A woman from Alberta has been denied coverage for dental implants to fill gaps in her mouth resulting from a cleft palate, something her doctor says is the result of her being Indigenous.
“I think everyone deserves the same treatment no matter what,” said Summer Dawn White Eagle, who was born with a cleft lip and palate more than 20 years ago on the Siksika First Nation east of Calgary.
Children born with cleft palates in Alberta are referred to the Pediatric Cleft Palate Clinic at either the Alberta Children’s Hospital in Calgary or the Stollery Children’s Hospital in Edmonton.
Almost all of the costs for dental procedures are covered under the Alberta Cleft Palate Dental Indemnity Program, established in 1974 and believed to be the first publicly funded program of its kind in Canada.
To be eligible for coverage you must be under 24 and a resident of Alberta.
‘All other children are getting covered’
White Eagle’s prosthodontist says he’s never encountered a problem getting compensated for dental implants for his non-Aboriginal patients.
“All the other children are getting covered by Alberta Health,” said Lim. “It doesn’t matter whether these other kids, whatever race or religion they are, as long as they’re a child, they get covered.”
The fees for First Nations Albertans are supposed to be split equally between the federal and provincial governments, but the federal program that covers the costs has denied payment to Lim.
According to the Health Canada website, “all dentally related costs associated with the treatment of a functionally handicapping malocclusion, such as cleft palate, are covered under the Non-Insured Health Benefits (NIHB) Program.” However, it says implants are excluded from coverage, and that exclusion can’t be appealed.
“I think everyone deserves the same treatment no matter what,” White Eagle said.
Her mother agrees.
“All children deserve to have the treatment,” said Anita South.
“If you have to go through life with big gaping holes in your mouth, that does something to how someone feels about themselves and how society feels about you.”
In a statement to CBC News, Health Canada said it has contacted Dr. Lim and is trying to find a solution.
“This case represents an unusual situation and Health Canada is actively working with its partners to determine a fair and timely solution,” the statement read.
“We have been in contact with the claimant’s prosthodontist to discuss the case in detail. Furthermore, we have reached out to our counterparts in the Government of Alberta in an effort to resolve the situation.”
Lim submitted the claim in April, 2016 and is still owed several thousand dollars for the implants.
“I think there’s a hole in the system that unfortunately puts First Nations people at an extreme disadvantage,” he said.
White Eagle’s journey has included more than 10 surgeries and procedures, including two jaw surgeries, bone and skin grafts to fill in her upper lip and palate. She’s also had surgeries to her eyes, nose and ears.
Advocating for the doctor
She now finds herself advocating for Lim to try and get his payment.
“It’s not fair, it’s not right,” said White Eagle of the situation.
She wrote to Alberta’s minister of Indigenous Relations in January, outlining the procedures she’s gone through and pointed out that she, like all other cleft palate patients, are entitled to the treatment and the people who provide it should be paid.
She hasn’t heard back.
Indigenous Relations Minister Richard Feehan’s office didn’t respond to a request for comment, but instead referred the matter to Alberta Health Minister Sarah Hoffman.
“We appreciate Dr. Lim bringing this situation to the Alberta government’s attention. Alberta Health staff have been in contact with the Cleft Palate program at Alberta Health Services and the federal Non-Insured Health Benefits program. The department will be working with AHS and federal government toward a solution for this patient and her family,” read Hoffman’s statement.
Lim says he will cover the costs of the implants for White Eagle, but fears some practitioners will opt out of treating Aboriginal children because they won’t get paid.
More work needed
South says Summer Dawn may require more plastic surgery for her upper lip and her daughter is having hearing problems that will need to be checked.
She says it pains her to see that Dr. Lim will not get paid for the work he’s done to help Summer Dawn.
“He’s done an amazing job with Summer; he has a heart for these kids, he needs to be paid,” said South.
White Eagle, who her mother describes as a “miracle child” for getting to where she is, is studying to become a professional make-up artist and is expected to graduate from her Vancouver-based program next month.
- Bryan Labby is an investigative reporter with CBC Calgary. If you have a good story idea or tip, you can reach him at [email protected] or on Twitter at @CBCBryan.