More Ontario doctors charging fees for uninsured services. This is why

Doctors in Ontario can charge additional fees to their patients for any service that is not covered by the Ontario Health Insurance Plan (OHIP).

In the past, many doctors didn't bother to charge the extra costs for uninsured services, but now more of them are asking their patients to pay up.

“Imagine reaching into your wallet, to hand over money to your doctor – that's unheard of,” said Mary, a woman who asked not to be identified by CTV News Toronto because she fears she’ll lose her doctor for speaking out about the fees.

Mary was surprised to get a letter asking her to pay annual fees or block fees for uninsured services of $135 per person, $205 per couple or $240 dollars for a family.

If she doesn't pay the annual fee, she will have to pay for uninsured services. Some examples include prescriptions by phone for $20, sick notes for $25, an ear wash for $50, the charge for a tax disability form is $100 dollars, and a driver’s medical form is $160.

“Well, I think that getting a prescription is a medical necessity. Now I have to pay $20 for it, and I don’t think that’s right,” said Mary.

Charging for uninsured services is not new, but more doctors are now doing it.

"It's becoming more and more common the phenomenon of block fees, and there is nothing illegal about it," said Dr. Danyaal Raza, a family physician at Toronto’s St. Michael’s Hospital, and an Associate Professor with the University of Toronto’s department of Family and Community Medicine.

He says he does not charge uninsured services fees, but he is in the minority.

Dr. Raza was part of a study in 2020 that found one in five Ontario family doctors surveyed offered patients the option of either paying a block fee or paying à la carte, while almost three in five charged on a case-by-case basis.

Only 11 per cent of Ontario doctors charged no fees at all for uninsured services.

The average annual block fee rate was $106 per individual and $194 per family.

Dr. Raza said it’s important to note that “doctors cannot refuse to look after you for something that is publicly covered or insured if you decide not to pay block fees."

“OHIP pays physicians for most medical services delivered to patients. Services not covered by OHIP or another insurance plan are called uninsured services. Government regulations have for a long time allowed doctors to charge patients reasonable fees for uninsured services,” the Ontario Medical Association (OMA) told CTV News Toronto in a statement.

“Common uninsured services include writing sick notes, printing or copying medical records, missed appointments, providing a prescription without also providing an associated insured service, and issuing certificates related to disability insurance, for tax credit, or other reasons.”

A spokesperson for the Deputy Premier and Minister of Health, Sylvia Jones, told CTV News Toronto, “It is against the law to charge for OHIP-covered services. If the ministry finds that a person has paid for an insured service or some component of an insured service, there is a mechanism in place for the ministry to ensure that the full amount of the payment is returned to that person. Ontarians who believe they have been charged for an insured service should contact the ministry by e-mail at [e-mail] or by phone (toll-free) at 1-888-662-6613.”

On Wednesday, Ontario Premier Doug Ford said he doesn’t want patients paying out of pocket for medical expenses.

“We also need to be clear, Ontarians will always access the healthcare they need with their OHIP card, never their credit card,” said Ford.

The OMA said fees are at the physician's discretion and said they should consider the complexity of the medical issue and how much time is spent on it. They add that a doctor should also think about a patient’s financial means, and consider reducing or waiving a charge if it places an unreasonable financial strain on the patient.