‘There is something wrong': Patients say they are paying out of pocket for cataract surgeries at private clinics
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.'
ARTICLE CONTINUES BELOW
'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.''
ARTICLE CONTINUES BELOW
ARTICLE CONTINUES BELOW
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.
'Out of control'
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.'
Richard Lautens Toronto Star
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.
ARTICLE CONTINUES BELOW
ARTICLE CONTINUES BELOW
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.
ARTICLE CONTINUES BELOW
ARTICLE CONTINUES BELOW
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.'
Hazy advice
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.
Family photo
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.
ARTICLE CONTINUES BELOW
ARTICLE CONTINUES BELOW
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.
ARTICLE CONTINUES BELOW
ARTICLE CONTINUES BELOW
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.'
ARTICLE CONTINUES BELOW
ARTICLE CONTINUES BELOW
Patients blame issues with medicare system
Jim Deutsch thinks that his wife's experience seeking care for her cataracts stems from a failure of Canada's medicare program.
Business
She paid $8,000 for cataract surgery at a private clinic on a doctor's referral. She says no one told her OHIP had a free option
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.
Business
She paid $8,000 for cataract surgery at a private clinic on a doctor's referral. She says no one told her OHIP had a free option
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.
ARTICLE CONTINUES BELOW
ARTICLE CONTINUES BELOW
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.
'Narrowly missed getting trapped'
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.'
Try Our AI Features
Explore what Daily8 AI can do for you:
Comments
No comments yet...
Related Articles
CBC
2 days ago
- CBC
Ontario doctors don't get paid when they treat uninsured patients. Here's how that might change
Several times a week, a man facing homelessness and mental health issues comes to the busy emergency department in downtown Toronto where Dr. Bernard Ho works, and doctors there treat him despite not being paid to do so. That's because the man doesn't have a valid health card — and he's not the only one. Ho said many doctors are forced to bear the cost of caring for people in need who can't prove they have health insurance. "We see them all the time. And unfortunately, we're not paid for them," Ho told CBC Toronto. Currently, most doctors across the province can't invoice the Ontario Health Insurance Plan (OHIP) for patients who can't prove they have coverage. The Ontario Medical Association is hoping to change that and is working to finalize a new compensation deal with the provincial government that includes the reintroduction of what it calls a "good-faith" payment policy, first scrapped in 1998. What is a 'good-faith' payment policy? 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 scrapped again in 2023. The Ministry of Health told CBC Toronto in a statement it's unable to comment on specific proposals while in active bargaining with the OMA. If the proposal is approved, the "good-faith" payment system would kick in under three scenarios, according to the OMA: Newborn patients experiencing glitches or delays while they await a permanent health card. People who are OHIP-eligible but don't have valid documentation or valid coverage, a category which could include people experiencing homelessness, mental health issues or other barriers to documentation. 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. 'Free for all' not the goal, OMA president says 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. "The Ministry may indicate that this is simply not their problem to manage … Some members of the public may feel similarly," the report says. Under the proposed policy, hospitals would need to make reasonable attempts to verify someone's coverage, said OMA president Dr. Zainab Abdurrahman. But if that's not possible, she believes the doctors caring for them should still get paid. "Our real focus is really the OHIP-eligible. Could someone [ineligible] slip in there? There's always a possibility," Abdurrahman said. "We're being very specific and very intentional … 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." 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. Similar programs exist across Canada: OMA 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. "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. 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. A similar policy was also recently implemented in Manitoba. Ontario doctors are close to a new compensation deal. Here's what it includes 7 days ago 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. 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. Ho says the policy could end up saving the province money, since people postponing care could face more serious health issues that need treating later on. "We do need to reduce these barriers to care and … create fair processes for these patients because they are disproportionately affected by this," he said. Abdurrahman said she's hoping for an update on the proposed policy this fall.
CTV News
06-08-2025
- CTV News
Ontario's family doctors could soon have a new compensation system. Here is how it will work
Ontario family doctors could soon be subject to a new compensation system as part of the province's efforts to incentivize physicians to work as general practitioners. Ontario Medical Association CEO Kimberly Moran tells CTV News that negotiations on the new system are ongoing but that she believes a deal can be reached within months. She said that while the matter is still under an arbitration board's review an agreement has already been reached with the Ontario government on 'most of the elements.' The focus of the new system would be to pay doctors for the time they spend doing administration, as well as the time they spend providing medical care, Moran says. Right now, family doctors are not compensated for the time they spend working on administration or with specialists on behalf of their patients. Instead, doctors operate under both a fee-for-service model, in which they are reimbursed under the Ontario Health Insurance Plan (OHIP) for every service they provide a patient and an enrollment system, in which they are paid a set amount per patient, regardless of how many times they see them. 'What this incentivized compensation model does is that it recognizes the work that's done by doctors that they have talked about as very challenging and that is a lot of critical administration,' Moran said of the new proposed model. 'It directly compensates that for them, so for example if you need referral to a specialization or if the family doctor needs to talk to your specialist about something, like none of that time is compensated. But now its going to be, so that's great.' Ontario has long had a shortage of family doctors. The provincial government has pledged to make sure that every Ontarian has a family doctor by 2029 and Moran said she is hopeful the new system will convince more physicians to enter family medicine. The OMA represents 31,500 practicing physicians in Ontario. 'The hope is that it will attract new physicians to the field, keep those who are practicing now and entice other doctors who have moved away from that kind of medicine back to practice medicine there,' she said. Ontario is short on doctors of all sorts but Moran emphasized the importance of family doctors right now. Right now, 2.5 million Ontarians are without a family doctor. 'What we wanted to do with this model was incentivize family doctors, those who have chosen family medicine,' she said. 'To have improved compensation is one of the ways we recruit and retain family doctors. It is going to be important over the next decade to make sure we have enough doctors through all of our specialties. But for this time, right now, where attachment to a family doctor is so critical, we wanted to focus here.' Moran said that under the existing payment system doctors were not compensated for the total time they spent with a patient who may come in 'with four, five, six different things to do.' She said that the new system 'means that if the doctor has to spend 45 minutes with a person who has lots of complexity, its going to be compensated properly.' Minister of Health and Deputy Premier Sylvia Jones was asked about the ongoing negotiations during an unrelated press conference on Wednesday but declined to comment, only offering that there were 'very positive movements' and that progress was being made. 'So, as we expand primary care clinicians, opportunities in communities, we want to make sure that those physicians, those clinicians, those nurse practitioners are well supported and we're doing that work with the OMA. I can tell you to date it has been very positive,' she said.
Winnipeg Free Press
05-08-2025
- Winnipeg Free Press
Guardians reliever Nic Enright, battling lymphoma, earns emotional first save
NEW YORK (AP) — The first career save for Nic Enright was a particularly meaningful one. Enright, who was diagnosed with Hodgkin lymphoma in late 2022 and is scheduled to complete his treatments later this year, allowed an unearned run in the 10th inning Monday night to close out the Cleveland Guardians' 7-6 win over the New York Mets. 'He was almost crying on the field just now,' Guardians manager Stephen Vogt said. 'If you read his story, it's pretty inspirational.' Cleveland selected Enright in the 20th round of the 2019 amateur draft out of Virginia Tech. He received his diagnosis Dec. 22, 2022 — 15 days after the Miami Marlins took him in the Rule 5 draft. After four rounds of immunotherapy in early 2023, Enright made nine minor league rehab appearances for the Marlins before being designated for assignment and returning to the Guardians in late May. He missed most of last season due to a right shoulder strain, but went 2-1 with a 1.06 ERA in 16 appearances with Triple-A Columbus. The right-hander has one more round of cancer treatment scheduled for November. 'I made the decision when I was diagnosed in 2022 with Hodgkin lymphoma that I wasn't going to let that define my life and dictate how I was going to go about my life,' Enright said. 'It's something where, for anyone else who is going through anything similar, (it shows) I haven't just holed up in my house and felt sorry for myself this whole time.' Enright made his major league debut May 25 and has a 2.01 ERA in 19 appearances for the Guardians, whose bullpen is in flux with All-Star closer Emmanuel Clase on paid leave as part of a sports gambling investigation. Hunter Gaddis and Cade Smith pitched the eighth and ninth innings Monday before Enright entered with a two-run lead. He gave up a two-out RBI single to Brett Baty before retiring Luis Torrens on a fly out to the warning track in right. 'I definitely held my breath as I saw Nolan (Jones) kind of keep running,' Enright said. 'But I had faith. As he kind of got closer to the wall, I realized it was losing steam.' Enright was showered with beer by teammates in the locker room. Thursdays Keep up to date on sports with Mike McIntyre's weekly newsletter. 'I was so happy, oh, I was going nuts in here,' Guardians starting pitcher Slade Cecconi said with a smile. 'I was going absolutely berserk. He came in running up the stairs, smile on his face.' Enright thanked his wife, his parents and the rest of his family for their support throughout an interview at his locker. He got the ball from the final out and plans to set aside his uniform and hat as well as a lineup card. 'Really, really cool,' Enright said. 'These last couple of years, especially, I've gone through a lot of adversity and just everything that's gone on. And so for me, it's being able to reflect on those in these moments. I think that helps being able to slow the game down. Because it hasn't exactly been a red-carpet rollout for my career trajectory.' ___ AP MLB:
