Manitoban tussels with province over U.S. medical bill

When gym teacher Rob Trachtenberg began feeling severe numbness and pain in his right hand late in 2024, he never expected that his path to relief would lead him across the U.S. border.

Frustrated by what he says was an 18-month wait for treatment in Manitoba, he opted to drive to Fargo, North Dakota, for a 45-minute procedure, only to be denied reimbursement by his home province. He raises pressing questions about surgical wait times in Manitoba and how, or whether, the province compensates residents seeking treatment outside its borders.

Trachtenberg said his symptoms began late in 2024 and soon worsened. After visits to a minor injury clinic and his family physician, he was diagnosed with carpal tunnel syndrome. But the wait for a specialist and then for surgery loomed large.

“They told me that consultation and surgery could be as long as 18 months,” he says. His right hand had become numb across three and a half fingers. “I was in pain, I couldn’t hold things … I hung in there until Christmas, then went on medical leave.”

Because his condition was classified as “elective” under provincial rules, he could not simply pay to have the surgery done privately within Manitoba. To seek care elsewhere, including another Canadian province or the U.S., he first needed to be seen by a specialist, and that itself had a prohibitive wait.

He researched private options outside the province and, eventually, found a hand surgeon in Fargo. Within days, his surgery was scheduled and completed for $2,400 USD. But when he applied for reimbursement, Manitoba declined.

Trachtenberg pressed on. He eventually had his left wrist operated in Winnipeg in September 2025, about 10 months after his first diagnosis, but he remains embroiled in an ongoing dispute with the province over whether he should be partially reimbursed for his American surgery. He argues it was the only viable path at the time, and would have cost Manitoba far more if he’d remained off work or become disabled.

Trachtenberg’s story is not unique. Wait times for surgeries and specialist consultations in Manitoba have crept upward, and experts warn the system risks becoming increasingly inaccessible.

According to the Government of Manitoba, hip and knee surgeries, the median wait time across Winnipeg facilities in 2025 has hovered around 35 weeks.

A report by the CIHI (Canadian Institute for Health Information) found that despite increased surgical volume relative to pre-pandemic levels, demand has grown faster, contributing to longer backlogs.

And Doctors Manitoba says only 38 per cent of knee replacement patients receive surgery within the 26-week target, ranking the province among the slower performers in Canada. Doctors Manitoba

Still, the system’s limitations are felt most acutely by people in cases like Trachtenberg’s where delays carry serious health risks. As he recounts, if nerve damage had advanced unchecked, he could have faced permanent loss of function.

Manitoba’s policies on out-of-province medical care are tightly constrained.

According to the provincial government, a referral from a specialist is required. The referral must show that the patient needs a medically necessary insured service that cannot be rendered in Manitoba (or, for out-of-country referrals, that no equivalent care is available in Canada).

Prior approval is mandatory, the government says, especially before treatment occurs. Without prior approval, the province may refuse to cover costs. Travel subsidies, including reimbursement for transportation, may be available but only after approval.

Coverage does not extend to all components of cost in foreign jurisdictions. For instance, physician services may be covered up to Manitoba rates, and hospital services abroad may be covered at a percentage (e.g., up to 75 per cent) rather than full local rates.

Interprovincial services within Canada often fall under “reciprocal billing,” meaning physicians can bill Manitoba for patients from other provinces at Manitoba rates, not necessarily full local costs.

If a patient receives care in a neighbouring province where a Manitoba doctor refers them, they may face full cost recovery fees (i.e. paying full non-resident rates).

In Trachtenberg’s case, the province cited that he didn’t follow the required referral process (i.e., being referred by a specialist first) as grounds for denying his reimbursement.

In short, even if the system effectively forces a patient to seek care out-of-province, the province reserves the right to refuse cost coverage if its formal procedural requirements (e.g., specialist referral, approval steps) haven’t been met.

Trachtenberg is adamant that the province’s refusal to reimburse him (or at least partially compensate) is short-sighted, and even wasteful.

“If I’d waited until September, I probably would never have regained use of my hand … (By seeking treatment early) I actually saved the government money,” he says, pointing out that a year of disability or medical costs would far exceed the $3,500 (in CAD) he spent.

» Winnipeg Sun