Tuesday, April 20, 2010

OHIP


In Ontario, most people are covered by OHIP, which is the Ontario Health Insurance Program. Basically, when you see a Doctor or other health care professional, you present your OHIP card, and the service provider bills OHIP for their services - you don't pay anything. Well, that is the way it works in most cases - there are some services that are not covered by OHIP.

Anyway, the other day I got to wondering if there was any way to reconcile what OHIP is being billed vs what services I actually got. I wanted to see if the health care practioners were being honest, and not billing for services I never got. I also wanted to see exactly how much they were charging OHIP for their services. For example, how much if any, is my doctor billing OHIP for prescription refills made over the phone by my drugist.

After searching the various OHIP website pages, I could not find anything. So, I sent off a note to the main contact listed for OHIP explaining that I wanted to see my OHIP records for 2009 and 2010 year-to-date. To my surprise, I got a reply which detailed the process:
Dear Sir/Madam,

Thank you for your e-mail sent to ServiceOntario for the Ministry of Health and Long-Term Care.

A Personal Claim History (PCH) is a summary or listing of all services received under a person's Ontario Health Insurance Plan (OHIP) health card number. It is not an individual's personal medical record history, but rather, a payment record of medical claims submitted by health care providers against a specific health number.

A PCH may include details such as: date service was received, fee paid to the health service provider, health number, patient's name, fee schedule code, health care provider's name, date the claim was approved for payment by the ministry, etc.

The ministry's databases keep fee for service records for seven years, plus the current year.

This signed request must be made in writing (no special form is required) and include the following information:

  • health card number
  • date of birth
  • time frame of history
  • mailing and physical address (if different)
  • signature and date

The request can be sent to:

Ministry of Health and Long-Term Care
Personal Health Information Office
Corporate Administration Services
49 Place d'Armes, 4th Floor
P.O. Box 48
Kingston ON K7L 5J3

There is no fee for this service when the request is performed by the original cardholder.

Thank you again for your inquiry.

Regards,
M. Steinbok
Customer Service Agent
ServiceOntario -- making it easier
Visit us at: www.ServiceOntario.ca

So, I sent off a letter today, requesting my history of OHIP billings for the past year and a half. Now I wait for the reply.

I post this here for all people of Ontario: you should be requesting a similar history and comparing it to your actual medical services that were rendered to you. No one else is going to audit your records.

14 Comments:

Anonymous Anonymous said...

OMG....Thank You,Thank You, Thank You...I have been looking EVERYWHERE for this information..:o)

10:54 AM, June 15, 2010  
Blogger Anon Emous said...

You're welcome. I got my report a few weeks after making the request. The only problem is that is contains differnt codes for different services, and I really don't have a list of what these codes mean.

12:38 PM, June 15, 2010  
Anonymous Anonymous said...

Thank you very much .It's really useful information. I was so frustrated that Canada doesn't have a system that allows people to audit their OHIP fraud.surprisingly I got the letter and I discovered that i made an operation last month which i never did.

4:05 PM, July 27, 2010  
Anonymous Anonymous said...

BRILLIANT! GOOD FOR YOU! we should all challenge our physicians to not enrich themselves from the system's back...

8:47 PM, December 02, 2010  
Anonymous Anonymous said...

I found about this process as well last week when I called Service Canada. I needed such a record to provide to another govt. agency as proof of my doctor visits. Unfortunately as I did not find a family physician until 6 months back, even though I have been in Canada for 5 years, I called Service Canada.
I have mailed that letter last week and was told it will take 30 business days.
It is pretty ironic they don't publish what the service codes translate into, in the history they send.

2:45 PM, February 18, 2011  
Blogger All Things West Indian said...

Does anyone know if there is a fee to obtain ohip records of ones self.

I ask this because i was in an accident and a lawyer was handling my claim. After the settlement he took 75% of my settlement and charged me fees that I believe was fraudulent. For example; he charged me for obtaining ohip records. He charged me $2500 for photo copying..and it was about 200 pages.

He also charged me for obtaining my ODSP RECORDS.

i NEED to know if these charges were legitimate.

I would appreciate any light that can be shed on my issues. I know I would be responsible for disbursements and have no problem paying them...but I have a feeling that I was gouged by this lawyer nad i'm really feeling like an idiot if he gets away with it.

thanks again

F

10:43 AM, May 27, 2011  
Blogger All Things West Indian said...

Hi all. I really need some sound answers to my question.

Here's my situation.

I was involved in an auto accident and hired a lawyer to handle my claim. After the claim was settled, the lawyer took almost 75% of the money. He charged me for obtaining records from OHIP, ODSP ETC...HE CHARGED ME $2500 FOR PHOTOCOPYING WHEN MY FILE WAS ABOUT 200 PAGES.

My question is; is there a fee for obtaning my ohip and odsp medical records?

Thanks, I would appreciate any assistance you can provide.

Out of $15.000,,,the lawyer took $9,700..leaving me with $5,300

10:48 AM, May 27, 2011  
Blogger Anon Emous said...

There is no charge for this service.. And you can request all your OHIP records back to any date, for example the last 5 or 10 years. The only catch is that you must make the request in writing and submit via Canada Post — they do not accept email or phone requests

10:32 AM, May 28, 2011  
Blogger tanbir said...

thanks a lot. this was a great help for me too.can you pls tell me how long it took for you to obtain the information? Its been over a month since I applied and still waiting for the record.

5:16 AM, March 13, 2012  
Blogger Anon Emous said...

Tanbir,

I received my package in about 3 weeks. Wait another week, and if you still have not received it, call Service Canada.

7:59 AM, March 13, 2012  
Anonymous Anonymous said...

how do we make this request.Please give me a format for this
thanks
hasan

2:10 AM, August 01, 2012  
Blogger Anon Emous said...

Hassan, no special format is required.. Just write a letter and include the nesceesar information.

9:20 AM, August 01, 2012  
Anonymous Anonymous said...

The OHIP service codes are all publicly available here:

http://www.health.gov.on.ca/english/providers/program/ohip/sob/physserv/physserv_mn.html

5:02 PM, November 21, 2012  
Anonymous Anonymous said...

Yes just google ministry of health schedule of benefits. I bill ohip and it can be tricky with codes. Basically they get a consult for seeing you then the fees for whatever you had done on top of that.

10:33 PM, December 13, 2012  

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