Ontario Health Coalition reports on Illegal, Unlawful and Unethical: Case Studies of Patients Charged for Medical Care in Ontario’s Private Clinics

By Pepper Parr

May 7^th, 2024

BURLINGTON, ON

 

I recently had cataract surgery done on both eyes.  I had an excellent ophthalmologist.

My cost, the amount I had to pay the hospital where the surgery was done amounted to, $440.

There was an additional small cost to have the eyes measured.  My ophthalmologist didn’t like what she saw in the test results and asked me to return to the clinic in Hamilton to a re-test – at no cost to me.

The service at the hospital in Stoney Creek where the surgery was done was superb – from the front desk where intake was done to the nurses who got me through the checking on data, asking questions about my blood pressure, my diet.  The front desk intake clerk deserves a medal for the way she handled people who were elderly and concerned about the surgery

With the surgery complete my opticians took over from the ophthalmologist.  If there is a problem its gets caught at the optician level and they advise the ophthalmologist.

I was  in the hands of people who are very good at their jobs.

There are many people who did not have the experience I had.  Many have been scammed and told that the procedure was going to cost much more – thousands for some.

I had been working with a clinic in Burlington where it became evident to me that they were attempting to up sell me – I moved on when it began to seem a little dodgy to me.

The Ontario Health Coalition released a new report this month about private for-profit clinics unlawfully charging patients for health care.

They are currently ramping up promotion of the May 30th rallies to reach more Ontarians than we ever have and put pressure on the Ford government to stop privatization.

Below is just a sampling of media coverage that the OHC received during the past three weeks.

(April 16, 2024)

By: Ainsley Smith & Caryn Lieberman, Global News Toronto

More than 100 patients have come forward to voice their concerns over being charged for care in private clinics in a newly-released report by the Ontario Health Coalition (OHC). A majority of these patients are seniors living on fixed incomes, with the fees imposing significant financial burdens on them.

The Ontario Health Coalition, which advocates for publicly-funded health care, held press conferences across the province to release the report, titled Illegal, Unlawful and Unethical: Case Studies of Patients Charged for Medical Care in Ontario’s Private Clinics, which stated that for-profit clinics expanded by the Ford government have been charging patients thousands in unlawful fees.

The report featured case studies on more than 100 patients, who said they’ve either been charged extra fees, been denied treatment, been told if they didn’t pay, they would face “extreme” wait times, or even been tricked into add-on fees.

The report said some patients faced bills upwards of $8,000 for eye surgeries and tests, resulting in considerable financial strain. According to OHC, one patient had to go back to work at the age of 71 to cover their bill, while others resorted to accumulating debt, depleting their savings, borrowing money or sacrificing other necessities.

One patient, Shalom Schachter from Toronto, told Global News he was sold a story about needing extra eye testing and lenses by an ophthalmologist surgeon and ended up paying close to $1,200 at a for-profit clinic.

“I could use the OHIP paid-for equipment, but that wasn’t going to be the best for me. He had diagnostic equipment that was going to identify my condition in a more accurate way,” said Schachter.

Maureen Monro of London reported that she was told she would have to wait two years unless she paid thousands of dollars for cataract surgery.

“I was informed the cost to receive the surgery would be almost $7,000. Being as I live alone, I did not want to lose my quality of life. Therefore, I paid the $7,000. Being a senior on a fixed income, I am still trying to catch up with bills from this surgery.”

In the report, the OHC highlighted discrepancies in Premier Doug Ford’s assurances regarding the privatization of surgeries and diagnostics. Despite his “headline-grabbing” pledge that Ontarians would only need to use their OHIP cards, not their credit cards, for medical payments, and the promise of robust safeguards against extra billing and user fees, the reality of patients being charged user fees at private clinics contradicts these commitments.

“It is unlawful to charge a patient for any OHIP-covered service or any part of an OHIP-covered service. In fact, it’s illegal,” said Natalie Mehra, executive director of OHC.

The report also revealed the predominant fees patients faced were associated with eye surgeries at for-profit clinics, particularly for cataract procedures. Many patients said they were not informed the service was OHIP-covered, while a third of patients said they were charged between $500 and $5,000 per eye for the surgery.

Kate Armstrong, a small business owner in Toronto, was one of these people.

Armstrong was informed by a surgeon at a private clinic that the wait time at a public hospital would be “impossibly long” and that the hospital could not offer the desired “upgraded” lens. Consequently, she opted to undergo additional tests and eye surgery at a private clinic.

“$8,000 later, I don’t believe it was an accident that they swiped my Visa card instead of my OHIP card. It was never actually discussed on any level that OHIP covered any of it,” she said to Global News.

In the report, the OHC said the most common violations of public medicare laws in private clinics included telling patients they had to pay for medically-needed surgeries, requiring patients to pay for add-ons not needed or covered by OHIP and charging for preferential access to care for those who paid out of pocket.

“They’re seniors… They’d have to go back to work at 70 and 80 years old to cover these costs. It’s disgusting. It violates every moral that we have,” said Mehra.

In response, a spokesperson for the Minister of Health told Global News that over the last year they’ve added tens of thousands of OHIP-covered cataract surgeries and achieved some of the shortest wait times of any province in the country.

“Through Bill 60, our government has further strengthened the oversight of community surgical and diagnostic centres, by bringing these centres under the oversight of a patient ombudsman, ensuring access to services cannot be conditional on their choice to pay or not pay on additional, uninsured service and putting into law that Ontarians will always access insured services at community surgical and diagnostic centres with their OHIP card and never their credit card,” the spokesperson said.

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.”

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 Ontario government is paying a for-profit clinic more than it pays its public hospitals to perform identical, provincially covered surgeries, according to documents obtained by CBC News.

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.

The province wants to expand for-profit clinics and allow them to do surgeries like hips and knees in an effort to reduce wait times across the province.

Many of the patient testimonies included in the report described similar stories to Edwards — people said they were referred to a private clinic by their physician or optometrists after being told they would have to wait years to get the surgery if they went to the hospital to get it done.

Others said they felt like they had information withheld by the clinics and charged for unnecessary add-ons, like upgraded lenses.

Ontario Health Minister Sylvia Jones responded to the coalition’s concern about patients being up-sold for those services.

“We’re talking about a group that’s ideologically opposed to any innovation and any changes in the health-care system,” she told CBC News.