Everyday, family physicians encounter overwhelming requests for medical services falling outside the Ministry’s OHIP coverage, commonly referred to as uninsured services. Despite the significant time commitment involved and the OMA updates the Uninsured Services Guide every January, many physicians are not billing their patients. While various reasons may exist for not collecting payment, the reality is that many primary care doctors are unaware of the overall cost incurred to their practice by not charging for these non-OHIP covered services.

In this blog, we take a deep dive into the time and costs associated with delivering commonly requested uninsured medical services and provide insight in finding the right balance.

The Rise in Health Care Costs

As health care costs rise, the Ministry continually moves formerly insured services to the uninsured category, transferring the financial burden from the Ministry to physicians. Family physicians, lacking the authority to determine what falls under insured or uninsured services, find themselves having to directly charge their patients for their time and efforts instead of relying on Ministry reimbursement. It is becoming more important for doctors to understand how much time and money they are losing by not charging for these uninsured services.

To gain insight into the importance of billing for uninsured services, we spoke with Dr. Fadie Amin, a full-time family physician practicing comprehensive care. Dr. Amin shared insights into the most common uninsured services and the average time physicians spend on them.

Prescription Renewals by Fax

One of the most frequent daily uninsured services family physicians are tasked with is handling prescription renewals (medication refills) faxed in by the patient’s pharmacy upon patients’ requests. Despite being a relatively straightforward uninsured service, the sheer volume of these daily requests presents a time-consuming task for both staff and doctors. On average, depending on the practice size, physicians may need to manage five to 15 or more prescription renewals daily.

Service Completion Process:

1. Receipt of faxed request.
2. The requested renewal is added to the patient chart.
3. The physician reviews the request, and necessary documentation is added to the patient’s medical file.
4. The prescription is faxed back to the pharmacy.

Often, there may be a back-and-forth exchange between the physician and the pharmacist if the requested medication(s) is/are on backorder and must be temporarily substituted with an equivalent.

Time and Cost Allocation:

• Time to complete service: 5-10 min per patient (average of 3-5 minutes for physician and 5 minutes for staff)
• OMA suggested rate: $25 per patient

Note: All rates mentioned in this blog are based on the OMA’s Physician’s Guide to Uninsured Services.

Missed Appointments

Although it sometimes cannot be avoided, when patients miss scheduled appointments, it directly results in financial losses as those time slots could have been allocated to other patients, generating revenue through billed services. On average, doctors experience five missed weekly appointments, each lasting at least 15 minutes (physical exams are also routinely missed, and between 30-60 minutes is blocked off on a physician’s schedule for these visits).

Process of Completing the Service

1. The physician or staff contacts the patient to notify them of their missed appointment and the associated fee.
2. Collect payment.

Time and Cost Allocation:

• Time for patient calls: 5 minutes per patient
• OMA suggested rate: $55 per patient or 5 minutes of a physician’s hourly rate ($663.50 per hour)

Attending Physicians Statement (APS)

An APS is a report detailing a patient’s health condition, often requested by third-party insurance companies or workplaces. These reports are typically written for patients if they need time off work (or modified duties) for medical reasons. Following the COVID-19 pandemic, there has been a significant influx of individuals taking time off, attributed to both physical and mental health conditions. Physicians receive an average of at least three APS requests weekly.

Service Completion Process:

1. Completion of a report with a series of questions. Depending on the severity of the medical condition, the report can range between 2-20 pages. Often, patients are asked to schedule an appointment to complete the questionnaire.
2. The physician must send the report to the third-party insurance for review. There is significant communication between the insurance company and the physician as they work together to determine the coverage for the provided service.

Time and Cost Allocation:

• Time to complete service: 1 hour per patient
• OMA suggested rate: $160 or physician’s hourly rate ($663.30 per hour)

Massage, Chiropractor & Physiotherapy Notes

Physicians provide notes to third-party insurance companies for patients’ massage, chiropractor, and/or physiotherapy needs. On average, a physician may receive about four to five of these requests weekly.

Process of Completing the Service:

1. Physician books an appointment with the patient to complete the note request.

Time and Cost Allocation:

• Time to complete service: 5 min per patient
• OMA suggested rate: $37 per patient