Ontario documents show patient complaints over cataract billings

As Ontario prepares to expand the number of private clinics that perform publicly funded cataract surgeries, documents show those procedures form one of the most common complaints the province receives from patients about unfair billing practices.

The Canadian Press submitted a freedom-of-information request for copies of complaints made under the law banning medical professionals from charging patients for services covered by the Ontario Health Insurance Plan.

From 2020 to 2022 there were 68 complaints, with 15 of them about charges for eye exams and 13 of them related to cataract procedures. Other complaints involved a range of medical procedures including blood tests and prenatal testing.

While the absolute numbers are relatively small, NDP health critic France Gelinas said the true number of patients with similar complaints is likely much higher, because not many people know how to go through the process.

The ministry's response to many of the patients who complained about charges for cataract surgery was to tell them the records showed they had actually consented to paying for non-insured services.

In response to one person who complained that they had paid $2,400 for "cataract extraction with intraocular implant service covered by Ministry of Health," the ministry wrote that records showed the patient had agreed to non-insured extras. They received a $200 credit for the cost of a medically necessary lens, but the premium lens they received had to be paid for out of pocket.

"According to the records provided, you had consented to paying for and receiving these services," the ministry told the patient.

"The [Commitment to the Future of Medicare Act] does not apply to uninsured services, and any costs associated with these services are the responsibility of the patient."

Gelinas said such examples show that patients receiving publicly funded surgeries in private clinics are being upsold and are not always clear on what charges they will have to pay out of pocket.

"If the people went through the process of finding which number to call [to complain], of leaving a message, of waiting three weeks for somebody to call them back, of waiting another three months for them to do their investigation to get an answer ... you didn't have consent," she said.

"This is not what consent is. We're talking about people who have poor vision — that's why they're going for cataract surgery — who are most of the time a bit elderly, and this is not informed consent."

Expansion of private clinics coming

Liberal health critic Adil Shamji said there is a "significant power imbalance" between doctors and patients that can lead to people accepting doctors' recommendations for certain procedures or special lenses without fully realizing the additional cost.

"In a medical environment, doctors have access to all kinds of information that patients do not," Shamji, a doctor himself, wrote in a statement.

"When you mix that with pressure from shareholders and their incentive to maximize profits, you get patients feeling pressured to receive uninsured services without their truly informed consent."

The NDP, Liberals and Green Party have all raised concerns that the government's expansion of allowing private clinics to perform publicly funded procedures will only increase patients' vulnerability.

The Progressive Conservative government is preparing for the next step in its expansion of the number of private clinics offering publicly funded tests and procedures such as cataract surgeries and MRIs, as well as adding hip and knee-replacement surgeries.

Health Minister Sylvia Jones has said the expansion will allow more procedures to be performed and will reduce wait times, and patients will never have to pay out of pocket for OHIP-insured services.

Her spokesperson said that the law enabling this expansion also brings the new clinics under patient ombudsman oversight and ensures access to publicly funded services can't be conditional on the patient agreeing to an additional, uninsured service. Accreditation Canada has been selected to develop an enhanced oversight and quality assurance program for those clinics.

The government provided the amounts reimbursed over several years to patients who complained under the Commitment to the Future of Medicare Act. Between 2019-20 and 2021-22 those amounts were approximately $21,790, $3,527 and $18,723.

Many of those complaints involved clinics, but others included hospitals and laboratories.

There are currently more than 900 private health facilities in the province, largely providing diagnostic imaging services.