Tips to help you get compensated fairly for services not covered by OHIP
How much time does it really take to write a quick sick note for a patient?
When peers ask Dr. Ryan Banach that question, he prefers to reframe it entirely.
“Well, let’s talk about how much that really costs us,” the Toronto family physician told a recent webinar for OMA members on uninsured services billing.
With a ballpark five minutes spent per note, and six notes written per day, it adds up to 30 minutes daily – or two full hours of time per four-day workweek.
None of that time is covered by OHIP.
“Would you ask your accountant to work for free for two hours?” Dr. Banach asked. “I don’t think you would.
“We have to respect ourselves. We have to respect our time.”
Yes, billing patients and other third parties directly for services not covered by OHIP can result in some uncomfortable changes and conversations.
But, Dr. Banach advises, you can ease the process by following a few guidelines and lessons he’s learned from 16 years of practising medicine.
Physicians are bound by law and professional ethics to charge patients and third parties reasonable fees for uninsured services and to consider the patient’s ability to pay for them. And some services, such as record-keeping or arranging referrals, are not billable to anyone. Consult the CPSO guidelines for more detail.
The OMA has a comprehensive guide to insured services, updated annually, that provides some recommended reasonable rates. It also has an OMA multiplier to help calculate the value of services not explicitly listed.
These services can include administrative tasks (forms, prescription renewals without a visit), procedures that aren’t medically necessary (travel vaccinations), and medically necessary services for people not covered by OHIP.
If you determine patients are in financial need, you can waive or allow payment in instalments, but Dr. Banach recommends informing them of the service rate so they’re aware of its value.
A quick calculation – based on gross income, number of hours worked and the OMA multiplier – can help you figure out what your rate should be. Knowing that figure, which many doctors underestimate, is critical to developing your thinking around billing, Dr. Banach says.
If you work with other physicians, your colleagues might have different perspectives on what services should be billable and for how much.
A good idea is to start with the billable services and rates everyone agrees on, he says. You can always add things afterward.
Clear communication goes a long way in helping patients understand why you need to charge for certain services.
“We tell them, ‘These things aren’t covered by OHIP. Billing them to OHIP is fraud,’” Dr. Banach explains. “Patients understand, over time.”
Establish clear policies and keep patients informed at every step of the journey to avoid unpleasant surprises. Display your policies prominently on posters around your office (a template is available in English and French), determine the reason for a patient’s visit and discuss any fees with them beforehand.
If you’re leaving practice and redirecting patients to a new physician, you can’t charge patients to transfer their records to that physician, Dr. Banach says.
But if the patient chooses a different provider, you can bill for the transfer under IPC-imposed limitations, outlined in the OMA’s guide to uninsured services.
Dr. Banach began charging a fee ($20 at first, later raised to $75) to combat a rise in missed appointments and patients showing up late without a courtesy call. And it’s worked.
“The second there’s a fee and it’s going to cost them something,” he says, “all of a sudden, patients are more respectful of your time.”
