Ontario hospital network says it sometimes charges patients for variety of tests
Posted: June 1, 2022
(May 31, 2022)
By: Chris Herhalt, CTV News
Amid ongoing concerns about fees for routine diagnostic medical testing in Ontario, one hospital network has charged patients to perform a raft of different tests – ranging from STDs to cancer screening to select blood tests – in certain circumstances for at least five years.
Fee guides obtained by CP24 from the Grey Bruce Health Services hospital network in the Owen Sound area show that between 2017 and 2021, a number of diagnostic tests were paid out of pocket by the patient or their private insurer if they were referred to the hospital for a test by their family doctor.
Over those four years, the fee guides show the number of tests requiring private payment at the hospital network has fluctuated between 160 to 170 listed tests, and costs for some have ballooned.
One test, Septin9, is a blood-based DNA test used to screen men for colorectal cancer.
In 2017, it was not listed in the document.
Four years later, it was listed, at a cost of $199.
Grey Bruce Health Services spokesperson Mary Margaret Crapper says that if a patient is admitted as an inpatient or outpatient to one of its six facilities, the charges do not apply.
“However, if your family physician referred you for one of these tests, then you would be charged based on the prices in the documents you sent me. These prices are set by the referral labs we use to conduct the tests,” she told CP24. “In our smaller, rural hospitals, there are no private labs, so we draw the blood, and send it to a private lab so that our patients don’t have to travel. And for those tests not covered by OHIP, there is a fee.”
Other tests detailed in the guides include the Herpes Simplex PCR test, used to detect the presence of the Herpes Simplex Virus 1 or 2.
In 2017 it was not listed in the guide as a test requiring private payment.
In 2021 it cost $160.
Asked specifically about the fee guides, the Ontario Ministry of Health said the Grey Bruce hospital network is responsible for covering cost of testing through the budget it receives from Ontario Health.
“Consistent with the ministry’s funding model, hospitals (e.g., Grey Bruce Health Services) are financially responsible for providing laboratory services for their registered in/outpatients under their global budget, this includes laboratory services referred to other laboratories. To that end, hospitals are permitted to direct non-hospital patients (i.e., community patients) to the community laboratories,” a spokesperson told CP24.
It also said the Herpes Simplex PCR test is covered through OHIP when it is performed at one of 11 laboratories belonging to Public Health Ontario.
Another blood test detailed in the fee guides is the Wafarin (Coumadin) test, used to assess the performance of a blood thinning drug in preventing blood clots.
In the 2017 fee guide, it cost $30. In the 2021 guide, it cost $101.
The Grey Bruce fee guides also detail new charges for a selection of prenatal tests used to determine the presence of certain birth defects.
Included in the 2021 edition of the guide but not the 2017 one are MaterniT and Harmony (NIPT) prenatal tests.
They range in cost from $495 to $795.
A Ministry of Health spokesperson said they should be covered by OHIP but only in select circumstances.
They said any pregnancy involving twins, a mother who will be age 40 or older at time of birth, or any mother with a history of prior genetic risk would have the tests covered by OHIP.
One test, for Ibuprofen sensitivity, was not included in the 2021 version of GBHS’s fee guide but listed in the 2017 edition.
It cost $42 in 2017.
Crapper said the hospital wants its patients to be aware of the circumstances where tests must be paid out of pocket.
“This is public information, and we need the patients to understand that not all lab tests are covered by OHIP,” she said.
CP24 has received multiple reports from all across Ontario of patients having to pay out of pocket for diagnostic tests that until recently were covered by OHIP.
The Ministry of Health flatly denied any changes have been made to OHIP coverage of diagnostic tests when asked on Monday by CTV News Toronto.
“There have not been any changes to tests that are covered under the Ontario Health Insurance Plan (OHIP) Schedule of Benefits-Laboratory Services (SOB-LS) that may have led to a patient being charged,” a spokesperson said. “There are certain criteria that need to be met in order for those services to be covered. For example, the SOB-LS lists out the specific tests that are eligible for OHIP coverage in a community setting (i.e. non-hospital) from named providers, and may include specific eligibility criteria for the test as well.”
Perry Brodkin, a lawyer and former official with OHIP for two decades, says to him, it appears Grey Bruce Health Services’ collection of fees for certain tests in select circumstances is not allowed under Ontario law.
“I don’t think they’re padding anything, I know that (GBHS) don’t know the law, because nobody knows the law – but who else knows the law – presumably civil servants in the Ministry of Health know that law.”
He said patients in Grey Bruce should be refunded any money they paid.
“GBHS should return all of those payments to patients for the past five years. But will the ministry order them to do that?”
Crapper referred any inquiries about whether GBHS was complying with provincial guidelines to the Ministry of Health.
As for social media reports of this occurring in other jurisdictions, Brodkin says patients need to take it up with their family doctor.
For its part, the Ontario Health Coalition has told CTV News Toronto that it has been following up with patients who have paid out of pocket for diagnostic tests they believed should have been confirmed but hasn’t yet come across cases that have recently been removed from OHIP coverage.
“All I can say is that if you’ve been billed for Lifelabs or Dynacare for a diagnostic test, just contact your physician, because you don’t have the requisition anymore,” Brodkinsaid.
If someone is billed for a test conducted at a public hospital, Brodkin says they need to contact the patient ombudsman.
In their statement Monday, the Ministry of Health also noted that the “Commitment to the Future of Medicare Act (CFMA) prohibits charges by any person or entity for insured services or for access to insured services.”
The ministry said that if a patient feels that they have been charged for a service that is insured they can call the CFMA Program report line at 1-888-662-6613 or email firstname.lastname@example.org.