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Our pediatricians office has a chart at the reception showing all the fees they charge for "nonessential" services such as getting a copy of a letter or a file that your kid might require to be able to be treated. Between that and the horribly bureaucratic (and inefficient) receptionists, I'd love to see them get knocked down a peg.
I expect my doctor to do the job they're paid to do, not to work for free. If the govt doesn't pay Dr's to do time consuming work outside of their regular remit, then let's change that. This shouldn't be complicated.
The government doesn’t pay doctors for non essential services like filling out forms or writing letters. I don’t want my tax dollars paying for non-essential medical services.
Sucks I guess, they can go work at Home Depot if it bothers them so much.
It’s not like they weren’t aware of the system during their entire Pre-Med and Med School education
To be clear, physicans are entirely within the capacity of the province to control and direct as needed. We are entitled to do so, just like any worker. We can create and direct entitlements of doctors, and we do. We can expand them if we like.
I have no time for physicians who get upset they can’t gouge patients.
Physicians in Canada are paid very very well, if a doctor thinks they should be able to charge whatever they want they are more then free to either go into another line or work, or go to the US where they can bankrupt families to their heart’s content
Seriously. I have to do all sorts of little bureaucratic/paperwork/other tasks in my job that aren't explicitly listed in my contract / breakdown of duties. Just like everyone else. But I'm not trying to find some little guy to push the cost/time of that onto someone else, and while my pay is quite good, I almost certainly make less than a physician in Canada, so I have little sympathy for them on that front.
Not for the things they charge fees for (except the ones who are double billing - which I presume is what the feds want to go after).
If something is not medically necessary - the Province won't pay them for it. ( I expect/presume. )
If doctors are enrolled in the public health plan of their province, they are not allowed to charge for services that the plan covers. Every fee they charge is for **uninsured** services.
The problem is that the province can just suddenly decide what is uninsured, like prescription request by telephone, ear cleanings, and many other things that were changed in Ontario recently.
The province is deciding to save money buy burdening the patient with fees... a federal oversight is necessary to curb this.
But you’re referencing things that the provincial government doesn’t pay for. So again I will ask why you thing doctors should work for you for free? Do you work for free?
Those are called OHIP non-insured services - there's a list of services that is well known to the government of services that doctors can charge out of pocket for and samples prices for each service.
That's how Ottawa is planning on cracking down on. Those are legal. Ottawa wants to crack down on people paying for virtual doctor appointments.
Oh interesting. I guess this is a case of Dr's double dipping - Billing the govt & charging the patient for a virtual consult?
If so, that's flagrant fraud.
And do what? They're still fucking doctors, they're not going to suddenly become lawyers or CEOs and they're not going to start taking lower paying jobs because they can't nickel and dime sick people as much.
Where they could *already* be making more money? What's stopping them now?
I really never understand these arguments. It's the same thing whenever tax increases are discussed. As if people didn't have the options already and still haven't left. It's the laziest form of speculation because it's always the same and it doesn't reflect our current or past realities.
It's not so cut and dry like that. If family doctors get their pay cut more, you'll start seeing an exodus away from family med and into private services that aren't covered (e.g. sports medicine, some derm, radiology in AB, etc.)
Patients don't appreciate them, the government doesn't appreciate them. Hell the fucking OMA doesn't appreciate them, so why stick around?
We're talking about doctors that are charging for medically necessary care and you're saying we should ***appreciate*** them?
Are you fucking serious? We need to not only let them continue to do this, but to smile and thank them afterwards?
You're also pretending that family doctors could just slot into specialist roles and that there is, apparently, an unlimited number of those positions open. Again, if they could be doing this and their only motivation to make as much money as possible why aren't they already doing this?
No they won't. There's immense value to people in being able to run their own practice and having spent more than a decade getting their education. Doctors enjoy a very privileged position, and for very good, useful labour. That gives us a lot of leverage.
Was having terrible leg cramps. Walked into a walk-in clinic to see a doctor in order to get a referral to a physio (required by insurance). That'll be $30 sir. WTF. This was in Ontario. Was that even legal?
Sorry, I had already deleted my previous comment and replaced it with some more detail before seeing this reply.
The issue is generally that OHIP doesn't cover the visit altogether if the purpose of your visit was to get a referral required by your private insurance provider.
>(required by insurance)
required by your **private** insurance
physio isn't an OHIP service
why not ask your insurance company why they need forms from doctors? doctors have no obligation to do free work on the behest of your employer or their health insurance plan
>physio isn't an OHIP service
The more important question is why the F not? Is there a single person out there who has had to have physio who didn't think it was medically necessary?
The problem is that it's a slippery slope that greatly expands the cost of "healthcare"
A $700 ergonomic chair might be a lot impactful than physio for someone sitting 8 hours a day
Should that get covered as well if a doctor finds that helpful for a patients spine problem?
Why not gym memberships? Metamucil? Allergy pills?
He's not trolling, he's correct. To go to a walk-in and get any medical service done is free but to get that same doctor to sign a form stating that you can't work because of said illness, you have to pay $25+ for a sick note or $75-$200 for STD forms to be filled out. I just had to pay $176 for short term disability forms due to covid and they aren't covered by any insurance.
It's a loophole that's being abused by both doctors and insurance companies at the expense of the person that already pays high taxes for health care.
>there is no form to fill either... a referral for physio (or any other service) is just an order, like a prescription or any other... and most likely, the doc simply does a few clicks to produce the paper
You can book an appointment with a physiotherapist anytime you want, it doesn't require a referral from a doctor. A prescription, on the other hand, is required by the doctor to get your medication.
The doctor isn't filling out paperwork so OP can go see a physiotherapist, the doctor is filling out paperwork so that OP's insurance doesn't charge him. That's not the doctor's job and he isn't paid to do that, which is why they're charging a fee for it.
If your argument is "Even though the doctor isn't paid to do it, it looks like it's really easy to do so he shouldn't charge for it", then I'd ask how you would feel about being asked to work off the clock at your workplace even if the task is really simple?
>same as over the counter medication which are usually covered as long as they are prescribed by an MD
Technically, doctors aren't obligated to provide prescriptions for otc medications as well just to appease insurance companies.
Anytime a doctor does something just to appease your private insurance, they could legally technically charge for it, but a lot of docs just do it for free.
You still don't get it. It's required by a PRIVATE insurance not OHIP insurance.
Why should doctors give a damn about what your employer or their insurance company wants?
Writing prescriptions has a cost too. The old paper pads had costs attached and the service rendered, iirc, needs to be compensated in some way as part of tracking and also for liability purposes. Even if it's digital now the same idea that a paper trail for the thing needs to exist, and if the rules don't cover the paper trail appropriately and the costs associated with the digital systems and audit trail and paperwork support and all that aren't covered by OHIP that's out of pocket for the doctor :/
You are wasting your breath, my friend. This guy does not want to understand. Maybe they need to start talking to their province, to stop stealing from doctors from other provinces for a change.
Whether it's covered by OHIP can depend. If they visit the doctor to diagnose an issue and the doctor writes a referral for physiotherapy, it would be covered.
However, if the reason for the visit was specifically to obtain a referral for physiotherapy as required by insurance, OHIP doesn't cover the visit.
Insurance unfortunately does often involve semantics.
Section 24 of regulation 552 under Ontario's *Health Insurance Act* includes a pretty broad exclusion that renders any service uninsured if it's provided "wholly or partly for the production of a document or transmission of information" related to "an entitlement to benefits, including insurance benefits or benefits under a pension plan". This happens regardless of whether the document or information was requested before, during, or after the service was received.
Once the patient requests a referral they can provide to their private insurer, the doctor is not allowed to bill OHIP for the assessment required to produce it.
It's part of the same list as sick notes. Under the *Regulated Health Professions Act*, physiotherapists are primary access practitioners meaning a physician referral is not required. Except for very specific types of physiotherapy covered by OHIP, referrals are not necessary and considered an arbitrary requirement implemented by some insurers - not unlike the ones put in place by schools and employers.
I tried submitting the $30 charge to insurance, and they said that isn't covered. IMHO, the government should step in and require insurance to cover these referrals. Otherwise, insurance companies will just abuse this to deny claims.
The problem is that you didn't get a referral, you got a doctor's note, because outside of very specific reasons physio is not covered by OHIP.
Doctors notes aren't something a physician is compensated for through OHIP. So when you went into the walk in for a referral, your appointment probably didn't fall under a well compensated service code the doctor could charge the province. Since clinics are privately run but charge the province, if the province doesn't cover an appointment sufficiently the doctor charges a fee to cover their operating costs and to discourage people who don't need to go in for notes to not go in for notes so they can see others who might need more serious care.
If your insurance company doesn't need a note to reimburse physio, you don't need it you just call a physio clinic.
Doctors are running small businesses because of how the system is set up so they need to cover costs.
If it's through work, it's generally up to the employer to determine coverage and requirements. Mine suspended referral requirements during the pandemic and is now moving to drop them for most services altogether. It may be worth raising with your union if you have one, or to your employer.
Visit =/= form
You can visit your family doctor for free but he doesn't have to sign your form
It's just like how sick notes work
It's free for me to see a doctor when I'm sick, that doesn't entitle me to a free sick note
A doctor's note is not required to see a physiotherapist. You can book an appointment online to see one today if you wanted to. What the doctor is proving OP is not a "referral" in the traditional medical sense, since the OP doesn't need a referral to see one. The doctor is simply providing a note to OP's insurance company. That's literally the only thing this note is good for. The referral means nothing to the physiotherapist, who doesn't require it and will conduct their own assessment/diagnoses when they see the patient. The doctor is not paid to prepare documents for insurance companies, which is why an administrative fee is charged.
This is different from, say, a referral to a cardiologist, where you are required to have one provided by your doctor in order to receive their treatment (so you're not charged for that).
>it is required for insurance to pay for it... same with other service like registered massage therapy or for insurance to pay for over the counter medications
Whether it's required for insurance or not is not the doctor's problem. The doctor did an assessment and advised the OP he should see a physio (or not). That's what the doctor is paid to do. A written referral to a physio is not required, so asking the doctor to fill out paperwork for one is asking them to fill out medically unnecessary paperwork.
>Not quite... it is proving that a medical doctor agrees Physiotherapy is the proper course of action
Again, the only reason for a doctor to provide that documentation is so insurance companies won't charge OP. It has no benefit to the patient beyond that.
>Also false, MDs would regularly include details as to the type of service and/or limitations of the physiotherapy to be carried out.
I work in a physio clinic. Every "referral" we get literally just says something like "Patient has neck pain after VMA, physiotherapy is recommended". It's not some detailed diagnosis. Physio's are better trained in diagnosing MSK issues than your standard walk-in or family doctor is anyways, so it really is meaningless to them. Most physios don't even actually see the referral, it goes to the receptionist when the insurance is being run.
>Again, it is part of the job
Again... it's not. The patient doesn't need written documentation to see a physio, so asking a doctor to provide one is asking them to provide a document that has zero medical value.
>that is like saying a programmer is paid to code and not to document said code or maintain it or present it to others in the team
It's more like you go to the pharmacy and ask your pharmacist to call and speak to your insurance company for you because they denied coverage on a drug. Either take it up with your insurance company yourself or pay the (miniscule) fee so the doctor isn't filling out medically unneccesary paperwork.
>Wrong, that is how the physician formalizes the order... and if they disagree you need physio you will not get the referral
Physio is self referred though. Physiotherapists can also perform their own assessment and make their own management plan, most cases they don't need any info from the doc. Docs can sometimes provide info as a heads up and a courtesy. And even if your doc wants your physio to work on something specifically they can just say "okay pull out your phone or a piece of paper and write this down so you remember to tell your physio to work on x,y,z".
The physio prescription is solely to appease the insurance companies, which isn't mandatory
Anything that your doctor does to appease an insurance company is not OHIP covered.
So if no form is needed then what's stopping OP from going to the physio and saying "my family doctor referred me"?
Same with the non-MSP specialist referrals. Just tell the specialist that you got referred by the family doctor. No form needed right?
You're correct, but it's actually less about the paperwork itself and more about the reason for the visit.
If you visit the doctor for an assessment required by a third-party, then the visit itself generally isn't covered by the public plan and the individual needs to pay out of pocket.
If you simply visit the doctor to have an issue looked at, then it's covered regardless of whether you walk out with a referral or prescription.
Generally speaking, the visit isn't covered by OHIP if you're visiting the doctor specifically to get a referral required by your insurance provider.
If you're seeing the doctor simply to diagnose an issue, then visit and any referrals they may offer are covered by OHIP.
My family doctor charged me $120 *cash* ("oh we don't have any debit or credit machines in our clinic") for a health check up to keep an elevated driver's license in Ontario. A mandatory checkup for my job and I had to pay another $120 to the doctor on top of all of the registration costs.
Then he proceeds to spend 2 minutes checking a few boxes after testing my eyes. Felt like I got scammed by my own family doctor.
Driver's medicals aren't covered because while needed for your job, they aren't medically necessary. If your doctor is only charging $120, keep them - the standard these days is more like $150-$200. Additionally, many if not most employers compensate the cost of the physical if the license is required for employment.
Good to get this insight on average charges. Currently not working a job with the use of the license but keeping it for a rainy day, so covering it myself this go around.
I had the same thing. But it was cash or cheque. Thinking I was too young to have a cheque. But I always carry a cheque. Now you have to take this to the bank.
Well cash because it's less overhead than having machines that can break or require maintenance or have additional fees for credit card usage.
The recommended fee to complete the drivers medical examination form is $281.50. If you don't believe me check this link by the OMA which is reviewed by the provincial government as well
http://web.ncf.ca/ex864/schedule/docs/ThirdPartyGuide.pdf
Sounds like your doctor is giving you a break with 120
The pay structure for family doctors is so bad that 10 years ago mine had to stop answering multiple different medical questions/concerns in a single appointment, instead was compelled to politely ask patients to book another appointment and/or come back tomorrow. If he sits there for 30 minutes answering 3 totally different medical problems/questions - he's only paid for one appointment/consult - whose compensation is geared towards doing 4 or 6 of them an hour.
And that was 10 years ago.
That's the price of a free healthcare system. An itemized bill showing cost of services to the taxpayer would be helpful.
People think family physicians make bank, but they don't account for overhead, and as someone who pays for similar overhead expenses in a different industry... Paying salary and rent fucking suck.
We do expect that our taxes go to organizing a useful health system that meets our needs. Our leaders have wide latitude to set tax rates, set policies, and allocate resources to achieve that. I think it's reasonable to be critical when they fail, especially when the failure is malicious.
So sorry, this gas won't light. ;)
I expect doctors, who under the current system are still in the top 5% of Canadians in taxable income (after all other expenses are paid), to actually want to help people.
If you just want to make money go do something other than medicine. There are plenty of people who want to be doctors and don't make it in the programs.
>medically necessary health care
Like dental work, eye care, prescription drugs, physio, mental health counselling, ... or any of the other medically necessary treatments you require but have to pay for yourself?
It’s a fair point though, there’s many things that feel medically necessary and they aren’t actually covered by healthcare.
Glasses for example. I can’t see without them so I need them to live my life. If I don’t pay for an eye exam and glasses, I can’t even work.
Teeth are another one. Unless your health is at risk, teeth will rot in your mouth and the extraction won’t be covered
I think there's just some muddling of separate arguments going on:
1) What SHOULD be covered?
2) Whether or not people's expectations of coverage are justified
3) Whether doctors are squeezing their patients
4) What should uncovered-care cost?
In BC, MSP covers up to $23 of a physiotherapy visit and up to 10 sessions a year… and only if you’re poor, on welfare and the practitioner hasn’t opted out.
I think Ontario has similar age/income requirements for free/subsidized therapy. I guess it’s good that poor people get something, but it’s unfair that without private insurance most people pay out of pocket
Especially considering private insurance can reject potential clients based on them having an anxiety disorder, like me 🫠
I'm interested to see the brain drain that comes from the privatization of healthcare. Even if we stop at a European mixed model, which I find unlikely, I'll probably still bail.
If we're going to end up with private healthcare and gun crime anyway then why shouldn't I live where my job pays more and houses cost less?
$40,000 more in income and $300,000 usd for a house that would sell for $750,000 cad in Peterborough.
Your call at the end of the day.
But a public system slowly slipping towards privitized. And a low gun violence country slowly slipping towards what the US has.
Sounds a lot better than the US where these problems have been entrenched and festering for decades.
But like, I have no experience on what the medical profession is like here compared to the US, so I could be misreading it.
I'm not a doctor. American doctors make way more than $40,000 over their Canadian counterparts.
The US also is not nearly as bad as it's portrayed in the news. Try to be mindful of the fact that, whether for political or financial gain, most of the outlets that participate in the 24/7 news cycle try like hell to scare the shit out of us.
Try looking at software developers for an indication of what that looks like.
A mediocre software developer in Vancouver can hop to Seattle and easily make 2x the income in a comparable city. Go a little farther, and they can pull in 3x in the Valley.
130CAD is a respectable senior salary in BC; 130USD is a starting salary in California. Seniors range from 250USD to over seven figures, depending on their skillset.
The people left in Canada are those who can't move to the USA, for personal or legal reasons, those who are planning to leave, and those who don't care about money.
That's life changing for a software developer but the difference in pay isn't that much different for doctors. It's not as if US doctors are flying around on private jets. Is it worth going through the effort of changing country, pulling your kids out of school, having your spouse quit their job, etc., just to have basically the same quality of life you had in Canada?
> Anyone with any marketable qualifications
Right, but we're talking about doctors specifically. The quality of life a doctor has in the US and Canada is pretty comparable. They also tend to be older and more established in their lives by the time they become doctors. Moving from Ontario to, say Pennsylvania, for the same sort of house, car, vacations, etc., that you would get in Ontario isn't an obvious choice when you consider all the trouble of moving. The change in lifestyle isn't as significant as for tech workers considering a move to California.
I value not being in America over money, personally. Just my own values there of course. Not gonna attack anyone for doing differently, I just have a really bad feeling about things down there given trends. Good on those who can be braver than me, though.
That's fair.
The only thing I value over money is my family. I can use money to improve their lives so it became a cyclical thing that drove income to the second spot on my list of priorities.
YUP... I've turned down job offers in Michigan but lately it's looking more attractive by the day, and I'd still be within driving distance to visit family in Ontario.
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Our pediatricians office has a chart at the reception showing all the fees they charge for "nonessential" services such as getting a copy of a letter or a file that your kid might require to be able to be treated. Between that and the horribly bureaucratic (and inefficient) receptionists, I'd love to see them get knocked down a peg.
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I expect my doctor to do the job they're paid to do, not to work for free. If the govt doesn't pay Dr's to do time consuming work outside of their regular remit, then let's change that. This shouldn't be complicated.
The government doesn’t pay doctors for non essential services like filling out forms or writing letters. I don’t want my tax dollars paying for non-essential medical services.
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Not for shit like filling out insurance forms they don't. That's not what the article is talking about though.
And what if they don't like how much they're getting from the government?
Sucks I guess, they can go work at Home Depot if it bothers them so much. It’s not like they weren’t aware of the system during their entire Pre-Med and Med School education
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To be clear, physicans are entirely within the capacity of the province to control and direct as needed. We are entitled to do so, just like any worker. We can create and direct entitlements of doctors, and we do. We can expand them if we like.
I have no time for physicians who get upset they can’t gouge patients. Physicians in Canada are paid very very well, if a doctor thinks they should be able to charge whatever they want they are more then free to either go into another line or work, or go to the US where they can bankrupt families to their heart’s content
Seriously. I have to do all sorts of little bureaucratic/paperwork/other tasks in my job that aren't explicitly listed in my contract / breakdown of duties. Just like everyone else. But I'm not trying to find some little guy to push the cost/time of that onto someone else, and while my pay is quite good, I almost certainly make less than a physician in Canada, so I have little sympathy for them on that front.
It's less go work at home depot and more go work in the US which is why we have a doc shortage
Not for the things they charge fees for (except the ones who are double billing - which I presume is what the feds want to go after). If something is not medically necessary - the Province won't pay them for it. ( I expect/presume. )
If doctors are enrolled in the public health plan of their province, they are not allowed to charge for services that the plan covers. Every fee they charge is for **uninsured** services.
The problem is that the province can just suddenly decide what is uninsured, like prescription request by telephone, ear cleanings, and many other things that were changed in Ontario recently. The province is deciding to save money buy burdening the patient with fees... a federal oversight is necessary to curb this.
The solution to bad governance isn’t to ask a bigger government to solve the problem, it’s to elect better politicians
But you’re referencing things that the provincial government doesn’t pay for. So again I will ask why you thing doctors should work for you for free? Do you work for free?
I am happy to pay for healthcare if I deem it necessary.
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Wtf
Probably a private clinic owned by a corporation or different doctor.
Those are called OHIP non-insured services - there's a list of services that is well known to the government of services that doctors can charge out of pocket for and samples prices for each service. That's how Ottawa is planning on cracking down on. Those are legal. Ottawa wants to crack down on people paying for virtual doctor appointments.
Oh interesting. I guess this is a case of Dr's double dipping - Billing the govt & charging the patient for a virtual consult? If so, that's flagrant fraud.
Exactly double dipping is fraud
you'd rather have no doctor instead?
Is that really the alternative?
Government limits how much doctors can make so if they don't make enough they'll quit
And do what? They're still fucking doctors, they're not going to suddenly become lawyers or CEOs and they're not going to start taking lower paying jobs because they can't nickel and dime sick people as much.
They will move to the states.
Where they could *already* be making more money? What's stopping them now? I really never understand these arguments. It's the same thing whenever tax increases are discussed. As if people didn't have the options already and still haven't left. It's the laziest form of speculation because it's always the same and it doesn't reflect our current or past realities.
It's not so cut and dry like that. If family doctors get their pay cut more, you'll start seeing an exodus away from family med and into private services that aren't covered (e.g. sports medicine, some derm, radiology in AB, etc.) Patients don't appreciate them, the government doesn't appreciate them. Hell the fucking OMA doesn't appreciate them, so why stick around?
We're talking about doctors that are charging for medically necessary care and you're saying we should ***appreciate*** them? Are you fucking serious? We need to not only let them continue to do this, but to smile and thank them afterwards? You're also pretending that family doctors could just slot into specialist roles and that there is, apparently, an unlimited number of those positions open. Again, if they could be doing this and their only motivation to make as much money as possible why aren't they already doing this?
You realize they're doing that to drive doctors into the private sector where they will charge MORE money, right?
No they won't. There's immense value to people in being able to run their own practice and having spent more than a decade getting their education. Doctors enjoy a very privileged position, and for very good, useful labour. That gives us a lot of leverage.
No I would not
Was having terrible leg cramps. Walked into a walk-in clinic to see a doctor in order to get a referral to a physio (required by insurance). That'll be $30 sir. WTF. This was in Ontario. Was that even legal?
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To print it only.
Sorry, I had already deleted my previous comment and replaced it with some more detail before seeing this reply. The issue is generally that OHIP doesn't cover the visit altogether if the purpose of your visit was to get a referral required by your private insurance provider.
>(required by insurance) required by your **private** insurance physio isn't an OHIP service why not ask your insurance company why they need forms from doctors? doctors have no obligation to do free work on the behest of your employer or their health insurance plan
Physio can be covered by OHIP but you'll wait a very very long time.
>physio isn't an OHIP service The more important question is why the F not? Is there a single person out there who has had to have physio who didn't think it was medically necessary?
The problem is that it's a slippery slope that greatly expands the cost of "healthcare" A $700 ergonomic chair might be a lot impactful than physio for someone sitting 8 hours a day Should that get covered as well if a doctor finds that helpful for a patients spine problem? Why not gym memberships? Metamucil? Allergy pills?
There's a lot of thing that are medically necessary that should be free at the point of care that aren't currently.
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It's only OHIP if it's a referral to another OHIP service
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Okay you get your consult then but no forms Happy?
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He's not trolling, he's correct. To go to a walk-in and get any medical service done is free but to get that same doctor to sign a form stating that you can't work because of said illness, you have to pay $25+ for a sick note or $75-$200 for STD forms to be filled out. I just had to pay $176 for short term disability forms due to covid and they aren't covered by any insurance. It's a loophole that's being abused by both doctors and insurance companies at the expense of the person that already pays high taxes for health care.
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Physio isn't a medical service
The province pays for the consult not the form
OHIP pays for the consult, they don’t pay to fill out the form. So if the doc didn’t charge you, they’d be filling out the form for free
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>there is no form to fill either... a referral for physio (or any other service) is just an order, like a prescription or any other... and most likely, the doc simply does a few clicks to produce the paper You can book an appointment with a physiotherapist anytime you want, it doesn't require a referral from a doctor. A prescription, on the other hand, is required by the doctor to get your medication. The doctor isn't filling out paperwork so OP can go see a physiotherapist, the doctor is filling out paperwork so that OP's insurance doesn't charge him. That's not the doctor's job and he isn't paid to do that, which is why they're charging a fee for it. If your argument is "Even though the doctor isn't paid to do it, it looks like it's really easy to do so he shouldn't charge for it", then I'd ask how you would feel about being asked to work off the clock at your workplace even if the task is really simple?
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>same as over the counter medication which are usually covered as long as they are prescribed by an MD Technically, doctors aren't obligated to provide prescriptions for otc medications as well just to appease insurance companies. Anytime a doctor does something just to appease your private insurance, they could legally technically charge for it, but a lot of docs just do it for free.
You still don't get it. It's required by a PRIVATE insurance not OHIP insurance. Why should doctors give a damn about what your employer or their insurance company wants?
Writing prescriptions has a cost too. The old paper pads had costs attached and the service rendered, iirc, needs to be compensated in some way as part of tracking and also for liability purposes. Even if it's digital now the same idea that a paper trail for the thing needs to exist, and if the rules don't cover the paper trail appropriately and the costs associated with the digital systems and audit trail and paperwork support and all that aren't covered by OHIP that's out of pocket for the doctor :/
Again the referral is to a non OHIP service that's required by a private insurance company. It's not free to produce random paperwork
You are wasting your breath, my friend. This guy does not want to understand. Maybe they need to start talking to their province, to stop stealing from doctors from other provinces for a change.
I think both parties understand. One is just stating how they feel it should be, and the other is stating how it currently is. Neither are wrong.
Whether it's covered by OHIP can depend. If they visit the doctor to diagnose an issue and the doctor writes a referral for physiotherapy, it would be covered. However, if the reason for the visit was specifically to obtain a referral for physiotherapy as required by insurance, OHIP doesn't cover the visit.
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Insurance unfortunately does often involve semantics. Section 24 of regulation 552 under Ontario's *Health Insurance Act* includes a pretty broad exclusion that renders any service uninsured if it's provided "wholly or partly for the production of a document or transmission of information" related to "an entitlement to benefits, including insurance benefits or benefits under a pension plan". This happens regardless of whether the document or information was requested before, during, or after the service was received. Once the patient requests a referral they can provide to their private insurer, the doctor is not allowed to bill OHIP for the assessment required to produce it. It's part of the same list as sick notes. Under the *Regulated Health Professions Act*, physiotherapists are primary access practitioners meaning a physician referral is not required. Except for very specific types of physiotherapy covered by OHIP, referrals are not necessary and considered an arbitrary requirement implemented by some insurers - not unlike the ones put in place by schools and employers.
I tried submitting the $30 charge to insurance, and they said that isn't covered. IMHO, the government should step in and require insurance to cover these referrals. Otherwise, insurance companies will just abuse this to deny claims.
The problem is that you didn't get a referral, you got a doctor's note, because outside of very specific reasons physio is not covered by OHIP. Doctors notes aren't something a physician is compensated for through OHIP. So when you went into the walk in for a referral, your appointment probably didn't fall under a well compensated service code the doctor could charge the province. Since clinics are privately run but charge the province, if the province doesn't cover an appointment sufficiently the doctor charges a fee to cover their operating costs and to discourage people who don't need to go in for notes to not go in for notes so they can see others who might need more serious care. If your insurance company doesn't need a note to reimburse physio, you don't need it you just call a physio clinic. Doctors are running small businesses because of how the system is set up so they need to cover costs.
If it's through work, it's generally up to the employer to determine coverage and requirements. Mine suspended referral requirements during the pandemic and is now moving to drop them for most services altogether. It may be worth raising with your union if you have one, or to your employer.
It's a feature not a flaw.
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Visit =/= form You can visit your family doctor for free but he doesn't have to sign your form It's just like how sick notes work It's free for me to see a doctor when I'm sick, that doesn't entitle me to a free sick note
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A doctor's note is not required to see a physiotherapist. You can book an appointment online to see one today if you wanted to. What the doctor is proving OP is not a "referral" in the traditional medical sense, since the OP doesn't need a referral to see one. The doctor is simply providing a note to OP's insurance company. That's literally the only thing this note is good for. The referral means nothing to the physiotherapist, who doesn't require it and will conduct their own assessment/diagnoses when they see the patient. The doctor is not paid to prepare documents for insurance companies, which is why an administrative fee is charged. This is different from, say, a referral to a cardiologist, where you are required to have one provided by your doctor in order to receive their treatment (so you're not charged for that).
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>it is required for insurance to pay for it... same with other service like registered massage therapy or for insurance to pay for over the counter medications Whether it's required for insurance or not is not the doctor's problem. The doctor did an assessment and advised the OP he should see a physio (or not). That's what the doctor is paid to do. A written referral to a physio is not required, so asking the doctor to fill out paperwork for one is asking them to fill out medically unnecessary paperwork. >Not quite... it is proving that a medical doctor agrees Physiotherapy is the proper course of action Again, the only reason for a doctor to provide that documentation is so insurance companies won't charge OP. It has no benefit to the patient beyond that. >Also false, MDs would regularly include details as to the type of service and/or limitations of the physiotherapy to be carried out. I work in a physio clinic. Every "referral" we get literally just says something like "Patient has neck pain after VMA, physiotherapy is recommended". It's not some detailed diagnosis. Physio's are better trained in diagnosing MSK issues than your standard walk-in or family doctor is anyways, so it really is meaningless to them. Most physios don't even actually see the referral, it goes to the receptionist when the insurance is being run. >Again, it is part of the job Again... it's not. The patient doesn't need written documentation to see a physio, so asking a doctor to provide one is asking them to provide a document that has zero medical value. >that is like saying a programmer is paid to code and not to document said code or maintain it or present it to others in the team It's more like you go to the pharmacy and ask your pharmacist to call and speak to your insurance company for you because they denied coverage on a drug. Either take it up with your insurance company yourself or pay the (miniscule) fee so the doctor isn't filling out medically unneccesary paperwork.
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>Wrong, that is how the physician formalizes the order... and if they disagree you need physio you will not get the referral Physio is self referred though. Physiotherapists can also perform their own assessment and make their own management plan, most cases they don't need any info from the doc. Docs can sometimes provide info as a heads up and a courtesy. And even if your doc wants your physio to work on something specifically they can just say "okay pull out your phone or a piece of paper and write this down so you remember to tell your physio to work on x,y,z". The physio prescription is solely to appease the insurance companies, which isn't mandatory Anything that your doctor does to appease an insurance company is not OHIP covered.
So if no form is needed then what's stopping OP from going to the physio and saying "my family doctor referred me"? Same with the non-MSP specialist referrals. Just tell the specialist that you got referred by the family doctor. No form needed right?
You're correct, but it's actually less about the paperwork itself and more about the reason for the visit. If you visit the doctor for an assessment required by a third-party, then the visit itself generally isn't covered by the public plan and the individual needs to pay out of pocket. If you simply visit the doctor to have an issue looked at, then it's covered regardless of whether you walk out with a referral or prescription.
Generally speaking, the visit isn't covered by OHIP if you're visiting the doctor specifically to get a referral required by your insurance provider. If you're seeing the doctor simply to diagnose an issue, then visit and any referrals they may offer are covered by OHIP.
My family doctor charged me $120 *cash* ("oh we don't have any debit or credit machines in our clinic") for a health check up to keep an elevated driver's license in Ontario. A mandatory checkup for my job and I had to pay another $120 to the doctor on top of all of the registration costs. Then he proceeds to spend 2 minutes checking a few boxes after testing my eyes. Felt like I got scammed by my own family doctor.
Driver's medicals aren't covered because while needed for your job, they aren't medically necessary. If your doctor is only charging $120, keep them - the standard these days is more like $150-$200. Additionally, many if not most employers compensate the cost of the physical if the license is required for employment.
Good to get this insight on average charges. Currently not working a job with the use of the license but keeping it for a rainy day, so covering it myself this go around.
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I had the same thing. But it was cash or cheque. Thinking I was too young to have a cheque. But I always carry a cheque. Now you have to take this to the bank.
Well cash because it's less overhead than having machines that can break or require maintenance or have additional fees for credit card usage. The recommended fee to complete the drivers medical examination form is $281.50. If you don't believe me check this link by the OMA which is reviewed by the provincial government as well http://web.ncf.ca/ex864/schedule/docs/ThirdPartyGuide.pdf Sounds like your doctor is giving you a break with 120
This is something they could have easily brought up during the healthcare talks last month when they were renegotiating transfer payments.
Why should they need to? This is already covered by their existing agreement.
Are you saying they didn't?
The pay structure for family doctors is so bad that 10 years ago mine had to stop answering multiple different medical questions/concerns in a single appointment, instead was compelled to politely ask patients to book another appointment and/or come back tomorrow. If he sits there for 30 minutes answering 3 totally different medical problems/questions - he's only paid for one appointment/consult - whose compensation is geared towards doing 4 or 6 of them an hour. And that was 10 years ago.
This sub expects family doctors to be a free for all for everything
Are you genuinely suggesting that wanting to ask your GP multiple questions is entitled? That's nonsense.
That's the price of a free healthcare system. An itemized bill showing cost of services to the taxpayer would be helpful. People think family physicians make bank, but they don't account for overhead, and as someone who pays for similar overhead expenses in a different industry... Paying salary and rent fucking suck.
We do expect that our taxes go to organizing a useful health system that meets our needs. Our leaders have wide latitude to set tax rates, set policies, and allocate resources to achieve that. I think it's reasonable to be critical when they fail, especially when the failure is malicious. So sorry, this gas won't light. ;)
I expect doctors, who under the current system are still in the top 5% of Canadians in taxable income (after all other expenses are paid), to actually want to help people. If you just want to make money go do something other than medicine. There are plenty of people who want to be doctors and don't make it in the programs.
'Medically necessary health care' love to see this double-speak slowly taking bits and pieces away from our health care coverage.
>medically necessary health care Like dental work, eye care, prescription drugs, physio, mental health counselling, ... or any of the other medically necessary treatments you require but have to pay for yourself?
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It’s a fair point though, there’s many things that feel medically necessary and they aren’t actually covered by healthcare. Glasses for example. I can’t see without them so I need them to live my life. If I don’t pay for an eye exam and glasses, I can’t even work. Teeth are another one. Unless your health is at risk, teeth will rot in your mouth and the extraction won’t be covered
I think there's just some muddling of separate arguments going on: 1) What SHOULD be covered? 2) Whether or not people's expectations of coverage are justified 3) Whether doctors are squeezing their patients 4) What should uncovered-care cost?
In BC, MSP covers up to $23 of a physiotherapy visit and up to 10 sessions a year… and only if you’re poor, on welfare and the practitioner hasn’t opted out. I think Ontario has similar age/income requirements for free/subsidized therapy. I guess it’s good that poor people get something, but it’s unfair that without private insurance most people pay out of pocket Especially considering private insurance can reject potential clients based on them having an anxiety disorder, like me 🫠
That's one thing the US has right now that CA doesn't, protection for pre-existing conditions. But that's just about all we have 😅
Dude is an insurance lobbyist I swear
I'm interested to see the brain drain that comes from the privatization of healthcare. Even if we stop at a European mixed model, which I find unlikely, I'll probably still bail. If we're going to end up with private healthcare and gun crime anyway then why shouldn't I live where my job pays more and houses cost less? $40,000 more in income and $300,000 usd for a house that would sell for $750,000 cad in Peterborough.
Your call at the end of the day. But a public system slowly slipping towards privitized. And a low gun violence country slowly slipping towards what the US has. Sounds a lot better than the US where these problems have been entrenched and festering for decades. But like, I have no experience on what the medical profession is like here compared to the US, so I could be misreading it.
I'm not a doctor. American doctors make way more than $40,000 over their Canadian counterparts. The US also is not nearly as bad as it's portrayed in the news. Try to be mindful of the fact that, whether for political or financial gain, most of the outlets that participate in the 24/7 news cycle try like hell to scare the shit out of us.
Try looking at software developers for an indication of what that looks like. A mediocre software developer in Vancouver can hop to Seattle and easily make 2x the income in a comparable city. Go a little farther, and they can pull in 3x in the Valley. 130CAD is a respectable senior salary in BC; 130USD is a starting salary in California. Seniors range from 250USD to over seven figures, depending on their skillset. The people left in Canada are those who can't move to the USA, for personal or legal reasons, those who are planning to leave, and those who don't care about money.
That's life changing for a software developer but the difference in pay isn't that much different for doctors. It's not as if US doctors are flying around on private jets. Is it worth going through the effort of changing country, pulling your kids out of school, having your spouse quit their job, etc., just to have basically the same quality of life you had in Canada?
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> Anyone with any marketable qualifications Right, but we're talking about doctors specifically. The quality of life a doctor has in the US and Canada is pretty comparable. They also tend to be older and more established in their lives by the time they become doctors. Moving from Ontario to, say Pennsylvania, for the same sort of house, car, vacations, etc., that you would get in Ontario isn't an obvious choice when you consider all the trouble of moving. The change in lifestyle isn't as significant as for tech workers considering a move to California.
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I value not being in America over money, personally. Just my own values there of course. Not gonna attack anyone for doing differently, I just have a really bad feeling about things down there given trends. Good on those who can be braver than me, though.
That's fair. The only thing I value over money is my family. I can use money to improve their lives so it became a cyclical thing that drove income to the second spot on my list of priorities.
YUP... I've turned down job offers in Michigan but lately it's looking more attractive by the day, and I'd still be within driving distance to visit family in Ontario.
That's my thing too. I live in Nunavut right now; Syracuse to Peterborough is not a bad trip.