After a newborn passed away at a hospital near Toronto, Dr. Jane Healey encountered a tough decision when the OHIP claim was denied. She had to choose between sacrificing her payment or requesting the grieving parents to handle the matter at Service Ontario. The infant succumbed to a genetic ailment after 10 days, as explained by Healey, who opted not to trouble the family.
Healey highlighted that many physicians face similar challenges with OHIP billing, which has become a contentious issue in their negotiations for a new compensation agreement with the province. Despite Health Minister Sylvia Jones’s spokesperson, Ema Popovic, mentioning that the majority of claims are automatically processed, there are still approximately 1.16 million rejected claims each year out of over 200 million processed claims.
As the Section Chair of Pediatrics at the Ontario Medical Association (OMA), Healey noted instances where complex procedures, like limb reattachment surgeries involving multiple physicians, lead to unresolved OHIP billings. OMA President Dr. Zainab Abdurrahman expressed concern that such complexities could deter doctors from engaging in advanced medical procedures, hindering innovation within the province.
In response to the challenges faced by physicians, an arbitrator recently instructed both the province and the OMA to find solutions regarding good-faith payments and the manual review process for intricate OHIP billings. The OMA is advocating for the reintroduction of the good-faith payment system to enable doctors to invoice for patients without valid health cards, such as newborns and critically ill uninsured individuals.
Regarding the manual review process, which physicians assert can be lengthy and cumbersome for complex OHIP invoices, the OMA is proposing the establishment of an OHIP ombudsman office staffed with clinical experts. The ministry assured that the majority of cases are resolved within 30 days, with the option for doctors to appeal outcomes.
While the government is implementing measures to streamline administrative tasks for doctors, discussions with the OMA continue to modernize the billing system further. If an agreement is not reached by the new year, both parties may revert to arbitration, according to the arbitration award document.
