Private clinics ripping off the public – OHC’s evidence

Continued from the main post.

EvMedicare-privatization-FIidence

Results of Telephone Interviews with Independent Health Facilities, Private Clinics and Private Hospitals

March 2014

Eye Surgery Clinics

Kensington Eye Institute

Toronto

Services: cataract surgery

Referral needed: “we have a roster of 50 doctors that can give you a referral” – relationship between referring physicians and Kensington Eye Institute unclear.

OHIP card needed: yes

Extra charges: yes, for the assessment, an enhanced lens and administrative fee

Ottawa Eye Associates

Ottawa

Services: eye surgery

Referral needed: yes

OHIP card needed: yes

Extra charges: $190 plus $200 – $500 for tests and “upgraded lens”, and $1000 to jump the queue.

Description of the services subject to extra charges: “upgraded lens”, “better lenses”

Q: Apart from bringing your OHIP card, do you charge any other fees?

A: Measurements would have to be taken for your lens size. Those measurements could cost depending on what you decide. There’s an A scan that gives you measurements for the lens that is covered by OHIP and then there’s a test called the IOL Master that’s a private exam which costs $190. They both tell you what size lens would go in the eye, but there are also choices in lenses now, so you can upgrade your lens and pay by yourself or you can go for the standard lens that is covered by OHIP. So it is possible to not have very many fees if you opt for the standard stuff that OHIP offers, but if you do decide to upgrade and have better lenses implanted then you come into higher costs.

Q: How much do upgraded lenses cost usually?

A: They’re anywhere between $200 and $500 for one eye, depending on what type of lens you pick.

Q: When are you booking surgeries for?

A: Six months until the surgery. It depends though, some doctors will do it privately, so if patients want to move up and have it quicker they can do it at a clinic where it’s privately billed. Some doctors also work at the General, and some patients opt to go to the General because the waiting lists aren’t as long.

Q: How much would it cost to do it privately?

A: Not sure, but I think $1,000 per eye, I would have to check. 12

Dr. Cynthia Bullen Kesty North Bay

Services: eye surgery

Referral needed: yes

OHIP card needed: yes

Extra charges: $200 for measurement plus $200 for HRT scan

Description of the services subject to user charges: the “upgraded” lens was described as optional but the measurement and HRT scan for which the clinic charges patients were not.

Q: Do you offer cataract surgery?

A: Yes, we do.

Q: How can I get an appointment?

A: You need a referral from your family doctor or your optometrist.

Q: How long are the wait times?

A: We book the consultation four months after receiving the referral.

Q: What about the surgery?

A: Usually two weeks within the consultation.

Q: I know OHIP covers the surgery but are there any other additional fees/charges?

A: There’s a fee for the measurement which is $200 per eye, which is not covered by OHIP. And if the doctor requests a HRT scan, then that too, which costs $200.

Q: I know some places offer upgraded lenses, do you as well?

A: We do offer that but it’s optional. The measurements are required but these upgraded lenses are optional.

Dr. Jon Spencer

North Bay

Services: eye surgery

OHIP card needed: yes

Extra charges: $100 per eye.

Q: Are there any extra fees for the surgery?

A: Yes, the measurements for the implants that are not covered by OHIP.

Q: How much would those cost?

A: $100 per eye.

Custom Vision & Cosmetic Centre

Oshawa

Services: eye surgery

Referral needed: yes

OHIP card needed yes

Extra charges: $250 for both eyes

Description of the services subject to user charges: “enhanced” measurements

Q: Are there any other costs for the surgery?

A: The surgery cost is covered by OHIP but there are enhanced measurements that can be taken for $250 for both eyes, but these are optional. 13

Ottawa Eye Clinic

Ottawa

Services: eye surgery

Referral needed: yes

OHIP card needed: yes

Extra charges: $300 for tests, $300 – $500 per eye for “premium” lenses

Q: Are there any other extra fees?

A: The basic surgery is covered by OHIP but there is the option of getting a premium lens which gives better night vision and better correction for stigmatism. These premium lenses require two additional tests for $300, and the lenses themselves cost between $300 to $500 per eye.

Eye MD Institute

Brampton

Services: eye surgery

Referral needed: yes

OHIP card needed: yes

Extra charges: $150 per eye for tests plus “upgraded” lenses, plus possible private-pay surgery

Description of the services subject to user charges:

A: There are some upgraded tests that are not covered by OHIP.

Q: Are these tests standard or optional?

A: They are optional. Standard tests that are covered by OHIP are also available.

Q: Do you know how much the upgraded tests cost roughly?

A: $150 per eye.

Q: What’s the difference between the standard and upgraded testing?

A: Upgraded tests allow more accurate way of testing for the intraocular lens we would put in the eye.

Q: Do you also offer upgraded lens?

A: Yes, those would also cost extra.

Q: Do you know how much those cost?

A: No.

Q: Is there any way for me to pay privately to be bumped up the wait list?

A: Depends on which doctor you see because some doctors work at private clinics and some don’t. Doctors who work at private clinics can get you in faster.

Q: Do any of your doctors perform cataract surgery privately?

A: Yes.

Q: And if they are doing the surgery privately do you still need my OHIP card?

A: Yes. It’s just that you would need to pay the private clinics.

Q: Do you happen to know how much it costs?

A: Anywhere between $200 to $900 per eye just for the lens, and then the measurements costs would be different. 14

Dr. Robert H. Singer

Burlington

Services: eye surgery

Referral needed: yes

OHIP card needed: $225 for two eyes for measurements.

Extra fees: yes

Q: Are there any other fees?

A: Yes but we discuss that in the consultation because there are different types of measurements that are and are not covered from OHIP, depending on what you choose.

Q: How much do the measurements that are not covered by OHIP cost roughly?

A: $225 for two eyes.

.

Dr. Delan Jinapriya

Kingston Services: eye surgery

Referral needed: yes

OHIP card needed: yes

Extra fees: $100 per eye mandatory measurement fee. Lens fee $125 per eye plus.

Q: Are there any other fees with the surgery?

A: The measurement for the lenses is $100 per eye and if you decide to go with a specialty lens that’s an additional cost as well but there are standard OHIP-covered lenses too. So regardless, you would have to pay the measurement fees but the lens fee is optional.

Q: Roughly how much would the lens fee be?

A: $125 per lens for the cheapest ones, and then from there the smaller lenses become more expensive.

.

Hugh G. Jellie

Kitchener

Services: eye surgery

Referral needed: yes

OHIP card needed: yes

Extra charges: $100 for laser-measurement, additional charges for “upgraded” lenses

Description of the services subject to user charges: OHIP method termed “old method”

Q: Are there any extra fees for cataract surgery?

A: Cataract surgery and the appointments associated with it are all OHIP-covered but there is a new laser-measurement test that allows us to measure the lens of the eye that costs $100 per eye. There is also an old method by ultrasound which is OHIP-covered, so it depends on which method of measurement you choose.

Q: Do you also offer upgraded lenses?

A: Yes but the doctor will determine if those are required or not.

Q: What is the price range for these upgraded lenses?

A: Couple of hundred dollars. 15

Dr. Edward Mednick

Etobicoke

Services: ophthalmic ultrasound, cataract surgery

Referral needed: yes

OHIP card needed: yes

Extra-charges: “power lens” costs $200

Description of the services subject to extra charges: it is a “better lens”, referred to as “power lens”

Credit Valley Eye Care

3200 Erin Mills Pky, Mississauga, ON, L5L 1W8

Services: ophthalmologist, eye surgery

Referral needed: yes

OHIP card needed: yes

Extra-charges: yes, would not specify costs

A. We cannot say if there are extra charges, unless we see a referral. If the doctor requests additional or specific tests so he could have specific details, then patients could be charged.

Q: When would I find out if I need additional tests?

A: The additional testing required will be discussed with patients and the patients will be

aware if they need it or not. Ultimately it is the patient’s choice. They can decline and the doctor will continue with the treatments that are covered by OHIP.

North Toronto Eye Care

2115 Finch Avenue West Suit 407, Downsview, ON M3N 2V6

Services: ophthalmologist ultrasound

Referral needed: yes

OHIP card needed: yes

Extra charges: $100 – $250

Q: Would there be any tests that would be done before the procedure?

A: 2 tests are done

Q: Are they not covered by OHIP?

A: They are not covered by OHIP. But the consultation is covered.

Q: How much are these tests?

A: One cost $150 for pentacam; and $100 for an OPD test for a total of $250

Q: Are these necessary tests to get done?

A: If the ophthalmologist who is doing the surgery thinks these tests are necessary, then we do the tests.

Q: Do you do these tests for every patient?

A: We do these tests for almost all the patients. 16

Jarvis-Smythe Ophthalmologist

2917 Bloor Street West, Suite 8- Kingsway Medical Centre, Etobicoke, ON

Services: ophthalmologic ultrasound

Referral needed: yes

OHIP card needed: yes

Q: Would I come in for a consultation first, and have additional testing done?

A: Yes.

Q: Is that covered by OHIP?

A: Yes, the consultation and testing is covered by OHIP.

Q: Is the cataract surgery also covered?

A: Yes.

Q: Does the cataract surgery take place at the clinic?

A: The doctor who works at the clinic does the surgery, but the surgery and ultrasound are done at the hospital and not at the clinic.

Q: So there would be no additional fees? Everything will be covered by OHIP?

A: There are no fees, and everything is covered.

Dr. Orset W. Kkrypuch

Brantford

Services: eye surgery

Referral needed: yes

OHIP card needed: yes

Q: Can I pay for it?

A: No, we’re not allowed to do that at the hospital.

Q: Do you do your surgeries at the hospital?

A: Yes.

Thomsen Medicine Professional Corporation

Brantford

Services: cataract surgery and corneal transplants

Referral: yes

OHIP card needed: yes

Extra charges: no

Mark V. Neufeld Medicine Professional Corporation Guelph

Services: eye surgery

Referral needed: yes

OHIP card needed: yes

Extra fees: $200 for laser measurement.

Description of services subject to extra fees: laser measurement is “more accurate”.

Q. Are there any other fees?

A. Not unless you get a laser measurement it’s an extra $200 but it’s optional. We do ultrasound measurements, however some people prefer to have a laser measurement because it is more accurate. 17

Dr. David M. Anderson

Cambridge

Services: eye surgery

Referral needed: yes

OHIP card needed: yes

Extra fees: no

Bochner Eye Institute

Scarborough

Services: cataract consultation; Lasik surgery

Referral needed: yes

OHIP card needed: yes

Extra fees: $3,500 + per eye

Q. Do I have to bring my OHIP card or can I just pay for it?

A. Yes you have to bring your OHIP card because the consultation is covered. But the implant lens is what costs money.

Q. How much?

A. $3,500 and up per eye. There is a basic lens that OHIP covers, but because of new technology and design you can pay to get the better lens.

Q. Is that recommended?

A. Yes, the doctor will go through the options based on your lifestyle.

TLC Laser Eye Center

London

Services: provides cataract and Lasik surgery

Referral needed: no

OHIP card needed: yes

Extra charges: wouldn’t say

Q: Hi, I am just calling to find out some information about eye surgery. How would I be able to access the service?

A: First you will need to come in for a consultation.

Q: Would I need a referral from my doctor?

A: No referral from your doctor is needed

Q: Would the tests that will take place during the consultation cost anything?

A: The tests are free, but you would have to pay for the Lasik surgery.

Q: How much would the surgery cost?

A: You would first need to go to the consultation because the doctors’ deal with the pricing as there might be a promotion.

Q: Would you know the average price of the surgery that you charge?

A: You would need to speak to the doctors.

Q: How about for cataract surgery, would the same process apply?

A: No, for cataract surgery you would need to contact Dr. Nichols’ office at St. Joseph’s Hospital. They deal with cataracts and they would let you know whether to operate at the hospital or at the clinic, but you would first need to call them to find out more about it.

The researcher then called the doctor’s office at the hospital as follows: 18

Dr. Nichol’s office at St. Joseph’s Hospital, London

Q: Calling to find out more information about cataract surgery. Do you specialize in cataract surgery?

A: Yes we do. It depends on what you are looking to get done. We have different surgical options and methods which would require different lens. When you come for a consultation, we would be able to determine the types of lens and surgery you would require.

Q: Would I first need a referral before I can get the test done?

A: First get a referral before anything.

Q: Where would the surgery take place? Would it take place at St. Joseph’s Hospital?

A: The surgery would take place at TLC Laser Eye Centre.

Q: Would it be different if I got it done at the hospital (St. Joseph’s)?

A: It would be. At the TLC, you would be able to get better outcomes as there is more diagnostic testing and more preventative tests that can take place after you get the cataract surgery. At the hospital you are just getting the standard medically necessary procedure that would be covered by OHIP.

Q: At the clinic it would be a better option?

A: Yes because there are more tests that are done and better outcomes.

Q: How much would the surgery at the clinic cost?

A: There are different surgical options but on average it costs $1500/eye and it goes up from there.

Q: Would there be additional fees?

A: Depends on what is needed.

Cataract MD/Lasik MD

Mississauga

Services: cataract Surgery

Referral needed: yes

OHIP card needed: yes

Extra charges: $2,390 – $3,490 per eye.

Q: Would the test I need to get done be free?

A: The test that you would need would be free.

Q: Would it cost anything to get the cataract surgery done?

A: Do you live in Ontario?

Q: Yes.

A: The two places where the surgery takes place is in Mississauga and Ottawa.

Q: How much would the surgery cost?

A: On average we charge $2,390-3,490 per eye. We also correct your vision during the consultation, all at the same time.

Q: So the surgery would not be covered by OHIP?

A: Nothing is covered by the public health care system because this is a private clinic. But we charge no tax. 19

Herzig Eye Institute

Toronto

Services: cataract surgery

Referral needed: no

OHIP card needed: yes

Extra charges: approx. $1,500

Description of services subject to extra charges: faster, “special” lens.

Q: Do you do cataract surgery?

A: Yes.

Q: Would I need a referral?

A: You would need to first get a referral for your family doctor/optometrist

Q: What if I do not have a family doctor or optometrist?

A: That is okay, you don’t need one.

Q: Would I be able to just book a consultation?

A: Yes, you do not really need a referral.

Q: Okay, and would I need to first come for a consultation?

A: Yes, you would come to a consultation that is free and approximately 3 hours.

Q: Would the tests that take place during the consultation be covered by OHIP?

A: Yes, those tests would be covered by OHIP

Q: Would the cataract surgery also be covered?

A: You would have to pay approximately $1,500 for the surgery.

Q: Oh okay, so I would be able to get the service quicker if I paid the $1,500?

A: Yes it would be faster, because our services are different than in the hospital.

Q: How is it different than the hospital?

A: At our clinic, we have special lens and we run our own tests.

Osler Eye Care

Brampton

Services: cataract surgery

Referral needed: yes

OHIP card needed: Our first researcher who called was told yes but when we called back to clarify whether or not this clinic is selling surgeries to OHIP-covered residents our researcher was told that she does not need an OHIP card if they do the procedure in the private clinic.

Extra charges: $3,000 – $5,000

Q: I’m wondering if you offer cataract surgery?

A: We do, to get a consultation you would have to get a referral from your family doctor and have it faxed in which would be reviewed and then we get back to you with an appointment time.

Q: Is there a way to do it without a referral?

A: No, you would need a referral. You could get the referral from a walk-in clinic if you don’t have a family doctor but you would need to get it somehow since this is a referral-based clinic.

Q: Would I also need an OHIP card?

A: Yes, but you could pay if you don’t have an OHIP card.

Q: How much would you charge for that?

A: To see one of the surgeon specialists, it would be $300. 20

Q: And how much for the actual surgery?

A: The surgeons would discuss that with you.

Q: Can you give me a rough estimate now?

A: $3000 to $9000, it depends.

Q: Does that cover everything? Is there any other fees?

A: Yes it covers everything, no others fees are required.

Q: But that’s only if I don’t have an OHIP card right?

A: Yes that’s right.

2nd call by researcher:

Q. Can I pay for the surgery even though I have OHIP. I just want to get it faster.

A. Our doctors will do private surgery but they do it from another clinic. You get the referral here and the doctors will transfer you over to the other clinic.

Q. How much does it cost?

A. The doctor will tell you how much it costs. They will discuss the testing that is needed and all that information. The price range is $3,000 – $5,000 or more, it’s all determined by a doctor, depends on how advanced the cataracts are. Dr. Varma is booking now. He works out of the TLC clinic.

Q. Do I just go straight to TLC?

A. I don’t know, you have to call TLC (gave the phone number of the TLC clinic in Mississauga).

The researcher then called the TLC clinic in Mississauga below:

TLC Clinic

Mississauga

Q. I spoke with a woman at the Osler Clinic and the woman there mentioned that I could pay and get cataract surgery done faster. Do I need to go through them with the referral or can I just book an appointment directly with TLC? She mentioned that Dr. Varma is taking patients.

A. Yes, have you seen Dr. Varma before?

Q. No I haven’t. How much would it cost for the procedure?

A. You will pay between $1,500 and $3,000 per eye.

Q. Do I go to Osler or how do I get this?

A. You will have to get the referral sent to their office [Osler] and on the referral you can indicate that you want “TLC immediately” and they will forward that to us.

MRI Clinics

Lifelabs

300 Harwood Avenue South, Ajax, ON, L1S 2J1

Services: MRI

Referral needed: yes

OHIP card needed: yes

Extra charges: no 21

KMH Cardiology & Diagnostic Centres Inc.

Kitchener

Services: MRI and an array of other diagnostic tests

Referral needed: yes

OHIP card needed: yes but the clinic also sells MRIs that are not covered by OHIP (medically unnecessary)

Extra charges: the clinic sells MRIs that are not covered by OHIP (medically unnecessary)

Kingston MRI

Kingston

Services: MRI

Referral needed: yes

OHIP card needed: yes

Extra charges: no

Q: Are there any user fees attached to this process?

A: It is covered by OHIP you cannot pay for an MRI scan in the province of Ontario if you’re a permanent resident.

KMH Cardiology and Diagnostic Centre

Mississauga

Services: MRI and other diagnostics

Referral needed: yes

OHIP card needed: yes

Extra charges: no.

MyHealth Centre

London

Services: physiotherapy, CT and MRI

Referral needed: yes

OHIP card needed: yes

Extra charges: no 22

Colonoscopy/Endoscopy Clinics

Durham Endo Surgery Centre

Ajax

Services: colonoscopies

Referral needed: yes

OHIP card needed: yes

Extra charges: $50” administration” fee

Q: Would there be any additional fees?

A: There is a $50 administration fee that you would be given a receipt for that you can bring to your insurance company.

Q: What would the $50 cover?

A: It includes a CD for your doctor, different supplies the physician will need for the procedure, reports for your family physician and a snack.

Cleveland Clinic Canada

Toronto

Services: colonoscopy

Referral: yes

OHIP: yes

Extra charges: OHIP covers the colonoscopy. We do have a block fee that is $250 that is optional and it covers things that OHIP doesn’t cover.

The Medcan Clinic

Toronto

Services: range of services, also colonoscopies

Referral needed: Need to see MedCan doctor to be referred to colonoscopy suite.

OHIP card needed: yes.

Additional fees: Either $895 annual membership fee, or $2,595 standard initial comprehensive health assessment. Then $745 to use colonoscopy suite.

Taunton Surgical Centre

Services: range of services, also colonoscopies and endoscopies

Referral needed: yes

OHIP card needed: yes

Extra charges: our researcher called about a colonoscopy. She asked if there are other fees. The employee at the clinic informed her that they requested a block fee which the doctor will discuss at the appointment when he sees you. It is $60 for one year. 23

Private Hospitals

Shouldice Hospital

Thornhill

Services: hernia operations

Referral: Apparently there is self-referral: this is what the hospital told our researchers: “It is best to have a referral because you can go straight to a surgeon. If don’t have a referral, it’s okay, but you will probably need to see a GP first.”

OHIP card needed: yes

Extra charges: $250 per day for 3 – 4 days = approx.. $1,000

Q: Would there be any additional costs?

A: There is a cost for semi-private rooms and they only have semi-private rooms; $250 per day; keep you for 3-4 days.

Q: Is there a difference if it is done at your hospital compared to at a general hospital/why need to stay 3 – 4 days?

A: The reason was because procedure is different and don’t use “mesh” that is regularly used in hospital procedures. Mesh is very uncomfortable for patients and they use something different, therefore the recovery time is longer.

Centric Health/Don Mills Surgical Unit

Toronto

Services: surgeries, including cataracts

Referral needed: yes

OHIP card needed: yes

Extra charges: “depends what the ophthalmologist what they see on your eyes, what lens will work for your eyes”

Additional Fees: If you need upgraded lenses, there is an upcharge (would not disclose how much upcharge would be without a consultation).

“Boutique” Physician Clinics

La Vie Executive Health Centre

Ottawa

Services: Physicians, comprehensive health assessments

Referral needed: no

OHIP card needed: yes for some services

Extra charges: $2,000+: $2000 for comprehensive health assessment; concierge services: $125/month or $250/month for husbands, wives, children under 25 years.

Q: I was just calling to find out some information about your comprehensive health assessment. How much would it cost?

A: The comprehensive health assessment would cost $2000

Q: Would I be able to make an appointment to see a doctor?

A: No, our roaster is full.

Q: How would I be able to make an appointment? 24

A: We don’t have direct access to a family doctor at the clinic; you can only access a doctor from undergoing a comprehensive health assessment.

Q: But I would first have to pay the cost of a comprehensive assessment before I would be able to see a doctor?

A: Yes.

Q: Would any tests done during the comprehensive assessment be covered by OHIP?

A: We divert blood work, but for digital imaging we bill OHIP for those services.

Q: Are there any extra costs that I would have to pay to access other services?

A: There is concierge services, where there are unlimited access to the clinic, emergency treatment within 24 hours, and prescription over the phone, etc.

Q: How much would this cost?

A: All for $125/month and for husbands, wives, and children under the age of 25 years old it cost $250/month

Scienta Health Centre

North York

Services: Physicians, preventative medicine

OHIP card needed: no

Extra charges: yes – would not say how much

Q: I am just calling to find out about your clinic and the executive health program. Is it covered by OHIP?

A: Nothing is covered by OHIP.

Q: Okay, so I would pay out of pocket for the services?

A: If you have money, you pay for it, nothing is covered under OHIP.

Regal Health Services

Toronto

Services: physicians, comprehensive health assessment

Referral needed: no

OHIP card needed: OHIP may cove parts of the comprehensive health assessment, including blood work and imaging.

Extra charges: $3,300 annual fee

Q. Do I have to pay the fee to see the doctor or can I use my OHIP card?

A. You have to pay the fee because we’re a private clinic.

The Medcan Clinic

Toronto

Services: physicians, comprehensive health assessments.

Referral needed: no

Extra fees: $2,595 per year plus

What happened when called?

Q: I’m calling to find out information about the comprehensive health assessment at your clinic. What does it include?

A: The comprehensive health assessment is the main service. It is for 5 hrs and it takes place within that time, they do all the blood work you need, 12-15 diagnostic tests, and you get same day results. 25

Q: How much would this cost?

A: It is all for $2,595/year, this is tax deductable.

Q: Would there be any additional prices I would have to pay after the $2595/year for the assessment?

A: After the comprehensive health assessment depending on our need, we might have to pay $495 dollars, if we want to follow up with a family doctor at their clinic.

Q: And would you know approximately how much everything would cost in total?

A: The entire cost would come up to $3,100

A second researcher called to clarify whether or not it is possible to see a doctor at this clinic without being subjected to extra fees:

Q. Can I see a doctor without paying? Can I get it covered by OHIP?

A. No, you are paying the fee for our services and support, this is a private clinic.

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