side was basically paralyzed."
Expensive treatment
Because his MS was progressive, the neurologist put him on a fairly new IV treatment called Tysabri, with the aim of slowing the progress.
It's been helping, but it comes at a cost of around $3,500 a month — a big expense, especially since Ramsay can no longer work.
"It wasn't disappointment, and I wasn't upset — I was relieved because when you lose your vision and you can hardly walk and your left side is pretty much useless gone numb, you think brain tumour, that's what you think," he said.
"And to find that's not what it was, it's MS, it's like, 'OK, I can deal with this, this is not a life-ending diagnosis.' And I was relieved and I thought things were going to be great, I got coverage I'm going to be all right."
Asked to pay back $7K
And it was all right — for a while.
Ramsay filed two claims for his treatment. Both were paid out by Sun Life, but after submitting a third claim he received a letter stating his policy was being cancelled since, the company said, his MS was a pre-existing medical condition that he had not declared on his application.
Sun Life also asked him to pay back the more than $7,000 it had paid out for his treatment.
"The letter basically said I lied on my application, which I did not," Ramsay said, adding that he was not scheduled for an MRI when he applied and didn't get his diagnosis until five weeks later.
'It's the disbelief'
Ramsay says he filed an appeal along with supporting letters, including one from his family doctor, but Sun Life stood its ground, warning the next step was to send the account to a collections agency.
The good news is that the drug company that supplies his Tysabri is now giving it to him for free through a compassionate program, but Ramsay still can't believe his coverage was denied.
"It's the disbelief more than anything," he said.
"You think the insurance company's got your back — that's what they're there for, they've got your back when you're down, they're going to help you back up. Instead they just keep beating you down, and that's not the way insurance companies should be."
Ramsay is now having trouble finding other health insurance due to his condition, and says the rest of his family is having trouble as well, since other insurance companies are more expensive than the deal they got with Sun Life.
In a written statement to CBC on Friday the insurance company said, "Sun Life stands by its underwriting decision and we've been in touch with the family to explain our decision."
The company added that for compassionate reasons it has waived the family's outstanding costs.
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