AHS operated medical scan reimbursement policy for over a decade, but few knew about it

AHS operated medical scan reimbursement policy for over a decade, but few knew about it

AHS said policy, which operated 2011-2025, had ‘never been formally communicated or approved’

In October, Premier Danielle Smith and Minister of Primary and Preventative Health Services Adriana LaGrange appeared together in a video announcing changes coming to Alberta’s health-care system.

Once Bill 29 is passed, patients — including self-referred ones — who pay out of pocket for diagnostic tests like MRIs or CT scans will get reimbursed by the government if their condition turns out to be life-threatening.

“And make no mistake, this reimbursement incentive makes perfect sense for the taxpayers,” promised LaGrange, “because it means the government will save massive amounts of tax dollars by catching an individual's health problem much earlier.”

Watching the video of the announcement, one might think this kind of reimbursement would be an entirely new policy direction for the province.

But CBC has learned Alberta already had a reimbursement policy for privately paid exams that dated back to 2011.

The policy operated for about 15 years, but few people knew about it. Several questions about it remain unanswered, including the number of potentially eligible Alberta patients who never got their money back.

Documents obtained by CBC News show that in March 2025, AHS officials asked interim CEO Andre Tremblay for approval to discontinue a policy that reimbursed patients for MRI, CT and PET/CT diagnostic scans.

AHS told CBC News the program was discontinued in 2025 “due to the Alberta government’s incoming policy changes related to preventative testing, combined with inefficiencies and low uptake in the previous program.”

Private-pay reimbursement policy started in 2011

The AHS policy allowed the reimbursement of privately paid exams for patients whose cases were deemed by their treating physicians to be medically urgent.

Records obtained by CBC News from a request under Alberta’s Access to Information Act show AHS insiders did not know why or how the policy came to be in the first place.

“The original intent is unknown,” says a March 11, 2025, briefing note circulated among senior AHS leadership. “It appears the policy was not formally approved by AHS processes of the time.”

The health ministers in government over the life of this little-known policy shared no further information.

Alberta NDP MLA Sarah Hoffman, now shadow minister of hospital and surgical facilities, was Alberta's health minister from 2015 to 2019. She told CBC she didn't know about the policy.

Tyler Shandro, health minister from 2019-2021 under Jason Kenney’s government, declined to comment on the record.

Neither Fred Horne, minister of health and wellness from 2011-2014 under Alison Redford, nor Jason Copping, health minister from 2021-2023 under premiers Kenney and Smith, responded to CBC’s queries.

The briefing note goes on to explain the reimbursement policy was not publicized.

“The policy appears to have never been communicated broadly to stakeholders … including patients, physicians, and the government.”

This lack of communication, the briefing note explains, is why the policy had such low usage: only 40-50 patients a year submitted reimbursement requests, and only about 10 per cent of those requests were approved.

CBC shared the briefing note and AHS correspondence with Andrew Longhurst, senior researcher with the Canadian Centre for Policy Alternatives.

Asked about the small number of patients reimbursed under the policy, Longhurst had his own questions.

“It raises a lot of questions about who was accessing this queue-jumping program that was greenlit and not broadcast widely,” he said.

The policy had rules, but few knew them

The policy stipulated that “patients facing wait times for scheduled AHS exams considered medically urgent” work with their referring physicians to submit clinical information to justify being reprioritized in the queue by a radiologist.

If AHS couldn’t accommodate an earlier appointment, the patient could pay out of pocket for an exam and get reimbursed by AHS afterward.

The reason most reimbursement requests were denied, according to the briefing note, was because “this crucial policy aspect is not communicated to patients.”

Doctors were in the dark, too, contributing to the high rate of denials.

“Ordering providers have incorrectly informed patients that they will be reimbursed without following the appropriate steps,” the note says, “resulting in unrealistic expectations.”

CBC News asked the Alberta Medical Association about the reimbursement policy that started in 2011.

“As far as the current AMA leadership are aware, this policy was not formally communicated to the AMA,” a spokesperson said in an email.

“It does not appear to have been shared through established engagement or consultation processes between the Association and AHS.”

The Alberta Society of Radiologists declined to review the documents or respond to CBC’s request for comment.

At the beginning of March 2026, 39-year-old Edmontonian Siju Varghese suffered a gym injury that went from weakness to pain to agony over a few days.

“I was doing a bench press when I had a sudden failure on my left arm,” he told CBC News.

“The weight track collapsed on my left side, and I had to get help to lift the rack back up, and I felt a sudden weakness and loss of strength in my arm.”

His doctor said he needed an MRI for a diagnosis, but couldn’t tell him how long the wait would be. Meanwhile, the pain got so bad, Varghese couldn’t sleep.

“I felt like I was probably going to go insane … I felt the pain was unbearable,” he said.

His family doctor suggested paying privately for an MRI. Varghese got an appointment the next day, paid $600 and received a diagnosis: a herniated disc.

After a surgery referral and consultation, he was in the queue for back surgery, but he couldn’t wait — the pain drove him to the emergency department at the University of Alberta Hospital, where there were no beds available.

Varghese waited 16 hours before surgeons operated on him on March 19.

While he’s disappointed with his experience with the health-care system — specifically the delays while waiting in excruciating pain — Varghese finally got the treatment he needed.

But he says if he hadn’t sped things up by paying hundreds out of his own pocket, his outcome could have been a lot worse.

“My surgeon told me that he was glad that I paid for out-of-pocket MRI … and I got the process expedited,” he told CBC News.

“Because if I had waited longer, the nerve damage would have been worse, and I would have permanent loss of strength or loss of sensation in my arm.”

Now Varghese faces months of rehab, along with questions about why his case played out the way it did.

Among them: whether there’s a way to get his $600 MRI fee back.

AHS struggled with ‘capacity limitations’ for medically urgent scans

The March 2025 briefing note and related email correspondence obtained by CBC explained that AHS was having trouble accommodating reprioritized diagnostic exams based on medical urgency “due to capacity limitations and a rapidly growing waitlist.”

It said such reprioritizations came at the cost of delaying or cancelling “lower-priority exams.”

Chris Gallaway, executive director of Friends of Medicare, wondered about any patients who could be awaiting reimbursements.

“The government has this record of not being super transparent on their health care decisions,” he said.

“If you're ending this program, why not tell people and tell them why and tell them what the plan is for those handful of people you were reimbursing. What's their avenue now? You know, does that mean they're out of luck or what?”

CBC News put those questions to AHS and the Ministry of Primary and Preventative Health Services in relation to Varghese’s case. AHS said because the reimbursement policy in question was discontinued in 2025, he’s not eligible.

CBC asked AHS whether other patients whose private-pay scans happened during the active period of the policy, from 2011-25, could still be eligible for reimbursement, but AHS wouldn’t say.

As for the incoming policy, the ministry wouldn’t say if patients will be eligible if they paid for tests before that new legislation comes into effect, and it wouldn’t say if a case as serious as Varghese’s would count as life-threatening under the new rules.

“Regulations are currently being developed,” it told CBC in an emailed statement, “and we will have more to share regarding our preventative testing policy in the coming weeks.”

Jenn has worked as a journalist in the US and Canada, joining CBC Calgary in 2007. Her work has appeared on radio, television, and web, including current affairs, investigative and local news. Please send story tips to Jennifer.Blair@cbc.ca. Se habla español.