'I felt helpless': Ontario mother with expired health card told to pay out of pocket for son's hospital visit

An Ontario mother says an attempt to seek urgent care for her sick toddler at her local hospital was one of the most frustrating and upsetting experiences she’s ever had.

Sophia, whose full name is being withheld due to safety reasons, brought her toddler to Scarborough Health Network’s (SHN) Kids After Hours Clinic last Tuesday evening after he developed a fever of 107 degrees.

While filling out some paperwork to register for the visit, the single mother of two said she realized her son’s OHIP card was expired, but wasn’t too worried as they’d had an appointment at the hospital just a few days earlier without issue.

“I didn’t think it would be a problem,” said Sophia, adding she had heard SickKids hospital was dealing with overcrowding and long wait times, and wanted to try attending her local hospital first before going downtown.

The child’s expired health card became, in fact, a problem.

“The person at triage made a phone call and told me I’d have to pay for the visit,” Sophia told CP24.com, adding the amount she was told she’d be charged for her child to be seen by a doctor was roughly $500.

Sophia, who only recently returned to work after maternity leave and is struggling to make ends meet, is also alleging that staff at SHN did not treat her properly during this highly distressing ordeal.

“I was frustrated, worried, and scared. … My anxiety was through the roof. I felt helpless,” said Sophia, whose son was born prematurely and has had a number of health issues.

“My kid was sick and I just wanted him to be better … This didn’t have to happen.”

Sophia said she intends to file a complaint against the hospital. She also said she’s in communication with a few local politicians about possibly escalating the matter further.

“(Scarborough General) needs to be aware of how their staff are treating people,” she said.

“I don’t want another parent to go through what I went through.”

Scarborough Health Network spokesperson Leigh Duncan said their policy is that a patient with an expired OHIP card “would not be asked to pay out of pocket before being seen.”

“We do not refuse to see patients without a valid health card, including if it’s expired,” Duncan said, adding SHN does not refuse service to “patients in need,” even if their health card is expired.

“While we can’t comment on a specific case without the patient’s consent, we always strive to provide exceptional care. We offer our apology if the patient’s experience did not meet these high standards,” she added.

Sophia, meanwhile, said she was never formally refused service at Scarborough General, but instead was told she’d have to pay out-of-pocket in order to receive it.

After contacting Community Angels Toronto, a grassroots network based in the city’s east end that helps bridge gaps, for assistance, the mother and son were able to take an Uber to SickKids where he was seen several hours later without issue, Sophia said. The child is now doing okay.

“What happened is both angering and upsetting,” said Cindy Monk-Fuller, the group’s founder.

“I can’t believe (Sophia) was turned away (from free care) because of an expired OHIP card. She was treated poorly, like a second-class citizen.”

Monk-Fuller said what happened is a “terrible example of a system that is breaking down.”

“Everyone in healthcare is stressed out. This is such an unfortunate situation,” she added.

In a statement provided to CP24.com, Ontario Ministry of Health spokesperson Bill Campbell said this issue could have been easily addressed as “most expired and expiring health cards that are valid, can continue to be used for accessing insured health services.”

“Health care providers are encouraged to validate health cards at point of service using ministry health card validation mechanisms to ensure the card remains valid,” he wrote, noting individuals who are uncertain of the validity of their health cards should call the ServiceOntario INFOline at 1-866-532-3161.

Campbell further noted that under the Excellent Care for All Act, every Ontario hospital is required to have patient relations process for addressing patient and caregiver concerns. He urged any patient who has a complaint to start by contacting the hospital patient relations office.

“The Ministry of Health does not play a role in the management of hospitals. For more information regarding the day-to-day management of a specific hospital or their patient relations office, you may wish to reach out to that hospital directly,” he said.