We are seeing a rise in private-for-profit clinics that push extra charges on patients and pursue profit over patient care.
It is a violation of the Ontario’s Commitment to the Future of Medicare Act to charge for a medically necessary OHIP-covered service or to deny a patient an OHIP-covered service because they refuse to pay for a non-covered service. However, many clinics do just that.
This guide will help you spot for-profit care, avoid unnecessary costs, and feel empowered.
Most common types of predatory private clinics:
Profit-Driven Surgical Clinics
- Push non-OHIP covered upgrades, like more expensive lenses for cataract surgeries, often without informing patients there is a covered option.
- Scare patients with misleading information about public wait times.
- Often lack transparency around costs, leading to shocking final bills.
Private Primary Care or “Executive Health Clinics”
- Lead by doctors who bill OHIP for services, private doctors, or nurse practitioners.
- Most charge mandatory yearly fees to access primary care.
- Most clinics prevent patients from accessing OHIP-billing doctors unless they pay a mandatory fee for non-OHIP services. This is illegal.
Profit-Driven Diagnostic Services
- Allow patients to avoid waits by paying for an MRI or other OHIP-covered test.
- It is illegal to charge for these services when they are medically necessary.
Having day surgery outside of a hospital? You may be attending a private, for-profit surgical centre.
Ask these questions at surgical clinics BEFORE TREATMENT to avoid extra charges:
- Do you expect there to be extra charges?
- If yes: what are the charges for? Can I opt-out?
- Can I choose an OHIP-covered option instead?
- Is the non-covered option medically necessary? What benefit will it provide?
- What is the clinical difference between the paid and covered options?
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What is the wait time for OHIP-covered treatment?
- Private clinics sometimes use “wait times” and faster care as a tactic to encourage patients to pay, even when waits for publicly funded care are short.
- Check wait times here: ontario.ca/page/wait-times-ontario
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Will I be asked to make any decisions immediately before treatment? I would like to make them now instead.
- Some clinics capitalize on stress immediately before a procedure to push more expensive options.
Request written documentation about expected charges (if any) before receiving treatment. Keep this document, compare it to any charges you do receive, and be ready to dispute charges with the clinic. If you did not request this document, you can still dispute charges, especially if you find that you have been charged for OHIP-covered services.
If you believe you have been charged for an insured service or access to an insured service, contact the Ministry of Health by email at [email protected] or by phone at 1-888-662-6613
More information and examples from the Ontario Health Coalition: ontariohealthcoalition.ca/wp-content/uploads/Under-the-skin-private-clinics-and-illegal-user-fees-final.pdf
References:
Murky rules for nurse practitioners give rise to private clinics in Ontario | CBC News
Understanding public and private health care | CMA
As private-pay crackdown looms, 'executive health' clinics charge freely
Community surgical and diagnostic centres | ontario.ca
Harrison Healthcare - Premier Services
Does Ontario Have Private Health Care? Understanding Your Options