As Ontario prepares to increase the number of private clinics performing publicly funded cataract surgeries, documents show that these procedures represent one of the most common complaints the province receives from patients about unfair billing practices.

Canadian press submitted a freedom of information request to obtain copies of complaints filed under the law that prohibits medical professionals from charging patients for services covered by Ontario’s health insurance plan.

Between 2020 and 2022, there were 68 complaints, 15 of which related to eye examination fees and 13 to cataract procedures, with other complaints including a range of medical procedures such as blood tests and prenatal tests.

While the absolute numbers are relatively small, New Democratic Party health critic France Gélinas said the actual number of patients experiencing similar complaints is likely much higher because many people do not know how to follow up with the process.

The ministry’s response to many patients who complained about cataract surgery fees was to tell them that records showed they had already agreed to pay for uninsured services.

In response to someone who complained about paying $2,400 for “cataract removal with eye implant service covered by the Ministry of Health,” the ministry wrote that records showed the patient agreed to uninsured add-ons. They received a $200 credit for the medically necessary lens cost, but the premium lens they received had to be paid for out of pocket.

The ministry told the patient: “According to the records provided, you agreed to pay for and receive these services.”

“The Commitment to the Future of Medicare Act does not apply to uninsured services, and any costs associated with these services are the responsibility of the patient.”

Gélinas said such examples show that patients undergoing publicly funded surgeries in private clinics are increasingly being sold to and are not always clear about the fees they will have to pay out of pocket.

“If people go through the process of finding the number they can call [to complain], or leave a message, or wait three weeks for someone to call them back, or wait another three months before they can conduct their investigation to get an answer they said: ‘You did not have consent.’

“That is not consent. We are talking about people with vision impairment – which is why they are going for cataract surgery – who are mostly somewhat elderly, and that is not informed consent.”

Expansion of private clinics is coming

Liberal health critic Adal Shamji said there is a “significant power imbalance” between doctors and patients that can lead people to accept doctors’ recommendations on certain procedures or special lenses without fully realizing the additional cost.

Shamji, who is a doctor himself, wrote in a statement: “In the medical environment, doctors have access to all kinds of information that patients do not have access to.”

“When you mix that with shareholder pressures and incentives to maximize profits, you make patients feel pressured to receive uninsured services without truly informed consent.”

The New Democrats, Liberals, and Green Party have raised concerns that the government’s expansion to allow private clinics to perform publicly funded procedures will only increase patient vulnerability.

The Progressive Conservative government is preparing the next step in expanding the number of private clinics offering publicly funded tests and procedures such as cataract surgeries and MRI scans, along with adding hip and knee replacement surgeries.

Health Minister Sylvia Jones said the expansion will allow more procedures to be carried out and reduce wait times, and patients will never have to pay out of pocket for OHIP-covered services.

Her spokesperson said the law enabling this expansion also places new clinics under the oversight of the patient ombudsman and ensures that access to publicly funded services cannot be conditioned on the patient agreeing to an additional uninsured service. The Canadian Accreditation Body has been chosen to develop an enhanced oversight and quality assurance program for those clinics.

The government provided the amounts reimbursed over several years to patients who complained under the Commitment to the Future of Medicare Act. Between 2019-20 and 2021-22, those amounts were approximately $21,790, $3,527, and $18,723.

Many of those complaints relate to clinics, but some others include hospitals and laboratories.

There are currently more than 900 private health facilities in the province, largely providing diagnostic imaging services.