Billing for uninsured services and access to primary care highlighted in over 4K complaints to Ontario ombudsman

Ontario’s patient ombudsman received 33 per cent more complaints in 2022-2023 than it did the previous year, a new report has found.

The complaints, detailed in the report released Wednesday morning, reflect concerns about quality of care, billing for uninsured services, and difficulties accessing primary care.

According to Patient Ombudsman Craig Thompson, 4,388 complaints were made between April 2022 and March 2023.

This is roughly 800 more complaints than the previous fiscal year and the highest number of complaints in the office’s history—including the first year of the COVID-19 pandemic.

“What is notable, and troubling, is the significant growth in non-jurisdictional complaints that are mostly related to primary care and echo some all-too-familiar themes: people are having trouble accessing primary care, have limited options for their care, and often have nowhere to turn,” the report says.

• Download our app to get local alerts on your device
• Get the latest local updates right to your inbox

The patient ombudsman’s office works to resolve complaints from patients, residents and caregivers related to hospitals, long-term care and community care in Ontario.

About 50 per cent of the complaints received this fiscal year involved public hospitals. However, the office acknowledges this “is not surprising since significantly more people receive care from hospitals than from the other health sector organizations.”

Seven per cent of complaints involved long-term care, while six per cent were related to home and community care.

Thirty-seven per cent involved other health-care sectors outside of the jurisdiction of the patient ombudsman. This includes primary care and specialized care within practices as well as complaints against the ministries of health and long-term care.

'CLUSTER OF COMPLAINTS' ABOUT HOSPITAL BILLING

The patient ombudsman completed three complaint-based investigations this fiscal year.

One of those investigations responds to “cluster of complaints” regarding billing processes for uninsured patients and services at an Ontario hospital.

The complaints included:

• Charging patients for uninsured services despite patients reporting that they did not understand the forms or were “being asked to sign forms without their glasses.”
• Billing for preferred accommodations despite cancelled requests or when patients would have received the same accommodation without charge had they not signed specific forms
• Charging uninsured patients admitted involuntarily under the Mental Health Act
• Invoices that do not describe the reason for charges

“During the investigation, Patient Ombudsman also became aware of a process for charging patients for in-room telephone service by default unless the patient informed specific hospital staff that the phone service was not required,” the report said.

The ombudsman did not identify the facility related to the complaints.

The report outlines eight recommendations they made to the hospital to ensure uninsured patients are provided with accurate cost breakdowns up front and that this information is communicated in “a plain-language and understandable way.”

The ombudsman also recommended that the hospital “cease the by-default charges for telephones.”

Recent data from the Canadian Institute for Health Information has found that bedsores have risen in recent years. (Pexels)

Another investigation found that a patient was billed a chronic co-payment—a charge to patients staying long-term in hospital while awaiting placement in long-term care—despite being placed in a community facility.

The hospital in question has been asked to review all cases where chronic care co-payment billing occurred over the last five years to “determine whether the patient was correctly identified as meeting the criteria for billing” and reimburse individuals who were incorrectly billed.

The ombudsman also investigated a complaint expressing concerns that a “patient relations process” resulted in the termination of her patient-physician relationship. They recommended the hospital’s policy be updated to ensure patients and caregivers can make complaints “without fear of reprisal.”

MORE THAN 700 COMPLAINTS ABOUT PRIMARY CARE

The report notes that as of March 2022, 2.2 million people didn’t have a family doctor and the Ontario College of Family Physicians estimates that number could grow to three million by 2025.

“More than 100 of the primary care complaints to patient ombudsman were about difficulties patients experienced with walk-in clinics,” the report says.

“The complaints suggest that many people are relying on walk-in clinics in the absence of having stable, timely access to their own family practitioner. Some patients reported that their family physician threatened to de-roster them for visiting walk-in clinics.”

Patients said there were challenges with booking appointments, delays in care, and rude or insensitive communication.

Many of these complaints were referred to the College of Physicians and Surgeons, the ombudsman’s office said.

The report also circles back to what it calls “unresolved issues,” such as the pressures on Ontario emergency departments—a topic that was at the centre of the ombudsman’s 2021-22 report. They said they received 17 per cent more complaints this year about emergency departments, often reflecting delays, poor communication, a lack of sensitivity and worries about the quality of assessments.

“Patients and caregivers frequently cited concerns about emergency department triage processes, and a sense that their symptoms and health concerns weren’t being considered seriously, including reports that they were mocked or yelled at,” the report says.

“Of greatest concern is a growing number of complaints that serious health conditions were not recognized or treated, resulting in patients leaving to seek treatment elsewhere or serious consequences, including patient deaths.”

Among the complaints was that of a whistleblower—a health-care professional who worked in a hospital emergency department who described staffing shortages and delays in care that “resulted in falls and contributed to at least two patient deaths.”

Another patient said they waited in the ER for hours while having a miscarriage. During this experience, the patient said she nearly passed out in the washroom while bleeding. The report said that one clerk allegedly yelled at her while another rolled their eyes.

The ombudsman said the health-care system is still feeling a residual impact from the COVID-19 pandemic, resulting in staffing shortages, service delays and “a deep fatigue.”

The report also notes that the ombudsman’s expanded jurisdiction as a result of the Your Health Act, which allows private surgical and diagnostic centres to conduct more OHIP-covered surgeries, will be taken into consideration in the new year.

The office has been adapting its processes to “support the new services” as well as working with stakeholders.