Ontario government tells Ottawa woman OHIP won’t cover $110 Pap test

Routine cancer screening would have been covered by OHIP if it had been performed by a doctor or nurse who was part of a healthcare team. But this nurse practitioner worked independently in the clinic.

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An Ottawa woman who was charged $110 for a routine cancer screening by a nurse has been told by the Ministry of Health that she is solely responsible for the charge.

Eileen Murphy was outraged after she was charged $110 last month for a routine cancer screening with a nurse practitioner based at the Appletree clinic where she is a patient. She has a family doctor at the clinic, but that doctor had moved to northern Ontario, so she was advised to make an appointment with a nurse practitioner for the procedure. When she did, she was presented with a list of fees, much to her surprise.

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The procedure, which is part of the province’s cancer screening program, would have been covered by the Ontario Health Insurance Plan if it had been performed by a doctor, or even if it had been performed by a nurse practitioner who is part of a team of health and whose salary is covered by OHIP.

In Murphy’s case, it was done by a nurse practitioner who worked independently, something she didn’t know beforehand. Because they cannot bill for services under OHIP, as doctors can, the province also considers the service, although considered basic primary care, “not insured,” according to a letter it received from the ministry after complaining.

“We hope you understand that the ministry does not regulate charges for uninsured services or for services provided to uninsured persons, nor does it set prices for uninsured services. “Patients are responsible for any charges for uninsured services,” she was told in response to an email she sent to Health Minister Sylvia Jones last month.

This is in contrast to messages coming from the minister’s office in recent months as skilled nursing clinics that charge fees for primary care services have continued to open across the province. Among other things, the minister’s spokesperson said the province would not accept clinics charging for insured services.

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But observers and some who run the clinics say they are legal because independent nurse practitioners cannot bill OHIP for services and are meeting a demand. The letter to Murphy appears to support that view, in contrast to the message from the minister’s office.

A spokesman for Jones said at the time that the ministry would investigate the clinic. Spokeswoman Hannah Jensen added: “We will not tolerate any clinic taking advantage of a loophole created by federal law and charging patients for access to primary care.” The minister’s office also called on the federal government to close what they called a “loophole.”

The minister’s office did not immediately respond to comments for this story.

The message Murphy received from the Ministry of Health’s correspondence services in response to her complaint has a different tone: Essentially, clinics that charge for care provided by nurse practitioners are allowed to do so and patients are responsible for those uninsured fees.

Murphy was also told that the College of Nursing of Ontario has an independent practice guideline for nurses in independent practice that outlines expectations, including setting fees. It was referred to the regulatory body for any other concerns.

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Nurse practitioners who practice independently (meaning they are not part of a ministry-funded clinic) cannot bill OHIP for their services, as doctors can.

In Ontario, where nurse practitioners can perform many tasks that family doctors do and some 2.3 million residents lack primary care, more nurse practitioner clinics are popping up that charge fees for care. Ottawa has several, including at the Appletree clinic, where Murphy is a patient, as well as a Kanata clinic that charges patients a $600 annual access fee for primary care provided by nurse practitioners. Neither responded to requests for comment.

Murphy was angry because she had to pay for a routine Pap smear, which she had done after receiving a notice from the Ministry of Health informing her that she had to do so. Although she is a patient at the Appletree clinic near her home, she was informed that her doctor had moved to northwestern Ontario and was told to make an appointment with nurse practitioners at the clinic, not knowing that she would be charged for the service. service. She also charged a premium for her because she is over 50 years old. She says that, against her will, she was placed on a delivery system.

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Critics, including NDP Opposition Leader Marit Stiles, have urged the provincial government to ban charging fees for primary care provided by nurse practitioners, saying such clinics take advantage of the desperation of a growing number of people. without doctors.

The provincial budget, delivered Tuesday, included a $546 million increase in funding for family health teams, which the government said will connect 600,000 patients with new family or primary care doctors. Previously, he announced $100 million for family health teams, many of which will include nurse practitioners and some will be led by nurse practitioners. Those clinics will be fully covered by OHIP because they are part of a model in which health care workers receive a salary.

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