How Diagnostic Specialist Access Insurance Can Help You Jump the Line
Published: Oct 17 | 2017
Modified: May 13 | 2019
A meniscus tear in your knee is not something to laugh at, Dan* would tell you. Especially when it’s the result of everyday use.
Any injury that’s not easily treatable affects your quality of life. So when Dan’s family doctor referred him to an orthopedic surgeon he thought he’d solved his problem. Unfortunately, the surgeon informed him that the wait for surgery was going to be 9 months.
Dan’s story represents an all too-common scenario for health care in Canada.
Are Canadians happy to wait?
According to the 2016 Fraser Institute Report on Health Care Wait Times, Canadians today are waiting longer than ever before to see a specialist or get a diagnostic test. In 2016, the average wait time to get a diagnostic test was 3.7 weeks for CT scans and 11.1 weeks for MRIs. Trying to book with a specialist? Even longer. After a referral from a General Practitioner you are looking at an average wait time of 9.4 weeks before seeing a specialist.
Wait times are also dependent on the province you live in. While Ontario has the shortest wait times, New Brunswick has the longest.
Prolonged wait times can result in serious consequences. In addition to constant pain, waiting for an appointment with a specialist or a test can result in mental anguish and frustration leading to poorer health outcomes. In the absolute worst case scenario, potentially reversible illnesses and injuries are pushed into a chronic condition status, or even a permanent disability.
While we can’t speed up wait times, we can offer a solution to help you jump the line: Diagnostic Specialist Access Insurance (DSAI).
Why purchase Diagnostic Specialist Access Insurance (DSAI)?
DSAI is available as an employer group benefit. This boutique benefit allows all insured employees – who are placed on a medical wait-list that exceeds 21 day – immediate access to specialist consultations and diagnostic examinations in Canada.
DSAI coverage is available for the following specialties:
- Cardiology: Deals with ailments of the heart and blood vessels.
- Gastroenterology: Specializes in diseases of the gastrointestinal organs such as; esophagus, colon, gallbladder, and liver – just to name a few.
- General Surgery: Deals with abdominal ailments including breast, liver, colon, and vascular system.
- Ear, Nose and Throat (Otorhinolaryngology): Focuses on head and neck disorders.
- Neurology: Studies and treats diseases of the nervous system.
- Ophthalmology: Treats the structure and function of the eye.
- Orthopaedic: Specialize in disorders of the musculoskeletal system (bones, joints, ligaments, tendons, muscles, and nerves).
- Rheumatology: Treat inflammatory disease of the muscles and joints, including arthritis.
- Spine Team/Physiatrist: Triage approach of three physicians specializing in specific components of the back pain. Available only in the lower mainland of Vancouver, British Columbia.
- Urology: Care for patients who suffer from ailments of the urinary tract.
Best of all – employees are not out-of-pocket for the expenses. Payments are made directly to the provider.
What happens next?
After diagnosis or specialist consultation there are choices available! An insured employee can jump back into the public health system for surgery, or choose to have the surgery performed at the private clinic where the specialists typically work. The cost of surgery is paid out-of-pocket by the insured employee, but can be submitted through a Cost Plus plan or a Health Care Spending Account for reimbursement.
In Dan’s case, when he had to see a specialist again (with a lengthy wait time), he utilized his Diagnostic Specialist Access Insurance benefit. Dan said the person on the other end of the phone was helpful, friendly, knowledgeable, and collected relevant information from him. While he was ineligible for surgery, he spoke highly of the service, responsiveness, and friendliness of the person assigned to his file.
*At Benefits by Design, we use the same products and services as our groups. We like to share employee stories to speak to the power of our own benefits. Names have been changed to respect the privacy of our employees (past and present).
The Small Print on Diagnostic Specialist Access Insurance
- No deductibles or co-payments.
- Lifetime benefit maximum of $1,000,000 USD.
- Transportation costs for travelling to/from the pre-approved diagnostic facility will be reimbursed.
- Covers pre-existing conditions once the policy has been in effect for 24 consecutive months. Pre-existing conditions are medical or physical conditions which were diagnosed, or are known to exist, in the 24 months prior to start of the policy.
Please consult your Regional Director for more information.