I've been searching, and... Searching, and... searching. And not finding anything.

So even if most people here are definitely not from around here and don't know at all how it works around here in the province of Québec (Quebec in case you can't display accents), Canada, I feel desperate enough to ask.

A few years ago, the journalists came out with a news : from then on, the RAMQ (translates to something like "Bureau of Illness Insurance of Québec"), which is the governmental organism thanks to which we don't get ruined if we get sick, thanks to an adjustment to the law, would now cover expenses related to sex change. We're lucky, I know. (Well, I'm not that optimist. I feel the whole world, us included, is unlucky for not having every single health or social problem expense covered at 100%. I'm a socialist bitch, I know.)

However, no matter how much I check, I can't find any more info about it, and it's pretty important for my planning to know that. I've even called the RAMQ - the employee didn't know. I also asked a physician and a psychologist, and they didn't know. And where I live, there is ONE specialist in TG issues, and if I ever get to see him, it won't be before many months. And I don't know any local trans I can ask.

Does anyone have information, or a website I could have missed, that could give me answers to my questions ?

-What are the conditions ?
-Are legal change expenses covered ?
-Is the WHOLE SRS covered ?
-Is HRT covered ?
-Are FFS and other surgeries covered ?
-What portion of what is covered ?
-Do I have to pay then I get the money back, or do I simply do not pay ?
-Is electrolysis covered ?
-What else can be covered ?

I know I could just ask the psychiatrist about it, but :

-Maybe he doesn't know either.
-I'm bad at convincing people, and as I WILL have to pressure him into believing me when I say it's urgent, I believe knowledge of such things and maybe having a financial plan ready will help greatly.

EDIT : Oh, and my appointment is Monday, so please answer fast !

I'm not sure, but I believe currently the Gender Identity Clinic at CAMH in Toronto (the Centre for Addiction and Mental Health) is the only approved clinic able to assess and approve patients for health-plan-covered SRS (i.e. OHIP in Ontario, RAMQ in Quebec), which would mean in order to get your SRS covered, you'd need to get referred to CAMH, and get assessed there.  I'm not ABSOLUTELY sure of this, but I have heard CAMH is used by BC, not sure about other provinces - it may be the only assessment centre in the country.  I also know there is a current Human Rights case that could change that.  In terms of Quebec, I'm not sure who you'd need to call for information, but you could probably start with Dr. Brassard's clinic in Montreal.  They're known the world over, I hear he does 4 vaginoplasties a day, so they would certainly know how you'd get started.

Quote from: Colleen Ireland on October 29, 2010, 08:45:25 PM
I'm not ABSOLUTELY sure of this, but I have heard CAMH is used by BC, not sure about other provinces ...

As far as I know, it's used by BC and Ontario (via OHIP), I don't know the details of Québec's coverage.

Well, I did read everything from their site, but I'm not sure about calling. It's so gonna ruin me. Like, 30$ for the long-distance call xD. (Doesn't sound expensive, but this month I'll have like 5$ left after paying the rent... That's what I get for investing in an appointment with my psychologist who demands 70$ an hour.) If I don't find anything, I'll call them, I guess. I hope they can provide decent information.

Aside that, let me try to understand. So basically, you're telling me you believe all of Canada's approvals for coverage are made in Toronto, so I should call that office for information ?

PS : Whoa, 4 a day. In one side there's the short wait, but in the other, it kinda makes me afraid he does a fast job.

Quote from: A on October 29, 2010, 10:56:00 PMAside that, let me try to understand. So basically, you're telling me you believe all of Canada's approvals for coverage are made in Toronto, so I should call that office for information ?

PS : Whoa, 4 a day. In one side there's the short wait, but in the other, it kinda makes me afraid he does a fast job.

Sorry, A, I don't know if I'm helping or hurting.  I do believe, based on what I've heard, that CAMH is the only assessment centre for covered SRS in the country, but then Toronto believes itself the center of the universe, so I could be very wrong.  I don't know what the setup is in PQ (I lived in Montreal from '69 to '87, but it's been a long time).  I was suggesting you find out where Brossard's clinic is, and call there.  They would surely know what the setup for Quebec is.  Another possibility is if you could find another trans person near you, preferably post-op - are there any support groups in your area?  I've gotten my best information from a post-op friend I met last summer - she has been a godsend for me.  She's the one who advised me about getting referred to CAMH.  Anyway, I will ask the folks who run the Gender Journeys workshop if they have any info about Quebec, but that isn't till next Wednesday.  As far as solid information, that's the best I can do...

Oh, and four in a day doesn't sound like an assembly line to me.  Sounds rather like he knows the territory.  He's considered one of the best in the world...

I won't be lucky finding anything near me... There is like one gay support group (and it doesn't say LGBT, just gay), and the only thing related to trans I can get near me is an ad for a Trans Am that's for sale. (seriously) I'll try AlterHéros, which isn't regional at all, but still. My best chance.

Hey, I dont really post here but I thought id help since I have some information. I had heard about RAMQ paying too, and they do. The conditions are similar to that of the SoC. Contact the office of DR. Brassard. they will forward you the information you need. Basically, as I understand it, the whole process happens through Dr. Brassard, the only one approved to do the surgery (covered) by the government if i remember.

I have the pdf they sent me, but i cant PM. Requirements are:

12 month RLE
2 therapist letters (with a 6 months minimum therapy with either)
1 endo letter to confirm HRT
full medical check up + HIV test before surgery

50$ for the RAMQ processing

Im not sure which part is covered (surgery, hospital stay, complication, revision), but I know that GRS is.

Hope that helps

edit: grsmontreal.com

I have a chatroom acquaintance who transitioned to female about 20 years ago and she did it in a small community where logging and shooting and drinking are the only activities.  she is so far up north canada that the seaplane is the fastest way to get anywhere.
so transitioning can be done anywhere.

  I hope this helps a little! This is from the Facebook page Reinstate Gender Reassignment Surgery In Alberta.  All content is public.



This data is current as of Wed. April 15, 2009
(provided by CPATH)

Few provinces provide funding for SRS/GCS
At least 4 provinces require transgender people to travel outside the province for surgical readiness assessment
No facilities offering comprehensive care from counselling to surgery
No national guidelines of care

BC
Have designated surgery assessors (3 psychiatrists, 2 psychologists) so wait time is minimal
Surgeries not covered: phalloplasty and chest contouring
FTM: Hysterectomies performed within province by many surgeons
FTM: Mastectomy– covered but have to pay private facility fees and are reimbursed $1500 – average cost per person approx. 6-7K
MTF: penectomy, orchiectomy, vaginoplasty – covered but pt has to pay travel and private stay (1K) costs in Montreal
There is a surgeon in the province trained to do these surgeries but a public facility is not being made available

Alberta
Have designated assessor: psychiatrist Dr. Lorne Warneke in Edmonton
Covered:
FTM: hysterectomy, mastectomy, chest contouring, phalloplasty
FTM: penectomy, orchiectomy, vaginoplasty
Cover 16 people per year – not cases
Surgery performed in Montreal by Dr. Brassard
in April 2009, the conservative gov't budget cut funding to SRS in the new health care budgettThis represented $700K of a $13 billion budget

Saskatchewan
No designated assessor although Dr. Donna Hendrickson was a designated surgery assessor in BC before she moved back to Saskatchewan

Trans people have to travel to the CAMH for surgery assessment

Will cover direct surgical costs of phalloplasty and penectomy, orchiectomy and vaginoplasty (amounts approx to 25% of total cost because it is performed in a private facility in Montreal)

Manitoba
No designated surgery assessor
Trans people have to travel to the CAMH for assessment
Mastectomy, hysterectomy performed in province
All other surgeries performed in Montreal with only direct surgical costs covered (same as case with Saskatchewan)

Ontario
SRS funding relisted in June 2008
Ontario Human Rights Commission found the de-listing as discriminatory
CAMH/Sherbourne Health Centre and Rainbow Health Ontario working together on a surgical assessor designate plan
Covered:
FTM: hysterectomy, phalloplasty, mastectomy, chest wall contouring
MTF: penectomy, orchiectomy, vaginoplasty
In the meanwhile, trans people are being assessed again at the CAMH

Quebec
Must first pay private sector for psychiatric evaluation and services
SRS covered only if referred by Human Sexuality Unit at Montreal General Hospital
Surgeries covered:
FTM: hysterectomy, mastectomy, chest wall contouring
MTF: penectomy, orchiectomy, vaginoplasty
Up until 2008,
Hysterectomy done in Quebec
All other surgeries performed in Czech Republic or Thailand
In 2009, this ruling was changed and trans people now have surgery performed in Montreal by Dr. Brassard.

New Brunswick/Nova Scotia/PEI
Designated assessors as of September 2008
No surgeries covered
Transgender Health lobby group is making a proposal to Ministry of Health for funding.

Newfoundland
No designated assessors
Assessor training planned for August 2009
Trans people have to travel to CAMH for assessment
Surgeries apparently covered by provincial health plan but this has not been challenged

NWT/Yukon/Nunavut
No information yet
over a year ago
#
Michelle One minor update to that: It shows Alberta providing coverage...
over a year ago
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Mickey yes. It shows the coverage and then states "in April 2009, the conservative gov't budget cut funding to SRS in the new health care budget This represented $700K of a $13 billion budget"
over a year ago
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Michelle Oops - my misread. That's what I get for scanning rather than reading closely ...

sorry about that.
over a year ago
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Dominic So, does anyone know if the funding cut includes hysterectomies and mastectomies for FTM's?
over a year ago
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over a year ago
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over a year ago
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Rick Hey Kristopher and Mickey, can you tell me where you found this information on SRS (the source)? Is it avaliable online? I would love to read more on it.
over a year ago
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Mickey My information is from CPATH, the Canadian Professional Association for Transgender Health. I think their may have been some small changes in Quebec since then around referral.
over a year ago
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Rick Question: Does the funding for GRSs comes directly from the federal health canada funding given to each province?

If so, does that mean each provice just deligates funding for which they seem fit?
over a year ago
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Mickey all health care decisions are a provincial jurisdiction
over a year ago
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Rick That's what I thought. I wonder for provinces that don't fund any GRS what-so-ever, does this conflict with the health act at all. If so, in what form are provinces "said" to be held accountable.
over a year ago
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Mercedes If Provinces fail to meet the standards of the Canada Health Act, the Federal Government can withhold transfer payments. Understandably, the Federal Government tends to be reluctant to do this in cases of smaller disputes.

I'm not saying it's not worth thinking about, just that we are up against some limitations on what can be accomplished this way. Having a Federal affirmation that GRS is necessary and therefore mandated by the CHA would be more than a gesture, but less than a guarantee, and would likely require mobilizing across the country.
over a year ago
#
Rick Hey peeps....I am writing an advocacy piece for full funding provided for both MTF and FTM in BC. The piece is for a class, but I would also like to send it to the minister of health for the province of BC.

I was wondering if anyone had knew of any resources I could look up or any pdf's they could send me that speaks to the need funding of BOTH types of GRS's.

Anything would be a great help. You can post a reply here or send one to my facebook page.

All the best!

Rick
about 11 months ago
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Kate After some thirty years... there is now change in Manitoba.
Manitoba now covers mtf surgery 100% for genital. There is no longer any need to go to Toronto for assessments. Contact Klinic in Winnipeg for details.
This is as a result of an appeal, not resulting from any change in the government of Manitoba's position.
about 2 weeks ago

http://www.headandhands.ca/info.php?1?1

Thank you for your responses - I just learned of CPATH and read their pretty complete (but including a lame French translation, haha) sheet about what is paid and what is not. Thank you !

I am also transitioning in Quebec, and have some familiarity with the RAMQ in the process. 

Quote from: purple sky on October 31, 2010, 10:20:26 AM
Quebec
Must first pay private sector for psychiatric evaluation and services
SRS covered only if referred by Human Sexuality Unit at Montreal General Hospital
Surgeries covered:
FTM: hysterectomy, mastectomy, chest wall contouring
MTF: penectomy, orchiectomy, vaginoplasty
Up until 2008,
Hysterectomy done in Quebec
All other surgeries performed in Czech Republic or Thailand
In 2009, this ruling was changed and trans people now have surgery performed in Montreal by Dr. Brassard.

First this information is now out of date.  There is no need to see the Human Sexuality Unit at Montreal General Hospital anymore.  Good thing, I was in the program and it really didn't suit my needs.  As of fall 2010, you can now see any qualified therapist.  I know there is some conversations on going about what constitutes a qualified therapist.  Personally, I am see one that has a history in this program, but if you are not in the Montreal area I would imagine that a therapist in your area would be sufficient.  The 2nd opinion therapist you could always use a therapist in Montreal since they would be more familiar with the process and you only have to see them a couple of times. 

Quote from: cerealk on October 31, 2010, 08:10:34 AM
12 month RLE
2 therapist letters (with a 6 months minimum therapy with either)
1 endo letter to confirm HRT
full medical check up + HIV test before surgery

50$ for the RAMQ processing

Im not sure which part is covered (surgery, hospital stay, complication, revision), but I know that GRS is.

edit: grsmontreal.com

This info is what I have heard as well.  I also understand the cover the surgery and the stay in the recovery center run by Dr. Brassard.  No other aspects of transition are covered at this point (FFS, electrolysis) and the provincial drug plan picks about about half my bill for HRT.  There are a couple of organizations that know that have all the details including the ATQ http://www.atq1980.org/ and ASTTEQ http://cactusmontreal.org/fr/astteq.html

Anyway not much new to add, good luck
Jenna