{"id":68910,"date":"2025-08-14T11:45:08","date_gmt":"2025-08-14T11:45:08","guid":{"rendered":"https:\/\/www.newsbeep.com\/ca\/68910\/"},"modified":"2025-08-14T11:45:08","modified_gmt":"2025-08-14T11:45:08","slug":"ontario-doctors-dont-get-paid-when-they-treat-uninsured-patients-heres-how-that-might-change","status":"publish","type":"post","link":"https:\/\/www.newsbeep.com\/ca\/68910\/","title":{"rendered":"Ontario doctors don’t get paid when they treat uninsured patients. Here’s how that might change"},"content":{"rendered":"

Several times a week, a man facing homelessness and mental health issues\u00a0comes to the busy emergency department in downtown Toronto\u00a0where Dr. Bernard Ho works, and doctors there treat him\u00a0despite not being paid to do so.<\/p>\n

That’s because the man doesn’t have a valid health card \u2014 and he’s not the only one.\u00a0<\/p>\n

Ho said many doctors are forced to bear the cost\u00a0of caring for people in need who can’t prove they have health insurance.<\/p>\n

“We see them all the time. And unfortunately, we’re not paid for them,” Ho told CBC Toronto.<\/p>\n

Currently, most doctors across the province can’t invoice the Ontario Health Insurance Plan (OHIP) for patients who can’t prove they have coverage.\u00a0<\/p>\n

The Ontario Medical Association is hoping to change that and is working to finalize a new compensation deal with the provincial government\u00a0that includes the reintroduction of what it calls a\u00a0“good-faith” payment policy, first scrapped in 1998.<\/p>\n

\"ADr. Bernard Ho is one of many Ontario doctors who regularly find themselves caring for patients without provincial health insurance. (Submitted by Dr. Bernard Ho)What is a\u00a0‘good-faith’ payment policy?<\/p>\n

During the COVID-19 pandemic, Ontario revived a version of 20th-century “good-faith” payment policy, creating a stream of funding to ensure doctors got paid whenever they treated someone, even when the patient was not insured. The policy was\u00a0scrapped again in 2023.<\/a>\u00a0<\/p>\n

The Ministry of Health told CBC\u00a0Toronto in a statement it’s unable to comment on specific proposals while in active bargaining with the OMA.\u00a0<\/p>\n

If the proposal is approved, the “good-faith” payment system would kick in under three scenarios, according to the OMA:<\/p>\n

Newborn patients experiencing glitches or delays while they await a permanent health card.<\/p>\n

People who are OHIP-eligible but don’t have valid documentation or valid\u00a0coverage, a category which could include people experiencing homelessness, mental health issues\u00a0or other barriers to documentation.<\/p>\n

Uninsured patients presenting in critical conditions, who are unable or don’t have someone available to provide documentation. The category could include undocumented residents, temporary residents experiencing lapses in coverage, uninsured travelers facing medical emergencies, and individuals facing complications or emergencies after elective health or birth tourism.<\/p>\n

‘Free for all’ not the goal, OMA president\u00a0says\u00a0<\/p>\n

It’s that third scenario, in which doctors would bill for care for uninsured patients, that could face pushback, the OMA noted in a 2024 report.\u00a0<\/p>\n

“The Ministry may indicate that this is simply not their problem to manage \u2026 Some members of the public may feel similarly,” the report says.\u00a0<\/p>\n

Under the proposed policy, hospitals would need to make reasonable attempts to verify someone’s coverage, said OMA president Dr. Zainab Abdurrahman.\u00a0<\/p>\n

But\u00a0if that’s not possible, she believes the doctors caring for them should still get paid.\u00a0<\/p>\n

\"AOMA president Dr. Zainab Abdurrahman says the association’s goal is primarily for doctors to be paid for care given to people who are OHIP-eligible. (Ontario Medical Association)<\/p>\n

“Our real focus is really the OHIP-eligible. Could someone [ineligible] slip in there? There’s always a possibility,” Abdurrahman said.<\/p>\n

“We’re being very specific and very intentional \u2026 to help allay the fears that this is just going to be a free-for-all for everyone to come and get Ontario taxpayer-paid health care,” she said. “That’s not our goal.”<\/p>\n

When the policy was in place during the pandemic, the OMA found that 7,000 Ontario physicians provided 400,000 instances of care to patients without insurance.\u00a0<\/p>\n

Similar programs exist across Canada: OMA<\/p>\n

It’s unclear whether bringing back the policy could incentivize more medical tourism, said Boriana Miloucheva, an assistant professor of health economics at the Dalla Lana School of Public Health.<\/p>\n

“The option to get medical services and not pay [the bill] already exists,” she said. “It’s a good-faith program, but there should be reviews about who is actually billing and what they’re actually billing,” she said.<\/p>\n

Other provinces, such as B.C., Alberta, Saskatchewan, and Quebec, do provide similar payment options for emergencies, according to the OMA. Some of them allow retroactive billing or accept mailing addresses from homeless shelters as proof of residency for those without a health card.\u00a0<\/p>\n

A similar policy was also recently implemented\u00a0in Manitoba.\u00a0<\/a><\/p>\n

WATCH | Ontario and OMA say\u00a0they’re\u00a0close to reaching a new compensation deal:\u00a0\"\"<\/p>\n

Ontario doctors are close to a new compensation deal. Here’s what it includes<\/p>\n

The Ontario Medical Association is hoping to strike a new deal with the province that would change the way family physicians are compensated. CBC’s Dale Manucdoc has more on what the proposed deal includes. <\/p>\n

Ultimately, says Dr. Ho, this is about more than getting compensated for work. He says it’s a health equity issue for the province’s most vulnerable populations, who might delay care or turn down prescriptions they can’t pay for because they can’t prove they’re eligible for OHIP.\u00a0<\/p>\n

Ho says the policy\u00a0could end up saving the province money, since\u00a0people postponing care could face more serious health issues that need treating\u00a0later on.\u00a0<\/p>\n

“We do need to reduce these barriers to care and \u2026 create fair processes for these patients because they are disproportionately affected by this,” he said.\u00a0<\/p>\n

Abdurrahman said she’s hoping for an update on the proposed policy this fall.\u00a0<\/p>\n","protected":false},"excerpt":{"rendered":"Several times a week, a man facing homelessness and mental health issues\u00a0comes to the busy emergency department in…\n","protected":false},"author":2,"featured_media":68911,"comment_status":"","ping_status":"","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[34],"tags":[49,48,84,392],"class_list":["post-68910","post","type-post","status-publish","format-standard","has-post-thumbnail","category-healthcare","tag-ca","tag-canada","tag-health","tag-healthcare"],"_links":{"self":[{"href":"https:\/\/www.newsbeep.com\/ca\/wp-json\/wp\/v2\/posts\/68910","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.newsbeep.com\/ca\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.newsbeep.com\/ca\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.newsbeep.com\/ca\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/www.newsbeep.com\/ca\/wp-json\/wp\/v2\/comments?post=68910"}],"version-history":[{"count":0,"href":"https:\/\/www.newsbeep.com\/ca\/wp-json\/wp\/v2\/posts\/68910\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.newsbeep.com\/ca\/wp-json\/wp\/v2\/media\/68911"}],"wp:attachment":[{"href":"https:\/\/www.newsbeep.com\/ca\/wp-json\/wp\/v2\/media?parent=68910"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.newsbeep.com\/ca\/wp-json\/wp\/v2\/categories?post=68910"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.newsbeep.com\/ca\/wp-json\/wp\/v2\/tags?post=68910"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}