Pregnant Calgary couple 'shocked' after demand for $10K upfront payment to cover delivery costs
Immigration lawyer wants a more 'flexible and friendly' system after couple admits to paperwork error
A Calgary couple expecting the birth of their first child next month has no idea who will help deliver their baby or even where it will be born. It may not happen in Calgary, where they live, after a local obstetrician requested a $10,000 upfront payment for his services before the couple's first appointment.
Kevin Brosha and his wife, Dewi, met in Indonesia three years ago. Brosha, who is Canadian, and Dewi, who is Indonesian, were married in Canada last summer. In November, the couple confirmed the pregnancy and started making plans for Dewi to become a permanent Canadian resident.
Brosha says the demand for an upfront payment was surprising.
"I was just in shock when they told us that," he said.
"When I asked if we could make any arrangements to pay later, they said no."
The CBC has learned the upfront fee for uninsured maternity patients in Calgary has now gone up to $15,000.
The Broshas say they submitted applications for permanent residency and an open work permit in December, but one of the documents was missing a signature and was returned to the couple two months later.
The mistake set their application back at least two months — and Dewi's temporary residency status expired at the end of January.
It means Dewi is without health care coverage in Alberta and could face thousands of dollars in prenatal care and delivery costs.
Brosha, as a Canadian citizen, took on the task of handling Dewi's application and takes full responsibility for his mistake.
"I didn't know the system. I did my best to navigate it, but I didn't know the rules, and now we're in a situation where she's got no health care coverage," said Brosha.
The couple had been paying a family doctor to see Dewi for the past several months. However, she hasn't seen a doctor for several weeks, since the time she was referred to an obstetrician and the demand for a hefty upfront payment was made.
"It's stressful, but my husband always supports me," said Dewi, who is an electrical engineer and had worked for a Canadian company in Indonesia.
Urgent care, not preventive care
A Calgary obstetrician who is not involved in Kevin and Dewi Brosha's case says a group of Calgary physicians is working on a strategy to deal with the treatment of uninsured maternity patients.
Dr. Fiona Mattatall has researched the issue of non-Canadians seeking health care and or citizenship for their newborns.
"It's a complicated issue," she said.
In Calgary, Mattatall noticed an increase in the number of uninsured deliveries by non-Canadian patients between 2014 and 2016. She says the numbers levelled off in 2017 and 2018.
The research, published in the Journal of Obstetrics and Gynaecology Canada in 2017, found health care professionals agree on the "provision of emergency care, but not preventive care."
Some physicians and midwives ... do not feel that it's ethical to look after those patients.- Dr. Fiona Mattatall, obstetrician and gynecologist
The paper concluded: "Differing ethical perspectives on the care of these patients may lead to conflict within health care teams because of differences [in] ethical perspectives of care among team members."
Mattatall says if a woman in labour shows up in emergency, the physicians and midwives she interviewed said they would care for the mom and baby "and ask questions later."
But for preventive- and prenatal-care office visits, she says there was a mixed response.
"Some physician and midwives ... do not feel that it's ethical to look after those patients, especially when we are in a publicly funded health care system [where] we don't have limitless resources to look after everybody."
Mattatall says Calgary has seen an increase in birth tourism: expectant mothers delivering in Canada to ensure their babies become Canadian citizens.
Mattatall says she supports charging non-Canadians upfront for delivery services, which can cost tens of thousands of dollars.
"It could range anywhere from $3,000 up to $25,000 to $30,000 to have a baby, and I think most of us as Canadians don't appreciate what our health care actually costs, because we don't get a bill, but it is paid by our tax dollars," she said.
Brosha and his wife are considering travelling to Nova Scotia to have the baby. Brosha's uncle is a physician there and says a delivery without complications would cost around $5,000.
Mattatall says she's had discussions with the college of physicians and surgeons about the upfront payments.
In a statement to CBC, the College of Physicians and Surgeons of Alberta said that while "billing and fee codes" do not fall under the CPSA's authority, it expects physicians "to follow the code of ethics and standards of practice in regards to uninsured services."
"Our standards obligate a physician to provide acute, emergent care to uninsured patients; and in non-acute situations, they must inform a patient of any fees to be charged before the care is provided."
Doctors can set own fees
A spokesperson for the Alberta Medical Association says uninsured services are not regulated, and the association advises physicians "to charge an amount that reflects their professional costs and expertise, administrative and indirect costs."
A document obtained by the CBC outlines the "private pay care fees" some obstetricians are charging uninsured maternity patients.
It says a $15,000 deposit is due one week before a patient's initial consultation. The fee just went up from the $10,000 the Broshas were quoted earlier this month.
The $15,000 doesn't include hospital fees, which could cost $1,500 to $2,000 a night; the fees for an anesthesiologist if needed; or costs if the baby needs to be transferred to the neonatal intensive care unit.
Brosha says he was also unaware that Dewi's health care coverage could have been extended as a temporary resident.
The Alberta government advises people to apply "early" for an extension to their Canada entry documents, such as temporary resident or visitor visas, while waiting for permanent residency.
He's written to his UCP MLA, his Liberal MP, and the minister of immigration, asking for the extension.
A Calgary immigration lawyer says some compassion should be shown to the couple, since they appear committed to staying in the country long-term.
Entitled to health care coverage
"This is a bureaucratic snafu, albeit perhaps of their own making," said Michael Greene.
"This is somebody who should be entitled to health care. She's married to a Canadian. The child will be born as a Canadian citizen."
"And just unfortunately because they make a little mistake that was too hard to fix, they're put in this awful predicament, and it's going to cost them potentially a lot of money," he said.
Greene says Alberta Health does offer an appeal process for people who have been denied coverage.
"Yes, I've made a mistake. But I don't think that means that we should be on the hook for $30,000 for a birth," said Brosha.
The Broshas have to decide within the next few days whether they will fly to Nova Scotia to have the baby. After 36 weeks, Dewi will likely not be permitted to fly.
"I just pray and I hope everything will be fine," said Dewi.
Bryan Labby is an enterprise reporter with CBC Calgary. If you have a good story idea or tip, you can reach him at firstname.lastname@example.org or on Twitter at @CBCBryan.