"When the OHIP claim for a newborn dying at a Toronto-area hospital was rejected, Dr. Jane Healey faced a difficult choice: forgo her pay or ask the grieving parents to go stand in line at Service Ontario. The baby died of a genetic condition after 10 days, Healey said. In the end, she decided against bothering the family. That means that we aren't remunerated for some of that very difficult, highly emotional work that stays with you, she told CBC Toronto. And, Healey says she isn't alone."
"OHIP billing issues have become a sticking point for physicians as they work to finalize a new compensation deal with the province. Last month, an arbitrator directed the two sides to come up with solutions quickly. Over 99 per cent of claims are paid automatically as submitted, reflecting the system's productivity, said Health Minister Sylvia Jones's spokesperson, Ema Popovic. That's true, the Ontario Medical Association acknowledges. But there are over 200 million claims that get processed every year meaning about 1.16 million claims are rejected annually."
"Healey, who is also the OMA's section chair of pediatrics, says she and her colleagues have seen OHIP billings not be resolved because some procedures, like surgeries to reattach limbs, are too complex or involve multiple physicians. Of the claims that don't get paid automatically and are sent for a manual review, the ministry said two-thirds are categorized as complex surgical claims, where there are multiple procedures performed."
An OHIP claim for a newborn’s death was rejected, prompting a pediatrician to absorb unpaid work rather than burden grieving parents. More than 200 million claims are processed annually, with about 1.16 million rejected each year. Over 99 per cent of claims are paid automatically, but many unpaid claims are routed to manual review. Two-thirds of manually reviewed cases are complex surgical claims involving multiple procedures and physicians. Physicians report unpaid, emotional work and fear that billing disputes deter complex or innovative surgeries. An arbitrator urged quick solutions; the ministry reports most reviews resolve within 30 days and appeals are available.
Read at www.cbc.ca
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