Area of Law: Health Law
Answer # 701
OHIP and doctors' billingsRegion: Ontario Answer # 701
In Ontario, most doctors participate in the publicly-funded compensation schemes offered by the Ontario Health Insurance Plan or OHIP.
OHIP “insures” or pays for a wide variety of medical procedures considered essential for public and individual health. Doctors bill OHIP for the delivery of these services and the qualifying patient pays nothing.
Specific uninsured medical services are not covered by OHIP and may be charged directly to the patient at the discretion of the physician. Ontario’s College of Physicians requires that doctors, whenever possible, inform a patient of the charges prior to rendering the service. Typical uninsured services include dispensing fees, transferring medical records to another doctor, experimental medical procedures, immunizations, non-essential cosmetic surgery, and completing insurance forms.
In recent years, private clinics have been started that offer comprehensive health care services for a fixed fee, such as annual physical testing and physician referral programs. Many of the doctors associated with the clinics are paid on a fee-for-service basis by OHIP for some services, but the clinics are permitted to render other uninsured services at market rates.
For more information about OHIP, contact the Ontario Ministry of Health and Long-Term Care.
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