Uninsured Services: Fees and Charges

Bulletin, Mar. 1997

From time to time, the College receives inquiries from patients with respect to the costs associated with the provision of uninsured services. In some instances, the inquiry is simply to confirm that some services previously provided by O.H.I.P. are no longer insured services. In other instances, the inquiry deals with an unexpected bill for services provided.

When a patient is informed only after the fact that there will be charges for services provided, there are often feelings of anger and frustration. Patients understandably feel that they have not been dealt with fairly by their optometrist and, in reality, they have not been treated fairly by their optometrist.

Optometric patients have the right to know in advance of any services to be performed, and what, if any, the fees will be for the services. The patient given this information may consent to having the service(s) performed or the patient may refuse the service(s). This sharing of information, and the patient’s right to accept or reject the service(s), is part of the tenet of informed consent.

An effective way to ensure that the patient knows in advance that certain services to be performed are the patient’s financial responsibility is direct verbal communication between the optometrist and your patient. This should occur at the start of the examination and during the examination if additional tests are required.

Patients both expect and appreciate the optometrist taking the necessary time to discuss proposed clinical services and the fees for those services before the services are rendered. This type of communication allows the patient to be more directly involved in his or her own care. It allows the patient to know what tests are to be performed, and why they are performed. This dialogue improves the quality of the relationship between the optometrist and the patient.

It is good for the professional and the patient to have open and honest communication about the financial arrangements that exist between both parties.

Failure to provide a patient with advance information regarding any services to be provided, the nature and reason for those services, and the fees involved may be considered a matter of professional misconduct under O.Reg. 859/93, s.1.53, the Optometry Act, 1991.