More patients duped into private clinic health care fees as advocates call for action in Ontario

Ontario health care watchdogs are calling on the province to scrap medically necessary surgeries and tests at for-profit clinics after more than 100 patients say they were illegally charged thousands of dollars, including some cataract patients in Brampton.

The numbers come from a new report by the Ontario Health Coalition (OHC) that looked into claims of patients in Ontario who say they’ve been charged out-of-pocket fees for required medical procedures at for-profit clinics – charges that are unlawful under the Canada Health Act.

A survey of 231 Ontario patients found more than half reported being charged out-of-pocket fees for medically necessary services with 120 saying they were illegally billed.

“We have never received so many complaints from patients,” Natalie Mehra, executive director OHC, told Insuaga.com. “I sort of describe it as the wheels have come off the bus of medicare,” adding that the metaphorical bus is careening “toward the abyss.”

From 2020 to 2022 there were 68 complaints of medical professionals charging patients for services covered by the Ontario Health Insurance Plan (OHIP). More than a dozen of those charges were for eye exams and 13 of them related to cataract procedures.

Mehra said private clinics trying to up-sell clients isn’t new in Ontario but the problem has gotten worse since the province passed Bill 60 last year, which allows more private clinics to offer some publicly-funded surgeries and procedures. The province has billed the changes as a way to cut long wait lists for care, but the OHC says it’s opened up the health care system to more abuse.

Cataract surgery patients an easy target

Of all the procedures available at private clinics, the report found the largest proportion of patients hit with extra charges were for cataract surgery, like one person identified as “Patient L” in the report.

Patient L required laser cataract surgery back in 2018 when she was referred to a specialist in a private clinic in Brampton by her optometrist. After a $554 bill for tests, the patient was told the surgery would not be covered by OHIP because she would be receiving surgery faster than at a hospital – claims Mehra said are both false.

“Everything you need for a high-quality, effective cataract surgery with good outcomes is covered…this is a way to make extra money,” she said.

In total the OHC says Patient L ended up paying more than $3,300 for a surgery that ought to have been fully covered. Around a third of patients surveyed in the report said they had been charged or “manipulatively upsold” by private cataract surgery clinics.

More than 30 patients in the survey were charged for a combination of cataract surgery, extra eye measurements and tests, special lenses, eye drops, follow-up appointments and administrative fees.

“In some cases, patients reported that they were not given a choice about the type of lens they would receive or that the private clinics refused to answer further questions,” the report reads, adding that “many patients reported that they were not given a choice of whether or not to pay.”

The province announced in January 2023 it was making changes to allow private for-profit and not-for-profit clinics to conduct surgeries covered under Ontario’s insurance plan, including cataract surgeries, MRI and CT scans, and knee and hip replacements. At that time, there were about 900 private clinics operating across the province, many of them for diagnostic imaging and testing.

In Ontario, medical practitioners cannot charge for services covered by OHIP including cataract and intraocular lens.

The wait time myth

One way the OHC says clinics trick patients into paying out-of-pocket is by promising a shorter wait time for their surgery, with some saying they were told they would have to wait years in the public health care system.

But the OHC those claims are false as the average wait time for a high-priority cataract surgery lasts around three months, and that paying to jump the queue for health care also goes against the Canada Health Act.

Mehra said patients are often pressured to pay for a speedy surgery but says not to be fooled into paying for service, as the province has a website where you can monitor the wait times for different surgeries and procedures.

If you do get tricked into paying out-of-pocket for a medically necessary surgery, the OHC says to file a complaint with the province and you could receive a refund.

To stop more Ontario patients from becoming victims, Mehra and the OHC are calling on the province to reverse Bill 60 and do away with downloading medically necessary surgeries and tests to for-profit clinics.

“The solution here is not to pay millions upon millions for a new oversight regime…It’s to put that ownership and control back into public hospitals,” she said.

The OHC will be holding a rally to call on the province to take action and protect patients from being scammed at private clinics. The rally will be held in Toronto on May 30 starting at Nathan Phillips Square before marching up Hospital Row to Queen’s Park.

Ontario’s Commitment to the Future of Medicare Act includes a fine for accepting payment for a covered service of up to $50,000 for the first offence and up to $200,000 for subsequent offences.

You can check medical wait times in Ontario by clicking here, or visit www.ontario.ca to file a fraud complaint to the Ministry of Health.