Senior left covering cost of knee braces after Manitoba Health refuses to pay
Appeal board decision by Manitoba Health says list of insured orthotics hasn't been updated in 15-20 years
Curling, dancing and farming came easy to Wes Vanstone before his knees gave out, but Manitoba Health refuses to cover the bionic knee braces he needs now.
Adding insult to his injury is that the province's decision not to reimburse him, according to an appeal board decision by Manitoba Health, is due to the fact that the list of insured orthotics and prosthetics in Manitoba — called the Prosthetic, Orthotic and Other Medical Insurance Regulation (POMD regulation) — hasn't been updated in 15 to 20 years.
"I'm very frustrated, mad. About myself, sure it's the money, but it's not as much the money as I care about people. I always have. I've always been there to help out the underdog," said Vanstone, 78, from his farm near Miami, Man.
The bionic Levitation braces from Spring Loaded Technology cost Vanstone about $5,000.
Unlike knee braces covered by Manitoba Health, they use a spring to take the force away from three spots in the knee, as opposed to one, when he bends to sit or stand.
Prescription for bionic braces
Vanstone has patellofemoral arthritis, which has resulted in the displacement of his kneecaps to the sides.
After trying a number of different knee braces that provided no relief, his doctor wrote the prescription for the bionic braces, which provide more support for his condition, and come from the company based in Dartmouth, N.S.
"It takes 100 per cent of the brace to lift me, 'cause I've got no assistance from my kneecaps. It's got to be done with a mechanical device," he said.
Since last summer, the senior has worn the the spring-loaded braces to help him sit, stand and move around without pain.
"They make a world of difference," he said. "Curling I wear them, dancing, going out in public. I can go up down the stairs a bit without them, but they still help me a bit going up and down the stairs."
The difference is visible, too; without the activation of his braces, going from a standing to a sitting position results in audible cracking of his knees and brings tears to his eyes.
'Simply too new'
Vanstone purchased the braces believing he'd be reimbursed as he had been by the province for other kinds of braces in the past.
When Manitoba Health denied him, he appealed the decision. The appeal board found that since the braces were not listed on the medical devices schedule found under the the Health Services Insurance Act, no coverage could be provided.
"This schedule has not been updated in the last 15 to 20 years," the decision states. "The board has sympathy for the apellant's plight in that the orthotic he purchased is simply too new to have made the tariff."
"I just sat there in shock," said Vanstone, upon learning of the decision a week ago. He had travelled to Winnipeg with his wife, stayed overnight in a hotel and planned to show the board just how drastically the braces improved his quality of life at the appeal board meeting on Feb.22.
"I've been a farmer my whole life and I can't imagine being 15 to 20 years behind and putting it in writing and then signing it. I thought, OK, that put the icing on the cake and shut the door," he said.
Chris Cowper-Smith of Spring Loaded Technology said that the mechanical device is passively powered so the energy transferred into the spring is Vanstone's own body weight, which is returned to him to give the gentle push to help him stand, reducing his pain.
"We have lots of doctors that prescribe for our customers — patients that have tried pain meds, knee replacement, and the braces are what work for them," said Cowper-Smith. "When you consider knee replacement surgery can cost up to $50,000 across the country, the braces make more sense for some people."
'It brings tears to your eyes'
Vanstone is scheduled for knee replacement surgery this summer, but he's nervous about it, because the braces are what work. He's getting a 'beefed up' set again in July, he said, which will be at his own expense.
"I'm not able to live a life without the braces, because right now, without them, well, it brings tears to your eyes, that's all," he said.
"Sure they bang together when you walk and you sound like a caribou coming across the Northwest Territories 'cause you're clicking away. That's the way it is, and I'm happy to live with them the way they are."
A spokesperson for Manitoba Health deferred to the appeal board decision in the CBC's request for comment on Vanstone's case.
People can apply for special consideration on newer medical technology with a detailed rationale for why they need it.
However, Manitoba Health could not confirm whether that process is the same as the appeal Vanstone already made.
"Perhaps in the future, the tariffs found in the POMD regulation, and similar regulations enacted under the act, will be updated more frequently or at least be amended to include provisions that allow for expenses for new services and devices more previously in existence or considered to be reimbursed if they are medically required," wrote the Manitoba Health Appeal Board acting chairperson in her closing remarks on the appeal decision.
"Until that occurs there can be no coverage for devices created with new techniques and innovations, no matter how beneficial."