Montreal·CBC Investigates

Quebec family of 4 with baby on the way shocked after government revokes health insurance

Without warning, a Quebec family says all their medicare cards were cancelled. Worse, they may have to reimburse the provincial health insurance board tens of thousands of dollars because the board doesn't believe the family lives in Quebec.

Pregnant mom, husband and two young sons have eligibility revoked because RAMQ doesn't think they live here

RAMQ also cancelled the medicare cards of Sandra Tomb's two young sons. The decision is retroactive to their dates of birth, even though both boys were born on the West Island. (CBC News)

It came in a simple envelope.

But by the time Sandra Tomb finished reading the four letters inside, she says she felt like a criminal.

The letters, one for each member of her family, were from Quebec's health insurance board.

The board, known by the French acronym RAMQ, had stripped Tomb, her husband and their two young children of their medicare cards.

Tomb and her family live in Blainville, a suburb north of Montreal, and have for nearly four years.

But in the letters, RAMQ said the family wasn't eligible for coverage because they don't live in Quebec.

They were asked to return their cards immediately.

"I went into shock," said Tomb, who moved to Quebec from Lebanon as a child and is a Canadian citizen.

The letters arrived late on a Friday, too late to call the insurance board for answers.

That night and all through the weekend, Tomb and her husband barely slept.

Quebec mom angry after government revokes family health insurance 0:44

Their minds swirled with every worst-case scenario.

What if the children were hurt at daycare? What if she fell down the stairs?

"I did not feel safe for the first time in my life," said Tomb, who is pregnant with their third child.

Retroactive

The news got worse.

Not only was the family's medical coverage cut off, but the government said they must pay back any medical care or prescriptions they received.

For Tomb, it was retroactive to 2013.

For her husband, Mark Hoyek, it was retroactive to 2014, shortly after he became a permanent resident.

Their two children — Alexander, 3, and Christopher, 2 — lost their coverage from their dates of birth.

RAMQ does not believe 2-year-old Christopher Hoyek lives in Quebec. His medicare card was cancelled along with his parents' and older brother's. (CBC News)

Both boys were born at the Lakeshore Hospital on the West Island.

The couple felt blind-sided.

Tomb worries the bill may run as high as $50,000.

"It means, two births, all the medical appointments of my kids, all the medication I bought, everything," said Tomb.

Triggered by RAMQ card renewal? 

The problems with RAMQ began when Tomb tried to renew her medicare card last November.

A few weeks after she sent in her renewal form, RAMQ replied by letter, asking for proof of residence.

By phone, RAMQ reassured Tomb it was a random spot check and nothing to worry about.

Tomb and her husband sent copies of phone and hydro bills as well as the deed to their condo.

After a few more weeks and still no card, Tomb began to worry again.

She had prenatal and ultrasound appointments to make but couldn't book anything without her card.

She called RAMQ three times to find out about why she hadn't yet received it.

"They're like, just wait for the mail, you're going to have your answer," said Tomb.

The agent wouldn't give her any more information. 

Mark Hoyek says if there were questions about their family's eligibility, the government should have asked them for more information before cancelling their medicare cards.

In the letters Tomb received at the end of January, RAMQ says it did not have the necessary information it needed to maintain Tomb's or Hoyek's eligibility.

The letters also say they were not able to prove the family was living in Quebec.

"How do they dare take away the right of a two-year-old and a three-year-old?" said Tomb.

Hoyek was similarly stunned.

"No one called to say this paper was missing or could you provide more proof," said Hoyek. "I would have done that, no problem. But this just came out of nowhere."

Misunderstanding?

Apart from a few short vacations, Tomb says the whole family has lived in the Montreal area since 2013.

When she got the letters, she wondered if a mistake had been made.

To remain eligible for health care coverage in Quebec, residents can't be away from the province for more than 182 days in a calendar year.

In 2012, when Tomb got engaged, she stayed in Lebanon with Hoyek to plan their wedding. 

She admits she was gone for more than the maximum number of days allowed. Her card expired while she was away.

Sandra Tomb says she never had any problems with her medicare card until she sent in her renewal form last November.

When she returned to Montreal in January 2013, she informed RAMQ of her absence when she renewed her card.

"They were like OK, no problem, we just need proof of how long you went and when you came back," said Tomb.

Tomb was told she qualified for a rule where once every seven years, residents can be absent from Quebec for 183 days or more in a year and still remain eligible for coverage.

She got her medical card and never had any issues. 

Neither did Hoyek or her two children with their cards, until this January when the letters arrived.

Appealing RAMQ decision

As soon as she could, Tomb got in touch with RAMQ to appeal the decision.

She was told to send as much evidence as possible to show the family actually lives in Quebec.

Sandra Tomb and her husband, Mark Hoyek, are appealing RAMQ's decision. They have sent more than 400 pages of detailed financial and personal information to prove they live in Quebec.

Hoyek said he then spent an entire day at work, faxing hundreds of papers, full of their most personal details.

Page after page of bank and credit card statements dating back to 2013.

Photocopies of passports.

Proof their children go to daycare here.

Proof of employment.

All their mortgage information.

RAMQ says it is now reviewing their file and it has priority status. That was nearly two weeks ago.

Hoyek isn't upset about being checked. But if the information they initially provided wasn't enough, he would have given them what they needed.

"If it was not enough, just tell me," said Hoyek. "I have nothing to hide."

If there was a mistake, he wants it corrected immediately.

RAMQ's response

According to RAMQ, for the years 2011, 2012 and 2013, an average of 1,740 people a year lost their eligibility because they were outside Quebec for 183 days or more.

More recent numbers are not available because many medicare cards issued after 2014 have yet to expire.

One of the ways RAMQ catches cases of ineligibility is when people go to renew their card. The form asks people to declare any absences from Quebec.

Caroline Dupont, a spokeswoman for RAMQ, said it won't comment on individual cases, but a decision to revoke eligibility can be retroactive and extend to an entire family.

While Tomb's family waits for RAMQ to review their file, all their medical appointments are in limbo, including prenatal exams for Tomb, who is pregnant with their third child. (CBC News)

Dupont said in all cases where a person's eligibility comes into question, people are asked for the necessary documents to assess their eligibility.

RAMQ says it has up to 90 days to review an appeal.

Meanwhile, the stress is taking a toll on the family.

"None should go through what we went through," said Hoyek.

"A minute feels like an hour and an hour feels like a day."

About the Author

Leah Hendry is a TV, radio and online journalist with CBC Montreal Investigates. Contact her via our confidential tipline: 514-597-5155 or on email at montrealinvestigates@cbc.ca.

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