Amid continuing concerns about fees for routine diagnostic medical tests in Ontario, a hospital network has charged patients for a range of different tests, ranging from STDs to cancer screening to blood tests. selected, under certain circumstances for at least five years.
Tariff guidelines obtained by CP24 from the Gray Bruce Health Services hospital network in the Owen Sound area show that between 2017 and 2021, the patient or their private insurer paid for a series of out-of-pocket diagnostic tests. if they were referred to the hospital by a test from their GP.
Over the past four years, rate guides show that the number of tests requiring private payment in the hospital network has fluctuated between 160 and 170 listed tests, and the costs for some have skyrocketed.
One test, Septin9, is a blood-based DNA test used to detect colorectal cancer in men.
In 2017, it was not included in the document.
Four years later, it came out on the list, costing $ 199.
Gray Bruce Health Services spokeswoman Mary Margaret Crapper says if a patient is admitted as an inpatient or outpatient at one of their six facilities, the charges do not apply.
“However, if your GP referred you for one of these tests, you will be charged based on the prices of the documents you have sent me. These prices are set by the reference laboratories we use to carry. perform the tests, “he told CP24. “In our smaller rural hospitals, there are no private laboratories, so we extract the blood and send it to a private laboratory so that our patients do not have to travel. And for those tests not covered by the OHIP, there are a fee “.
Other tests detailed in the guidelines include the Herpes Simplex PCR test, which is used to detect the presence of Herpes Simplex virus 1 or 2.
In 2017 it was not listed in the guide as proof that it required private payment.
In 2021 it cost $ 160.
Asked specifically about rate guidelines, the Ontario Ministry of Health said Gray Bruce’s 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 (e.g. Gray Bruce’s health services) are financially responsible for providing laboratory services for their outpatients registered with their overall budget, this includes services “For this purpose, hospitals can refer non-hospital patients (ie community patients) to community laboratories,” a spokesman told CP24.
He also said the Herpes Simplex PCR test is covered through OHIP when performed in one of 11 laboratories belonging to Public Health Ontario.
Another blood test detailed in the tariff guidelines is the Wafarin (Coumadin) test, which is used to assess the performance of an anticoagulant drug in the prevention of blood clots.
In the 2017 rate guide, it cost $ 30. In the 2021 guide, it cost $ 101.
Gray Bruce’s rate guides also detail new charges for a selection of prenatal tests used to determine the presence of certain birth defects.
The 2021 edition of the guide, but not the 2017 edition, includes the MaterniT and Harmony (NIPT) prenatal tests.
Its cost ranges from $ 495 to $ 795.
A spokesman for the Ministry of Health said they should be covered by the OHIP, but only under certain circumstances.
They said any pregnancy that includes twins, a mother who was 40 or older at the time of birth, or any mother with a history of previous genetic risk would have the tests covered by the OHIP.
One test, for ibuprofen sensitivity, was not included in the 2021 version of the GBHS Tariff Guide, but was included in the 2017 edition.
It cost $ 42 in 2017.
Crapper said the hospital wants its patients to be aware of the circumstances under which tests must be paid out of pocket.
“This is public information and we need patients to understand that not all lab tests are covered by OHIP,” he said.
CP24 has received several reports from across Ontario of patients who had to pay out-of-pocket diagnostic tests that until recently were covered by the OHIP.
The Ministry of Health flatly denied that any changes were made to OHIP’s coverage of diagnostic tests when asked by CTV News Toronto on Monday.
“There has been no change in the evidence covered by the Ontario Health Insurance Plan (OHIP) Benefit-Laboratory Services Program (SOB-LS) that may have caused a patient to be charged,” a spokesman said. . “There are criteria that must be met for these services to be covered. For example, the SOB-LS lists the specific tests that are eligible for OHIP coverage in a community setting (i.e., non-hospital ) of designated suppliers, and may also include specific eligibility criteria for the test “.
Perry Brodkin, a lawyer and former OHIP official for two decades, tells him that it appears that the collection of Gray Bruce Health Services fees for certain tests in certain circumstances is not permitted by Ontario law.
“I don’t think they are exhausted, I know that (GBHS) they don’t know the law, because nobody knows the law – but who knows more – presumably the officials of the Ministry of Health know it. ”
He said Gray Bruce patients should be reimbursed for the money they paid.
“GBHS should return all these payments to patients for the last five years. But will the ministry order them to do so?”
Crapper sent any inquiries into whether GBHS complied with provincial guidelines to the Ministry of Health.
As for social media reports on this in other jurisdictions, Brodkin says patients should do so with their GP.
For its part, the Ontario Health Coalition told CTV News Toronto that it has tracked patients who have paid out of pocket for diagnostic tests that they believe should have been confirmed, but which has not yet found cases that have recently been removed from OHIP Coverage.
“All I can say is that if you’ve been billed to Lifelabs or Dynacare for a diagnostic test, contact your doctor, because you no longer have the requisition,” Brodkins said.
If someone is billed for a test performed at a public hospital, Brodkin says he should contact the patient’s advocate.
In its statement on Monday, the Ministry of Health also noted that the “Medicare Future Commitment Act (CFMA) prohibits the charges of any person or entity for insured services or for access to insured services.”
The ministry said that if a patient feels that they have been charged for a service that is insured, they can call the CFMA program reporting line at 1-888-662-6613 or email protectpublichealthcare @ ontario. ca.