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Private clinics charge thousands in extra fees for OHIP-covered surgery: Ontario Health Coalition
Posted: April 17, 2024
(April 16. 2024) By: Matthew Trevithick, CBC News
The Ontario Health Coalition (OHC) is taking aim at the province’s plan to expand the number of publicly-funded surgeries at private clinics, saying the experiences of two Londoners who were charged thousands for cataract surgeries is emblematic of the dangers that come with for-profit healthcare.
Their stories are among hundreds the OHC says it has received in recent years from Ontario residents who reported being charged hundreds or thousands of dollars of their own money for procedures covered by OHIP, despite such practice being barred under federal and provincial law.
Most of the people affected are seniors on fixed incomes, and a vast majority of complaints involve for-profit clinics charging for cataract surgeries, according to an OHC report released Tuesday.
“They’re the ones that are poaching patients out of a wait list in the public sector, telling them they’ll get their eye care taken care of much quicker,” said Peter Bergmanis, co-chair of the London Health Coalition.
“If they only waited a few months, they would actually get the best of care without any extra cost to them or the public.”
During Tuesday’s news conference, Bergmanis highlighted the experiences of Maureen Munro, a local senior, and Mike Suta, whose wife Debbie underwent cataract surgery.
Munro was facing the spectre of macular degeneration when she was referred to an eye surgeon by her optometrist, who told her waiting for cataract surgery at a hospital would take at least two years. Getting the procedure at the private clinic, she was told, would be faster and cost $3,000.
“I live alone. I’m an old senior. My late husband had macular degeneration, and his quality of life was zilch,” she said. “I wondered how many years did I have left?”
Munro said the procedure was completed at the private clinic in a matter of weeks, and learned upon leaving that her bill was closer to $7,000 — $3,000 for each eye plus additional charges, forcing her to take out a loan.
OHC said there have been incidents where patients were told they had to pay for OHIP-covered surgeries, or told that if they didn’t, they would face a lengthy wait for a hospital procedure.
Patients also reported being charged for cataract surgery add-ons they didn’t need, like extra eye measurements and tests, the OHC report said claimed were “safer or better” than OHIP-covered services.
OHC noted the patients were also denied access to surgery if they declined to pay out-of-pocket for them, the report says.
Health Minister Sylvia Jones has stated previously Ontarians would never have to pay out-of-pocket for OHIP-insured services with the private clinics.
In a statement, Jones’s spokesperson, Hannah Jensen, described OHC as an “out-of-touch, NDP-backed special interest group.”
Jensen said the province had added tens of thousands of OHIP-covered cataract surgeries over the past year, and that 80 per cent of patients see their procedure “within clinically recommended target times.”
Bill 60, which expands private delivery of care, also brought oversight of community surgical and diagnostic centres under a patient ombudsman, she said.
Suta says Munro’s experience echoes that of his wife when she sought cataract surgery on her right eye. Unwilling to contend with headaches for upwards of two years, she withdrew her savings and made an appointment with the surgeon recommended by her optometrist.
Unbeknownst to her, Suta says it was the same surgeon who had performed surgery on her left eye three years earlier at St. Joseph’s Hospital, a procedure which cost her nothing. (Coincidentally, the same surgeon performed Munro’s procedure, he says.)
“He could have just as well charged us OHIP too and done it in his private clinic, but he didn’t,” said Suta, who appeared on his wife Debbie’s behalf. “It’s like the wild west out there. There’s nobody actually saying, ‘you can’t do that.'”
Patients are essentially being left to fend for themselves in pushing back, Bergmanis says.
“Most patients that are in dire need of some care, they’re not thinking that way, they just go to the first person that they’re referred to,” he said. “There is nobody really controlling it. What if that optometrist has financial links to that surgeon?”
The province says when a provider is found in violation of the Commitment to the Future of Medicare Act, it gives them a chance to be in compliance. The act bans the charging of patients for medically-needed surgeries and diagnostic tests, according to OHC.
The province is preparing to expand the number of private clinics providing OHIP-covered tests and procedures — a move it claims will reduce wait times and save taxpayers money.
Last year, CBC News revealed the province paid a for-profit surgery clinic in Toronto – whose parent company’s lobbyists include Ontario’s former health minister – more to perform certain OHIP-covered procedures than public hospitals.
Health advocates and opposition parties allege it’s part of a broader effort to privatize Ontario health care in favour of one similar to that in the U.S., something the province has denied.
