Ontario’s outdated OHIP billing system is causing delays in doctors getting reimbursed for their services, leading to physician burnout and affecting patient care, the Ontario Medical Association says.
Challenges with OHIP billing have become so widespread that the problem has become a top concern for physicians across the province, the OMA says, with delayed payments and rejected or unresolved claims affecting a range of doctors and surgical specialists.
The administrative burden of dealing with OHIP issues is now taking significant time away from direct patient care, the physician advocacy organization says. It estimates that time spent on unresolved billing claims prevented doctors from seeing an additional 58,000 patients in 2024.
“We need to ensure that physicians can spend time seeing patients, not chasing their billings,” OMA president Dr. Zainab Abdurrahman told the Star ahead of a Monday press conference at Queen’s Park, where the organization will call on the provincial government to make a revamp of the OHIP system a top health care priority. The OMA represents about 50,000 Ontario doctors, medical students and retired physicians.
“We’re asking them to make sure the system is modernized to reflect the complexity of care that we provide,” Abdurrahman said. “We need physicians to get paid in a timely manner.”
Ontario doctors are reimbursed for the insured services they provide according to the OHIP Schedule of Benefits. They submit claims using specific fee-for-service codes, and billing errors can lead to rejections, or delays or decreases in payment. While doctors can appeal, it’s a time-consuming process, and not all will be granted or quickly resolved.
Abdurrahman said the OHIP billing system needs to be streamlined to curb the number of rejections, and that the appeal process needs to be less onerous and more timely and transparent. She said too many doctors are navigating outdated billing codes, dealing with payment errors and jumping through hoops when patients have invalid OHIP cards — challenges that have escalated in recent years.
“Before, it was anecdotal stories … now we can see these issues are actually quite prevalent,” she said.
A January survey conducted by the OMA found that 90 per cent of the 2,500 physicians who responded had OHIP claims for payment rejected in 2024, with about half stating the rejections were without reasonable cause.
The survey showed 66 per cent of doctors said time spent on OHIP-related administrative tasks took time away from face-to-face patient care, while about half said they were less willing to perform certain procedures because they feared rejected billings. The OMA says it estimates that doctors could have seen about 58,000 additional patients in 2024 if their time hadn’t been spent on OHIP billing issues.
A spokesperson for Health Minister Sylvia Jones said Ontario’s Medical Claims Payment System processes more than 200 million claims every year, and that 99 per cent are paid automatically as submitted. Jackson Jacobs said less than one per cent of all claims require manual review, and that more than 95 per cent of those are handled within 30 days.
“It’s disappointing that the OMA is choosing to focus on 0.58% of OHIP claims, rather than highlighting the real progress we’ve made together to support physicians,” Jacobs said in a statement, while pointing to the recent Physician Services Agreement between the province and the OMA that resulted in a pay increase for physicians across the board and FHO+, an updated payment model for doctors working in a family health organization. The OMA said FHO+ was “a turning point for family medicine in Ontario.”
Jacobs said the government is working with the OMA to modernize the billing system “to make it even more efficient,” and that FHO+ and the province’s Patients Before Paperwork initiative are examples of how the Health Ministry is ensuring doctors can spend more time with patients.
Abdurrahman said that while only a small percentage of OHIP billings get rejected or held up, the overall number is large and represents tens of thousands of services, including complex surgeries, for which doctors don’t get compensated.
“How is that fair, to say it’s OK to not properly remunerate people who have provided a service that is covered by your system?” she said.
