When a newborn passed away due to a genetic condition at a hospital in the Toronto area, Dr. Jane Healey faced a tough decision: either forego her payment or request the grieving parents to visit Service Ontario for resolution. Ultimately, she chose not to burden the family.

Dr. Healey, who serves as the OMA’s pediatrics section chair, highlighted that complex surgical claims, such as procedures involving multiple physicians or intricate surgeries, often encounter payment issues. This can discourage doctors from pursuing innovative and complex medical procedures.

To address these challenges, an arbitrator has instructed both the province and the OMA to collaborate on solutions concerning good-faith payments and the manual review process for intricate OHIP billing cases. The OMA advocates for reintroducing the good-faith payment system to allow invoicing for patients without valid health cards, like newborns, and individuals in critical conditions without insurance coverage.

Regarding the manual review process for complex OHIP billing, the OMA proposes establishing an OHIP ombudsman office staffed with clinical experts to expedite resolutions. Dr. Zainab Abdurrahman, the OMA president, emphasized the need for clinical expertise in reviewing medical documentation to prevent delays and issues in payment processing.

While the ministry claims that the majority of cases are resolved within 30 days and doctors can appeal outcomes, the OMA asserts that having non-clinical experts review medical notes poses challenges. Despite ongoing efforts to streamline the billing system, the OMA and the province must find common ground to avoid further arbitration come the new year.

The focus is on resolving billing discrepancies and improving the efficiency of the payment system for the benefit of both physicians and patients.