Tag Archives: Rehab

Have you been illegally charged for a public health service that should have been insured under the Ontario Health Insurance Plan (OHIP)?

Yesterday the Ontario government launched a phone line and e-mail address for complaints about extra billing.

In its release, the government says there were 189 new investigations into illegal billing in 2010/11. Since 2007, about $1.3 million in illegal billing has been recovered either through reimbursements or cancellation of charges. This is on a $47 billion a year public health system.

For the average patient, figuring out whether their service should be covered or not will be a challenge, with health care providers deciding what is medically necessary and what is theoretically voluntary.

In the examples the government gives on its web site, it suggests that block fees are acceptable if payment is voluntary, does not cover insured services, and must be for a specific period of time. Users must also be given the option to pay for services that are not insured on a per-use basis.

The Ontario Health Coalition issued a release yesterday applauding the crackdown on extra billing.

“We are asking each of the provincial political party leaders to make a clear commitment to roll back the expansion of for-profit clinics and institutions, the majority of which charge patients illegal fees and undermine public Medicare in Canada,” says Natalie Mehra, Director of the Ontario Health Coalition.

Recently OPSEU raised the question of Rouge Valley Health System charging a block fee of $500 for patients in their cardiac rehab program who wish to continue past six months. The fee is not broken out by type of service, such as access to the indoor track and exercise equipment, stress tests or ongoing counselling.

Under the Canada Health Act, hospital services are insured health services. The Act defines hospital insured services as services provided to in-patients or out-patients at a hospital, if the services are medically necessary for the purpose of maintaining health, preventing disease or diagnosing or treating an injury, illness or disability. It would be difficult for a hospital to maintain that cardiac rehab is not medically necessary for the purpose of maintaining health.

It is particularly difficult for Rouge to maintain these are not covered services when its new partner in the program is Lakeridge Health, which provides a year-long cardiac rehab program.

Will the government order Rouge Valley to reimburse the $500? We can only wait and see.

To access the phone line: Call 1-888-662-6613

Or e-mail complaints to: protectpublichealthcare@ontario.ca