Amid continuing concerns about fees for routine diagnostic medical tests in Ontario, a hospital network has instructed patients to perform a variety of tests – ranging from sexually transmitted diseases to cancer screening to select blood tests – under certain circumstances for at least five years.
The fee charts received by CP24 from the Gray Bruce Health Services Hospital Network in the Owen Sound area show that between 2017 and 2021, a number of diagnostic tests were paid for out of pocket by the patient or his private insurer, if targeted. to the hospital for a test by their family doctor.
During these four years, fee guides have shown that the number of tests that require private payment in the hospital network has varied between 160 and 170 of the tests listed, and the cost of some has risen.
One test, Septin9, is a blood-based DNA test used to screen men for colorectal cancer.
In 2017 it is not specified in the document.
Four years later, it was listed for $ 199.
Gray Bruce Health Services spokeswoman Mary Margaret Crapper said that if a patient is admitted to an inpatient or outpatient setting at one of his six facilities, no fees apply.
“However, if your family doctor recommends you for one of these tests, then you will be charged based on the prices in the documents you sent me. These prices are determined by the referral laboratories that we use to conduct the tests, “she told CP24. “There are no private laboratories in our smaller rural hospitals, so we take the blood and send it to a private laboratory so that our patients do not travel. And for those tests that are not covered by OHIP, there is a fee.
Other tests detailed in the manuals include the PCR test for herpes simplex, used to detect the presence of herpes simplex virus 1 or 2.
In 2017, it was not mentioned in the manual as a test requiring private payment.
In 2021, it costs $ 160.
Asked specifically about fee guides, the Ontario Department of Health said that the Gray Bruce Hospital Network is responsible for covering the cost of testing through the budget it receives from Ontario Health.
“According to the ministry’s funding model, hospitals (eg Gray Bruce Health Services) are financially responsible for providing laboratory services to their registered / outpatients within their global budget, this includes laboratory services recommended to other laboratories. To this end, hospitals are allowed to refer non-hospital patients (ie community patients) to community laboratories, “said a spokesman for CP24.
In addition, the PCR test for herpes simplex is said to be covered by OHIP when performed in one of 11 public health laboratories in Ontario.
Another blood test described in detail in the fee guides is the Wafarin (Coumadin) test, used to assess the effectiveness of the medicine in thinning the blood in preventing blood clots.
In the 2017 fee guide, it cost $ 30. The guide for 2021 costs $ 101.
The Gray Bruce Fee Guidelines also describe in detail the new fees for the selection of prenatal tests used to determine the presence of certain birth defects.
The 2021 edition of the guide, but not in 2017, includes the MaterniT and Harmony prenatal tests (NIPT).
Their price ranges from $ 495 to $ 795.
A spokesman for the Ministry of Health said they should be covered by OHIP, but only under certain circumstances.
They said any pregnancy involving twins, a mother who will be 40 or older at the time of birth, or any mother with a history of previous genetic risk will have OHIP-covered tests.
One ibuprofen sensitivity test was not included in the 2021 version of the GBHS Fee Guide, but was included in the 2017 edition.
That cost $ 42 in 2017.
Crapper said the hospital wants its patients to be aware of the circumstances in which tests must be paid for out of pocket.
“This is public information and we need patients to understand that not all laboratory tests are covered by OHIP,” she said.
CP24 has received numerous reports from across Ontario for patients who have to pay out of pocket for diagnostic tests that were until recently covered by OHIP.
The Ministry of Health categorically denied that any changes had been made in the coverage of OHIP diagnostic tests, when asked on Monday by CTV News Toronto.
“There have been no changes to the tests covered by the Ontario Health Insurance Plan (OHIP) Schedule of Compensation-Laboratory Services (SOB-LS), which may have led to patient billing,” a spokesman said. “There are certain criteria that must be met to cover these services. For example, the SOB-LS lists the specific tests that qualify for OHIP coverage in a community setting (ie outpatient) from those providers and may include specific eligibility criteria for the test.
Perry Brodkin, a lawyer and former OHIP employee for two decades, told him that collecting Gray Bruce fees from health services for certain tests was not allowed under Ontario law under certain circumstances.
“I don’t think they are filling in anything, I know that (GBHS) doesn’t know the law because no one knows the law – but who else knows the law – probably the civil servants in the Ministry of Health know this law. ”
He said Gray Bruce patients should be reimbursed for all the money they paid.
“GBHS must return all these payments to patients for the last five years. But will the ministry order them to do that? ”
Crapper forwarded to the Ministry of Health any inquiries as to whether GBHS was following the province’s guidelines.
As for social media reports about what is happening in other jurisdictions, Brodkin says patients should consult their family doctor.
For its part, the Ontario Health Coalition told CTV News Toronto that it is tracking patients who have paid out of pocket for diagnostic tests that they believe need to be confirmed, but have yet to come across cases that have recently have been removed from OHIP coating.
“All I can say is that if you’ve been charged for Lifelabs or Dynacare for a diagnostic test, just contact your doctor because you no longer have a request,” Brodkin said.
If someone is charged for a test at a public hospital, Brodkin says he should contact the patient ombudsman.
In a statement Monday, the health ministry also noted that “the Medicare Commitment to the Future Act (CFMA) prohibits fees from any person or entity for insurance services or access to insured services.”
The ministry said that if the patient believes he has been charged for a service that is insured, he can call the CFMA program report line at 1-888-662-6613 or send an email to protectpublichealthcare@ontario.ca.
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