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Were you billed for an OHIP-funded service at a private health clinic in Ontario? Here’s how you could get a refund
Posted: June 12, 2025
(June 12, 2025) By: Mike Pearson, InsideHaltoncom
Cataract surgeries, diagnostic imaging and services at private nurse practitioner clinics are three examples of out-of-pocket fees Ontario residents may face when accessing care at private health facilities, according to the Ontario Health Coalition.
Did you receive a bill from a private health facility for something you thought was covered by OHIP? You may not be alone.
If you’ve had cataract surgery, for example, and suspect you were charged for an OHIP-funded service, you could appeal the charges and have your money refunded.
Cataract surgeries, diagnostic imaging and services at private nurse practitioner clinics are three examples of out-of-pocket fees Ontario residents may face when accessing care at private health facilities, according to the Ontario Health Coalition (OHC).
Natalie Mehra, OHC executive director, said since the Conservative government announced plans to redirect resources to private clinics to free up surgical resources at hospitals, including cataract surgeries, patients may be misled about wait time length in a bid to secure out-of-pocket payment for surgery or for other add-ons.
“People are not going to private clinics because the wait lists are too long,” Mehra clarified in an email. “They are going to private clinics because that is where they have been referred by a family doctor or optometrist.”
According to the OHC, OHIP covers basic cataract surgery with a standard lens implant. Ontario patients who present a valid Ontario Health Card should not receive a bill for these OHIP-funded services.
Additional costs may apply for certain advanced technologies, specialized diagnostics and premium lens implants.
No private clinic can tell patients that they can get care faster if they pay a fee, the OHC notes.
A recent Toronto Star investigation found patients who visited private clinics for OHIP-insured cataract surgery felt they had to pay between a few hundred up to thousands of dollars to bypass reportedly long wait times for better treatment, including upgraded lenses.
Ontario Ministry of Health responds
In an emailed statement, Ema Popovic, press secretary for Health Minister Sylvia Jones, said 32,000 people accessed publicly funded cataract surgery last year at community surgical and diagnostic centres.
Nearly half of those procedures were performed at four new centres, launched by the province in 2023.
“To be very clear, Ontario has provisions through legislation that prohibit a patient from being charged for an OHIP-covered service,” Popovic said.
Provincial oversight was strengthened through Bill 60, passed in 2023, which aims to enhance transparency to ensure no extra charges occur for OHIP-funded procedures.
“Our government will continue to deliver more connected, convenient care in every corner of the province, always ensuring that people are accessing the care they need with their OHIP card, never their credit card,” Popovic added.
How to report a suspected violation
“If someone has been charged for an OHIP-covered service, they can contact the Commitment to the Future of Medicare Act program to open a review,” Popovic said. “Those who have been charged for an insured service will be reimbursed in full.”
Canadian Doctors for Medicare, an organization dedicated to preserving Canada’s publicly funded health care system, has an online form and contact information for provincial agencies who investigate patient claims of inappropriate charges for insured health services.
Ontario residents can contact the Commitment to the Future of Medicare Act program at 1-888-662-6613 or by email at protectpublichealthcare@ontario.ca.
