She ended up in hospital after her life-sustaining formula coverage was slashed
After the switch to Canada Life, Elizabeth Stagg has had to pay hundreds more out of pocket for food
A B.C. woman says she's effectively been left to starve because the coverage for the formula she needs to live was significantly reduced when the federal government switched insurance providers.
Three years ago, Elizabeth Stagg was hospitalized with a blood infection. Then her intestines shut down.
"I would actually end up getting sick every time I ate," she said.
The federal government employee was diagnosed with gastroparesis, a condition that paralyzes the stomach, stopping or seriously slowing food from moving between the stomach and small intestine.
She now relies on a feeding tube and formula to eat.
"It's actually been very difficult because I went from eating normally up until that hospital stay, and then suddenly 10 weeks later, I have a feeding tube and I'm being fed pretty much 100 per cent by a tube," she told CBC from her home in Abbotsford.
Stagg is among the 1.7 million federal workers, retirees and dependents who saw their insurance provider switch from Sun Life to Canada Life on July 1, and with it changes to what services and drugs are covered, how they're approved and what happens when they need to talk to an agent.
The Treasury Board of Canada Secretariat, which oversees labour relations between the federal government and the public sector, said changes made to the Public Service Health Care Plan (PSHCP), including claim limits, coverage terms and eligibility, were approved in the fall of 2022 — independent of the switch to Canada Life.
Those changes came into effect after Canada Life won a tender to administer the plan.
- This week CBC Ottawa will be sharing more stories of public servants affected by the switch to Canada Life. If you'd like to share your story, send us an email.
Formula classified as a drug
Under Sun Life, 80 per cent of the cost for her Nestlé Isosource 1.5 formula and corresponding spike sets — tubing for her feeding tube — were covered.
The two items together cost $90.45 for a four-day supply.
When PSHCP switched to Canada Life on July 1, she was told the spike sets were no longer covered. Her formula was classified as a drug with an identification number, and she was told 80 per cent would be covered to a maximum cap of $38.41.
"The switch to Canada Life has actually been very difficult for me," she said.
It's affected my health. It's affected my mental health because it's been so difficult and just a struggle to get ahold of anybody at Canada Life, and I'm not getting answers.- Elizabeth Stagg
When the switchover first happened, Stagg submitted six claims to the insurance company, each for $90.45.
Under Sun Life, she received $72.36 per claim.
Under Canada Life, only four of the six claims were reimbursed, and only for $30.73 each.
Another claim was rejected because she was told the formula wasn't covered. The sixth claim was given a different drug identification number and it only paid out $6.91.
That's a total of $300 less than what she received under Sun Life for 24 days of supplies.
"I thought, 'This has got to be a mistake,'" she said. "I was shocked because I was expecting a lot more money."
She's spent months trying to get in contact with a supervisor at the company, to no avail.
Unsure if she was going to be compensated, and unable to afford the extra cost, she eventually stopped buying the formula altogether near the end of August.
Ended up in starvation mode
Two weeks later, she ended up in the hospital with another blood infection, and doctors found something more.
"When they started me up on the formula my first night in hospital, I actually got a condition called refeeding syndrome," she told CBC.
Doctors said her body had effectively gone into starvation mode, and when she was given proper nutrition, it had caused her electrolytes to plummet — a potentially fatal condition.
After working for the federal government for 25 years and paying into the health insurance plan, she now feels defeated.
She's also put off getting a new $763 feeding tube — even though the one she currently has is causing her pain, redness and irritation to her stomach — because she can't afford it and doesn't know if it would be covered.
"It's scary because the economy, everything is so expensive these days, just trying to find the money to live. And here I may not be able to find the money to eat," she said. "To have [Canada Life] play around with a claim that is essentially life-sustaining nutrition."
It's unclear whether Stagg's situation is the result of a change in coverage when the Treasury Board negotiated a new plan, or whether that plan is being misinterpreted by Canada Life.
"It's affected my health. It's affected my mental health because it's been so difficult and just a struggle to get a hold of anybody at Canada Life, and I'm not getting answers," she said.
In a statement to CBC, Canada Life said it is expanding its call centre staff and hours to cover seven days a week as it tries to reduce wait times.
The insurance company also said it is aware exceptional coverage was granted to individuals so it has created a team to review claims that may have been denied to ensure those who were granted exceptions previously continue to receive coverage.
It also said it aims to prioritize urgent claims or those filed by people facing financial hardship.
While the Treasury Board said replacement therapeutic nutrients are covered with a prescription, it didn't address whether related items like gastrostomy tubes and formula bags are also covered.
It did say members can appeal any claims that are denied.
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