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Survival Tips for the OHIP Jungle

By Dr. Peter W. Kujtan, B.Sc., M.D., Ph.D.

Article printed on page 13 in the April 29 - May 1, 2005 issue of
The Mississauga News under the feature: Health & Wellness, Medical Matters.
Portrait of Dr. Peter W. Kujtan, supplied 2005
Dr. Peter W. Kujtan

OHIP is basically an insurance plan with no premiums. It is not free, and falls extremely short of covering everything. When patients do not understand the rules, the primary care physician begrudgingly transforms into a pseudo-bureaucrat forced to explain rules and ward off bartering. The number of people who think that doctors are employed by OHIP and can bend rules is truly mystifying. Understanding some of the rules empowers you to make more efficient choices. Here are a few tips to help you.

Making appointments. Decades ago, things ran on first come, first served basis. Today, many physicians' offices use computer-assisted managed time booking systems. These allow pre-booked and emergency slots to be combined. Things tend to run on time at the beginning of the day. Receptionists ask questions only to find out how much physician time they need to book. They really do not need to know the problem. Most appointments run about 15 minutes with about 8-10 minutes being direct physician contact time. The rest is devoted to check-in, phone calls, charting, letters, updates, and room preparation. Arriving 15 minutes late essentially cancels your appointment. OHIP does not cover missed appointments. You become responsible for these costs. Your OHIP insurance is designed to cover ONE medical problem during this time. You are entitled to two counseling appointments and one general physical in a calendar year, both entities allowing a generous 20 minutes of contact time. Try to avoid bringing "lists of problems." Your plan does allow you to book multiple visits on different dates to assess different problems. A "double-book" is an appointment to assess an urgent need. The time is only approximate. These patients are squeezed in when someone is late or fails to show.

Many patients complain about the time constraints that the OHIP plan places on their visits. One solution is to book a non-OHIP visit where you get 30 to 60 minutes of undivided attention. Not all primary physicians offer this type of visit, and costs run between $75 and $150.

Another tip is to keep a written journal of all medications and doses that you require. The journal can be used to track visits and also as a communication tool between your various health care providers. Medical information is the slowest moving entity on earth. Her Majesty's snail-mail has been the norm for the last 600 years. The computer chip has been dangled in front of the medical clan for decades but attempts to embrace integrated transfer of information have been repeatedly met with moral, legal and financial arguments. Do not believe anyone who tells you that medical results will be at your doctor's office tomorrow!

Specialist referrals. OHIP rules specify that certain conditions must be met in order to be referred to a specialist. Your primary care physician has to assess, make notes and basically claim for the problem first. He then must write to the specialist stating his assessment and ask for a consultation. OHIP also frowns on multiple referrals at the same visit. I usually code my visit to match the problem. This ensures that the specialist will be compensated when you see him or her. The specialist will send a written consultation back to your primary care physician down the road. You cannot call your GP (General Practioner) and ask for a referral, nor can you call the specialist and make your own appointment. However, to shorten a waiting list, you may want to call around to see which specialist is seeing patients the soonest and inform your GP. Making specialist appointments is considered part of the visit fee by OHIP. Unfortunately, the time element to accomplish this task is so great that it can quadruple the visit time and results in significant patient bottle-necks in offices. One of my pet peeves is that walk-in clinics will generally refer you back to your primary physician to perform this complex non-compensated task. It is viewed as difficult "pro bono" work, and every opportunity to download is taken.

Walk-in clinics. Although convenient, in the long run it can work against you. There are only two clinics in the entire city that will inform me when they have seen a patient of mine. This means that your medical information gets scattered in multiple places. No one looks at trends, and missing pieces make comprehensive care almost impossible. I myself work in an after-hours clinic once in a while. I am amazed at how different attitudes are. The majority of patients show up with one fairly straight-forward complaint, proving to me that OHIP works best on the impersonal level. No forms, no referrals and instead of lists, people can't seem to run out the door fast enough. I feel little stress and my bottom line can increase doing this mindless impersonal type of work, but I do not find it gratifying.

One of the most resentful encounters in medicine occurs when a long lost individual appears at the office door claiming to be a patient or "best friend" with a lengthy yet vague tale of multiple walk-in visits, tests in different locations, various treatments and frustrations, all followed by a long list of inflated promises made by others on my behalf. Occasionally, they bring short notes from various clinics applauding how skillful I am in performing miracles. I open their chart to find emptiness interspersed with a few notes about missed appointments. Despite my temptation to ask Revenue Canada for a second opinion, these rare finds proclaim themselves as bona fide taxpayers who are gracing me with a rare opportunity to serve their needs, and spend the next month working exclusively on their behalf. Nonetheless, we do take a stab at attempting to shed light on the problems despite the obvious obstacle sitting in plain sight. Tests are arranged, referrals made and demands for temporary narcotics are negotiated to a stalemate. Three months later? You guessed it, OHIP deems the health card invalid and the patient never did follow through on any of the time-consuming arrangements and has moved on to the naturopath. All in a day's work? Perhaps, but in Ontario it is more like: "All in a month's work."

Related resources:

Ontario Health Study. The Ontario Health Study is a large, long-term study involving 150,000 participants across the province. The Study will follow participants for at least 20 years to create an "information bank" that scientists can use to help understand how our genes, environment and behaviour work together to affect our health over time. This may ultimately improve prevention and early detection of a wide range of illnesses. How to Enroll.
Ontario Health Insurance Plan from Ontario Ministry of Health and Long-Term Care.
Fact Sheets - Publications: Ontario Health Insurance (OHIP).
Forms and Applications - Forms Online: Ontario Health Insurance (OHIP).
Questions and Answers: Ontario Health Insurance (OHIP).
Health Services in Your Community: OHIP Offices - Ministry Office Locations and Hours of Operation.

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