Cataract surgery is covered under OHIP, but patients say officials from private clinics strongly imply the OHIP lenses are inferior quality to more expensive ones.
Ottawa patients say they have been upsold and pressured to spend hundreds, even thousands, of extra dollars on cataract surgery, despite a promise from the Progressive Conservative government that Ontario residents would never need a credit card to pay for health care.
On Tuesday, the Ottawa Health Coalition, a health advocacy organization with groups across the province, brought forward stories from some patients who say they were pressured and upsold when undergoing cataract surgery. Officials say the increasingly common tales of pressure on patients to spend more should be a bigger issue in the ongoing provincial election campaign.
Similar stories are being heard across the province, said Kevin Skerrett of the Ottawa Health Coalition.
“Premier Doug Ford promised unequivocally, ‘No Ontarian will ever have to pay with a credit card. They will pay with their OHIP card.’ In direct contradiction to this pledge, patients are now routinely being charged hundreds or thousands of dollars in private clinics and nothing is being done to stop it,” said Skerrett.
Cataract surgery is covered under OHIP, but patients say officials from private clinics strongly imply the OHIP lenses are inferior quality to more expensive ones, that they require tests that are not covered, and if they pay more their surgery will be expedited.
Skerrett said for-profit companies have a conflict of interest when it comes to advising patients about their health needs.
“If you are doing this for profit, you have a problematic conflict of interest where you are incentivized by money to sell services and products that are not needed or to exaggerate the merit of a particular surgery, particular lenses, particular products because you make money from it. This is the kind of conflict of interest that our public medicare system is designed to protect patients from.”
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Among patients who faced extra charges for cataract surgery is Diana Ralph, a retired associate professor of social work at Carleton University who was referred to a private clinic in Ottawa. She said she felt pressured to pay extra for lenses after an opthamologist and sales representative implied that she would be left with inferior vision if she went with the lens that was covered by OHIP. They strongly recommended options ranging from $1,300 to $4,000 per eye. They also suggested that if she opted for a more expensive option she could have surgery within six months as opposed to more than a year for basic cataract surgery.
“This felt like a bribe to queue jump,” said Ralph.
She said she reluctantly agreed to the options that would cost $1,300 per eye and only after that was told it would likely still take a year or more for surgery.
“I felt offended by the dishonest and manipulative hard sell.”
She eventually decided to go with another clinic and is scheduled for surgery in a few weeks.
Another Ottawa resident, who asked to remain anonymous, was given a price of $11,000 for cataract surgery. Skerrett called that the highest number the advocacy organization has seen for cataract surgery. She was able to get out of the agreement after, according to Skerrett, she realized she had been upsold and pressured to sign the contract, and hadn’t been fully informed about her options.
In a third case, Ottawa resident Ken Harten said he reluctantly agreed to pay $840 for each eye to upgrade lenses and get specialized measurements. He said it was implied that he would be foolish to go with lower-priced options.
Harten said he could afford to pay the money, but he knows there are many individuals and families who could not and that is creating a two-tiered system.
Harten said his nephew, in his 30s, was almost blind because of cataracts. He was told he could have surgery on one eye within weeks, at a cost of $3,400. The family agreed to the cost because the need was so dire. A second surgery is schedule for later this year, to be covered by OHIP, Harten said.
“I have heard Premier Ford state on numerous occasions that Ontarians only need their OHIP card and not a credit card to receive medical care. That is not true. Ontario has a two-tiered medical system. If you have the cash, you go to a private clinic, which is like jumping to the front of the line,” he said.
“We are allowing our government to chip away at our medical system until it reaches the point that citizens give up in frustration and go out of country or to private clinics to receive timely medical care. If allowed to continue, the OHIP system will collapse and private insurers will control the medical framework, and we will have a system similar to the U.S. Is that what the citizens of Ontario want?”
So-called upselling has been a concern since before Bill 60, which paved the way for more private surgical and other health centres in the province, was introduced. It includes language that government officials said would answer concerns about extra fees and upselling.
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