Lois Cooper says she was sold thousands of dollars in extra services at a private, for-profit clinic, and when she started asking questions, the doctor told her to leave. She is not the only Canadian to have suffered this dubious practice.
It’s the pile of bills that sums up his medical journey.
“That’s the note I made when I got the phone call in January,” said the 75-year-old from Gravenhurst, Ont. “And I was told there would be a $150 fee… That was the beginning of starting to pay for stuff. »
Cooper had a macular hole in his right eye and needed medically necessary surgery called vitrectomiea procedure where the surgeon removes the gel-like substance around the eye called vitreous and replaces it with another solution.
Cooper was referred to a private, for-profit clinic north of Toronto, but before the operation began, she was asked to sign for optional tests, services and procedures.
At later appointments after the operation, the doctor told her she would have to keep her face down for two weeks – and that would require hiring a special wedge-type pillow. He also recommended glasses that would refract his vision. Months later, he recommended laser surgery to eye floaters, which Cooper says didn’t work. He even said he detected a mass behind his other eye that would require further surgery.
A second opinion from a Toronto doctor revealed that there was no lump in his eye.
Health Canada reports show that private for-profit clinics are selling patients extra services they don’t need. An Ontario patient says a private clinic got her approved for additional services that cost her thousands of dollars and even tried to get her to have another surgery she didn’t need.
When Cooper asked questions, she was shown the door — but not before being held liable for nearly $8,000 for appointments, equipment rentals and procedures.
Cooper was sold.
“I wouldn’t have spoken if I hadn’t heard Premier (Doug) Ford say these private clinics won’t charge you money, won’t charge extra,” she told CBC News. “I feel like it’s my public duty to say that’s not true.
What is upselling?
According to Dr. Danyaal Raza, a family physician at St. Michael’s Hospital in Toronto, upselling occurs when a patient is asked to pay for additional uninsured services while undergoing a procedure that should be covered by the public sector.
This is different from additional billing. This is when a private, for-profit clinic would bill the province for a procedure covered by government health insurance while also billing the patient.
Health Canada reports show that between April 2019 and March 2020, private for-profit clinics illegally sold and billed Canadians for tens of millions of dollars.
Early March, the federal government announced that it would cut more than $82 million in transfer payments to the provinces in cases where patients had to pay out of pocket for care that should have been covered in 2020-21.
“You’re paying out of pocket for health care you shouldn’t be paying for, and clinics aren’t allowed to bill you,” said Andrew Longhurst, a health policy researcher at Simon Fraser University in Vancouver.
Raza said it’s a slippery slope between extra billing and upselling.
“I think we have to be concerned about upselling, because that’s the thin edge of the corner towards extra billing, where patients are told that they can only get something that’s covered by the public if they pay out of pocket. »
How does upselling work?
Upselling can start with the power dynamics that often exist between patients and healthcare professionals. Cooper said it definitely started that way for her.
“I was sent there by my medical professional. So that would mean to me that’s where you should be and that’s how it’s done, and that’s what’s expected and you do it. »
Once she arrived in what she described as a “large warehouse with no ceiling” full of people, she had to sign documents before anyone saw her.
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It’s a situation, according to Raza, that’s filled with subtle pressure.
“You are not a doctor, you are not a nurse. You don’t have 10 years of medical training under your belt. So you’re at a huge disadvantage when you’re presented with information,” he said.
Cooper signed the paperwork, which she showed to CBC News, and underwent her vitrectomy. During the operation, she said, her retina was torn and she was told the cataracts had been removed, even though Cooper never knew she had cataracts.
She said she had regained sight in her right eye. However, on subsequent visits that cost her $150 for each appointment, the surgeon said he found a cataract in her other eye, told her she had dry eye disease, and convinced Cooper to have surgery at the laser for floaters.
Also, the equipment Cooper’s doctor told him to rent after the initial surgery, such as the special goggles and pillow, should have been covered by the government since it was a medically necessary procedure.
The bills eroded Cooper’s faith in a medical system that should protect patients.
“I don’t know if it’s illegal, but it’s unethical. I think the behavior is unethical,” she said.
Cooper would not publicly name the clinic. CBC News contacted the clinic for comment, but did not receive a response.
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Why should we care about upselling?
Dr David Urbach, chief surgeon at Women’s College Hospital in Toronto, said upselling is built into the business model where public money goes to private for-profit clinics.
“I don’t think they can be a viable business unless they get paid beyond what the government already pays public hospitals, or they levy all these unnecessary charges,” he said. he declares.
What worries Raza is what he calls “the slow creep”: As more patients are persuaded to spend money on additional tests and procedures, they may become accustomed to the practice.
“If you’re already used to paying out of pocket for uninsured services, suddenly paying for that insured service seems normal,” he said.
What can the public do?
Ultimately, Cooper started asking questions when he was told there was a mass in his eye that would require another vitrectomy.
“I asked him to explain the mass to me, and he looked at me as if I had three heads,” she recalls.
When she asked more questions, the eye doctor told her to leave. “And then he turned to his assistant and said, ‘Upload this to OHIP. « »
Despite her ordeal, Cooper is happy that the initial surgery to fix the hole in her eye was successful. Her vision isn’t perfect, but she can read and drive. But her story is a cautionary tale and she wants others to learn from it.
“I just want people to know that when they go to a private clinic, make sure you ask questions, don’t sign any papers. Go there first and get all the info on what they’re going to expect from you, then maybe go talk to someone else,” Cooper said.
“If you’re in a medical appointment and you’re asked to pay for a medical service, you should always ask whether or not you have to pay that fee to get the care you came for,” Raza said.
He added that if a patient feels they have been unfairly charged for a medical service performed at a hospital, they should contact the hospital’s patient relations department.
Unfortunately, Raza said, too much is being put on the patient to deal with at a time when they are most vulnerable.
“If I ask, ‘Am I going to be denied care, am I going to be placed at the end of the line?’ — it’s overwhelming, and frankly, we shouldn’t really expect or ask patients to be able to decode federal and provincial laws. »
