Ontario government tells Ottawa woman OHIP won’t cover $110 Pap test from Appletree clinic

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An Ottawa woman who was charged $110 for a routine cancer screening test done by a nurse practitioner has been told by the Ministry of Health that she is solely responsible for that charge.

Eileen Murphy was outraged after being charged $110 last month for a routine cancer screening test with a nurse practitioner located at the Appletree clinic where she is a patient. She has a family doctor at the clinic but that doctor had relocated to northern Ontario so she was advised to book an appointment with a nurse practitioner for the procedure. When she did, she was presented with a list of fees, to her shock.

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The procedure, which is part of the province’s cancer screening program, would have been covered by the Ontario Health Insurance Plan if it was done by a physician, or even it if was done by a nurse practitioner who is part of a health team and whose salary is covered by OHIP.

In Murphy’s case, it was done by a nurse practitioner working independently, something she didn’t know in advance. Since they are unable to bill for services under OHIP, as doctors can, the service — although it is considered basic primary care — is also considered “uninsured”  by the province, according to a letter she received from the ministry after complaining.

“We hope you can understand that the ministry does not regulate charges for uninsured services or for services rendered to uninsured persons, nor does it set prices for uninsured services. Patients are responsible for any charges for uninsured services,” she was informed in response to an email she sent to Minister of Health Sylvia Jones last month.

That is in contrast to messages that have come from the minister’s office in recent months as nurse practitioner clinics charging fees for primary care services have continued to open across the province. Among other things, the minister’s spokesperson has said the province would not stand for clinics charging for insured services.

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But observers and some who run the clinics say they are legal because independent nurse practitioners are unable to bill OHIP for services, and they are meeting a demand. The letter to Murphy seems to support that view, in contrast to the message from the minister’s office.

A spokesperson for Jones said at the time that the ministry would investigate the clinic. Spokesperson Hannah Jensen added: “We will not tolerate any clinics taking advantage of a loophole created by federal legislation and charging patients to access primary care.” The minister’s office also called on the federal government to close what they termed a “loophole.”

The minister’s office did not immediately respond to comment for this story.

The message Murphy received from the Ministry of Health’s correspondence services in response to her complaint takes a different tone – essentially that clinics charging for care given by nurse practitioners are able to do so and patients are responsible for those uninsured fees.

Murphy was also told that the College of Nurses of Ontario has an independent practice guide for nurses in independent practice that outlines expectations, including setting fees. She was directed to the regulatory body for any further concerns.

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Nurse practitioners in independent practice (meaning they are not part of a ministry-funded clinic) cannot charge the OHIP for their services, as doctors can.

In Ontario, where nurse practitioners can perform many tasks that family doctors do, and some 2.3 million residents are without primary care, nurse practitioner clinics that charge fees for care are increasingly popping up. Ottawa has several, including at the Appletree clinic where Murphy is a patient as well as a Kanata clinic that charges patients an annual $600 access fee for primary care delivered by nurse practitioners. Neither one responded to requests for comment.

Murphy was angry that she had to pay for the routine Pap test, which she had after receiving a notice from the Ministry of Health telling her she was due. Although she is a patient at the Appletree clinic near her home, she was informed that her doctor had moved to northwestern Ontario and was directed to book an appointment with nurse practitioners at the clinic, not knowing she would be charged for the service. She was also charged a premium because she is over 50. She says she was unwillingly placed into a pay-as-you-go system.

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Critics, including Opposition NDP Leader Marit Stiles, have urged the provincial government to ban the charging of fees for primary care delivered by nurse practitioners, saying such clinics prey on the desperation of growing numbers of people without doctors.

The provincial budget, delivered on Tuesday, included a $546-million increase in funding for family health teams, which the government says will connect 600,000 patients with new family doctors or primary care. Earlier, it announced $100 million for family health teams, many of which will include nurse practitioners and some of which will be led by nurse practitioners. Those clinics will be fully covered by OHIP because they are part of a model in which health workers receive a salary.

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