A public health-care advocacy group is calling on the Ontario and federal governments to investigate what it describes as “exploitative and predatory” instances of extra-billing by private clinics for cataract surgeries around the province.
According to the Ontario Health Coalition (OHC), clinics routinely charge patients for cataract surgeries that should be covered under OHIP and to skip reportedly long wait times. Both practices are known as extra-billing and are illegal under Ontario law and the Canada Health Act.
Cataract surgery is considered a “medically necessary surgery” by the province, so even if a person opts to go to a private clinic they shouldn’t be billed for the basic OHIP-covered procedure, which includes eye measurements. It is also illegal for doctors to charge patients to give them speedier care, although the OHC claims ophthalmologists will often say wait times are longer than they actually are to encourage patients to pay money.
On top of the extra-billing, the OHC alleges private clinics are charging patients for add-ons, including specialty lenses, under the guise that they are medically necessary for cataracts.
“These are exploitative and predatory practices against patients,” said Natalie Mehra, the executive director of the OHC, at a virtual press conference Tuesday morning announcing separate complaints addressed to
the Ontario and federal ministers of health that include patient reports and bills.
The Star has
previously reported on similar cases involving patients — many of whom are older and worried about losing their vision — paying from hundreds to thousands of dollars for their cataract surgeries after feeling pressured by private ophthalmologists to pay out of pocket for so-called faster or better care.
The OHC made its two complaints on behalf of 50 patients, four of whom were at Tuesday’s press conference to share their experiences navigating the private clinic system.
“I was shocked,” said Diana Ralph from Ottawa. “It felt like being in a car dealership.”
In 2024, Ralph went to two separate private clinics to get surgery for her cataracts. She paid the first clinic $1,300 to jump what she was told was a wait-list more than a year long. But after that clinic said she would still have to wait a year for her surgery despite paying out of pocket, she went to another private ophthalmologist, where she paid over $1,000 to remove the cataracts on only one of her eyes.
Meanwhile, Maureen Munro said she paid nearly $7,000 for her surgeries when she went to what her optometrist allegedly described as “the best eye surgeon” in London in 2022.
“Being on a pension, it’s tough,” Munro said. “Nobody has that amount sitting around.” She said she had to borrow money from her bank to pay for her operation.
The complaints come at a time when the provincial government continues to expand the number of privately run surgical and diagnostic centres performing cataract procedures, a move first announced two years ago.
Along with investigations, the OHC wants the province to reimburse patients who say they have been overcharged and to fine the clinics that are found to have done extra-billing.
As for the federal government, the coalition wants Ottawa to “bring Ontario” into compliance with the Canada Health Act — which allows the federal government to claw back a certain amount of funding for a province’s medicare program if the provincial government finds that extra-billing has taken place.
Health Canada did not reply to the Star’s request for comment by publication, while Ontario’s Ministry of Health directed the Star to its previous statements when asked for comment on the OHC’s complaint.
“This is a repeated story by the OHC, and as such, we have nothing further to add at this time,” the ministry wrote in an email Tuesday.