‘There is something wrong': Patients say they are paying out of pocket for cataract surgeries at private clinics

Hamilton Spectator

2 days ago

It all started at the optometrist.
Stephen Purdey was at a regular checkup to update his prescription last summer when his optometrist flagged something in his eye. The optometrist thought it was cataracts, but recommended Purdey visit an ophthalmologist to confirm.
So Purdey visited a private clinic in Toronto in March for a consultation after months on the wait-list to see a specialist, and that is where he said he started to feel 'vulnerable and susceptible.'
'Because of the combination of wanting to do the best thing for yourself,' said Purdey, who is in his 70s. 'Plus not necessarily understanding everything that the doctors are telling you, you really are as a patient vulnerable to suggestions.'
'And that's what happened to me.'
The ophthalmologist he was referred to, according to Purdey, acknowledged that the patient could get his procedure done for free under OHIP.
Cataract surgery is considered a 'medically necessary surgery' by the province, so even if a person opts to go to a private clinic they shouldn't be billed for the basic OHIP-covered procedure.
Patients who spoke to the Star said they went in for cataract surgery at private clinics and felt they had to pay between a couple of hundred and thousands of dollars out of pocket, whether to bypass reportedly long wait times or receive better treatment, including upgraded lenses.
Their stories come at a time when the provincial government continues to expand the number of privately run surgical and diagnostic centres performing cataract procedures, a move first announced two years ago. They also raise questions about whether there are sufficient guardrails in place to make sure patients don't feel pressured to pay out of pocket for upgrades they may not need.
In Purdey's case, he said his ophthalmologist offered him other options, such as laser-based eye measurements, instead of a free ultrasound measurement, and 'better quality' corrective lenses — treatments that would cost money but, to Purdey, sounded appealing.
'Right away you have the impression that lasers are better than ultrasound,' he said of the measurement procedure. 'And they said, 'Yeah, that's true.''
Laser-based measurements
have been found to be more accurate
than an ultrasound, although
the American Academy of Ophthalmology
notes that there does not appear to be a difference between using a laser or ultrasound during the cataract surgery itself.
Purdey was convinced, however, so he agreed to spend $650 on the laser measurements and an astigmatism test and said he'd consider paying another $200 to $1,600 for the so-called better lenses, then went home.
The four patients who spoke to the Star for this story are older adults who were worried that they might forever damage their vision if they didn't get surgery for their cataracts.
Some of these same patients also said they didn't think they were given all the information they needed to make a decision about whether to pay for so-called better measurements and lenses.
'It is really out of control,' said Natalie Mehra, executive director of the Ontario Health Coalition (OHC), an advocacy group focused on protecting public health care.
'Essentially it's like there isn't public medicare when it comes to eye surgery in Ontario,' says Natalie Mehra, executive director of the Ontario Health Coalition, an advocacy group focused on protecting public health care. 'It's gone.'
Things have gotten so bad from the perspective of the OHC that the group is filing formal complaints with the provincial and federal governments next week, Mehra said.
She said some private clinics around the province bill OHIP for medically necessary cataract surgeries, as they are allowed to, but also charge patients 'mandatory' user fees for things like eye measurements or the surgery itself in a practice known as extra-billing — which is illegal under Ontario law and a breach of the Canada Health Act. Extra-billing also includes charging patients for speedier care.
Mehra noted that the onus to report extra-billing to the province is on patients, many of whom do not realize that such 'mandatory' user fees aren't allowed. After investigating, if the province finds that extra-billing took place, it is required to report this annually to the federal government. Ottawa, in turn, will then claw back a certain amount of funding for the province's medicare program under the Canada Health Act.
And, on top of the extra-billing, private clinics are charging patients add-ons under the guise that they are medically necessary for cataracts, Mehra said.
Last year, Mehra said the coalition received more than 200 complaints over alleged extra-billing for cataract surgeries, one of the top two concerns the group heard from Ontarians. The other was about patients being kicked out of hospital before they are ready to be discharged. And Mehra said she believes there are probably thousands more who just don't know that they're being charged for what should be a free procedure.
For its part, the provincial Ministry of Health said that 32,000 people had publicly funded cataract surgery at community surgical and diagnostic centres in 2024.
'We will continue to deliver more connected, convenient care in every corner of the province, always ensuring that people are accessing the care they need with their OHIP card, never their credit card,' ministry spokesperson Ema Popovic said in an emailed statement.
Still, Mehra said the complaints heard by the OHC run counter to the intentions of the province's medicare system — something patients also echoed in interviews with the Star.
'Essentially it's like there isn't public medicare when it comes to eye surgery in Ontario,' Mehra said. 'It's gone.'
Up until her death in April from complications following cardiac surgery, something about a procedure Judith Deutsch had on her cataract back in 2022
didn't sit right with her, said husband Jim Deutsch.
Judith Deutsch, pictured here in March, didn't 'feel good' about her experience seeking care for her cataracts three years ago up until her death in April, husband Jim said.
Three years earlier, the Toronto couple had decided to go to a private clinic after they were told the wait time for cataract surgery covered by OHIP 'was going to be too long' by a doctor at a separate clinic. They considered the situation to be an 'emergency' — she incurred a concussion and a gash on her face because she couldn't see well — so the couple was willing to pay out of pocket to get care faster.
'It was going to cost a lot of money,' Jim told the Star. 'But she kept falling and just wanted to get it done as quickly as possible.'
Jim said he doesn't believe that he and his wife were scammed — they were aware of the private option and had the means to afford it. But he said the couple still didn't 'feel good' about paying to 'jump the queue' for Judith's surgery.
The OHC's Mehra said that long wait times are commonly mentioned by doctors at private clinics to encourage patients to pay out of pocket for their surgeries.
'They say the wait times in the public hospital are two years, which they are not,' Mehra said. 'Most people are getting it in 90 days, so they lie to patients and convince them to pay.'
According to
the province's surgery wait-time website
at the time of publication, the average wait time between a referral and the first clinician appointment for the lowest priority patients is 100 days. Meanwhile, the average wait time between a clinical decision for a surgery and the operation itself is 103 days.
It's not just wait times; doctors also upsell patients with 'medically unnecessary stuff,' Mehra said. She said the OHC has heard from past cataract patients that they were
encouraged to buy corrective lenses that address non-cataract issues like astigmatism.
Judith was one of these patients, with Jim saying his wife ended up paying more than $5,000 for her surgery, including specialty lenses that she thought were connected to her cataracts and
would lead to better outcomes for her vision, but later learned were for other eye conditions.
Although the couple willingly paid more to get faster care, they say they weren't aware the specialty lenses weren't necessary.
Mehra said she has also heard of patients being charged for post-operative medicine — something Paula from Barrie told the Star separately.
Paula told the Star she had to pay $230 for eye drops after her 2023 surgery at a private clinic, on top of the $5,000 she paid for special lenses and to get faster care. (She said her ophthalmologist told her the wait would be over a year if she did not pay $2,500.)
'That's not right,' Paula said of the eye drop charges. 'They should be covered.'
The Star agreed to use only Paula's first name since she has glaucoma and worries that speaking publicly could interfere with her ability to receive care.
While Paula knew going into her surgery that she wanted to get upgraded lenses and extra measurements, she said the ophthalmologist didn't ask her if she wanted the upgraded measurements.
'They should have asked me,' she said. 'If there were two options, they should have given me the option of 1 or 2.'
Jim Deutsch thinks that his wife's experience seeking care for her cataracts stems from a failure of Canada's medicare program.
The office of Ontario's Patient Ombudsman received some 4,429 complaints in the 2023-24 fiscal year — the most since it opened in 2016.
The office of Ontario's Patient Ombudsman received some 4,429 complaints in the 2023-24 fiscal year — the most since it opened in 2016.
'Medicare ended up being something that was quite different from what (Tommy Douglas) originally imagined,' said Deutsch, a psychiatrist who moved to Canada from the U.S. decades ago to work in the country's public system.
'Along the way we've ended up with this situation of scarcity and profit and allowing there to be private clinics that will offer something more speedily.'
Paula, too, believes the current system isn't fair — even if she said she would pay out of pocket again to get her surgery done faster.
'There is something wrong with the whole system,' she said, describing it as 'two-tier medicine.'
The OHC pins the blame on the Ford government, specifically the passage of Bill 60: Your Health Act in 2023.
The legislation
allows more private clinics to provide certain publicly funded procedures
, including cataract surgery. The provincial government said the Act was intended to reduce long wait times, while critics, including the OHC, said it would draw resources away from public hospitals.
'No one is able to regulate and control the private market for health care,' Mehra said. 'The most sensible thing we can do is bring (cataract surgeries) back into public hospitals.'
The Ministry of Health's Popovic stood by Bill 60 in her statement to the Star.
'To be very clear, Ontario has provisions through legislation that prohibit a patient from being charged for an OHIP-covered service, legislation that was strengthened by our government through Bill 60,' she said.
Popovic added that anyone who believes they have been charged for an OHIP-covered service can contact the Commitment to the Future of Medicare Act program to ask for a review, and that those who have been found to have been billed will be reimbursed.
After coming home from the private eye clinic, Purdey changed his mind; he wasn't going to pay for the laser measurements or other add-ons.
'I was told that the laser measurement stuff was better,' he said, 'but they didn't really tell me how much better it was.'
He called up the clinic to ask for the OHIP-funded procedures and in late May he had the first round of publicly funded surgery on one of his eyes.
'I'm quite satisfied,' Purdey said the day after his surgery. 'I feel like I narrowly missed getting trapped into spending a whole lot of money.'