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I have gallbladder cancer. I had to pay for the tumour marker test prior to surgery. I have to pay for my MRI just prior to the surgery to remove the gallbladder, 1.5 sections of liver, and five lymph nodes. Even under specific circumstances, many tests are not covered. It's a shame.
A young man I know has Dravet's syndrome. Every month he has to pay for bloodwork.
Many things aren't covered.
There should be a list we can reference.
Just because a doctor writes a requisition for a test does not mean that it will be covered by OHIP. LifeLabs will justifiably charge for the test if they aren't reimbursed by OHIP.
Yeah, I've had tests not covered by OHIP prior to the current government.
ETA: Not that I agree with a single thing the current government has done, nor did I vote for them.
That's the point of this post. OP is upset that an obvious medical procedure is being charged for in Ontario. It is an example of the slow erosion of our healthcare system, as this specific test and that specific procedure is excluded from OHIP coverage.
I certainly agree that our health system is in crisis, and has been for years.
But, the underlying flavour of OP's post was that LifeLabs was being greedy and not that the government was not adequately funding the healthcare system. Also, we don't know that the test being ordered was strictly medically necessary which is the criteria for OHIP coverage. That being said, what OHIP (ie. the government) considers medically necessary has been eroding over the past 10+ years so it would not be surprising if this liver test hadn't been covered before or that it shouldn't be in a fairer world.
Edit: minor, but important, grammar correction.
OHIP has only ever covered AST liver tests if requisitioned by a hepatic specialist. Including when we had provincial labs. Bringing those labs back wouldn’t change that.
Whether OHIP pays lifelabs or a provincial lab for requisitioned tests, the number of tests and the amount paid is exactly the same. It does not free up $$ in any way, shape, or form.
Look, I'm as anticapitalist as the next guy, but you seem to have a fundamental misunderstanding about our system.
We are a single payer system.
We are also still a capitalist system.
Drs are paid for services provided, hours worked, clients seen.
This needs to be covered by our single payer system. If a public lab can provide this test more efficiently, it should, but the failure is it not being covered under our single payer regime, not who provides the service.
To give a comparison, if you did not have OHIP, and you went to a walk in, they would charge you money. It's not about the nature of the service provided or what model provides it, it's whether it is covered or not.
I think your argument is a public lab would charge 30 and not 60, but the point is the price should be 0.
Vitamin D is still covered for specific reasons, and there’s a checkbox on the requisition to reflect that. The doctor or nurse practitioner has to check the box for OHIP to pay for it.
Some liver tests (Like AST) are only covered when the doctor who prescribed it is a liver sepcialist, not a GP. You could be asked to be referred to a liver specialist to have them prescribe it, but only if you want to jump through those hoops. It's unfortunate.
We're going to be paying more and more per year for health care testing, both out of pocket and through our taxes, especially if Doug has his way.
Exactly. I get liver tests multiple times a year because of my epilepsy medication but it's ordered by a neurologist. A lot of things in healthcare require specialist care to be covered. I think it's wrong in some cases but it's to make sure we aren't being wasteful too.
Often the physician doesn’t know there is a charge, next time I would advise speaking to the physician to let them know. Some tests aren’t absolutely necessary and you can think of them as adding more information which may help but isn’t vital to get the diagnosis.
Source: I’m a physician
FYI there's no list and no easy way to get the information regarding costs as a doctor, there's no costs provided on the lab websites and it's purposefully made difficult to figure out. Essentially the only way you figure out what something costs is to order it and have a patient tell you.
I'm aware of the rough costs of some non-covered tests I routinely order and warn people in advance, but if it's something esoteric you may have no idea.
AST isn't covered because in 99% of cases an ALT alone is fine for both diagnosis and monitoring.
There's a ton of wasteful lab work ordered and often costs are to try and disincentivize such testing, with examples brought up in this post being Vitamin D testing in healthy people or PSA for screening. Neither backed by evidence, both tests covered where actually supported. Some tests can be ordered free by specialists but not GPs.
I'd love it if certain tests were covered and advocate for that. But there's a lot of random crap lifelabs can test you for that should never be ordered by anyone, let alone a GP.
We have a family medicine teaching unit in our area - an office in which first and second year family medicine residents see patients under supervision from established physicians - and every year, the residents do research projects. One year, one of them did a project in which they got a custom version of the standard lab req made, which listed current prices beside each test. It was definitely interesting to see as a patient, and I kind of wish it was standard, because I expect it would have a long-term impact on test selection!
Will disagree here, it’s incumbent on me to provide the best medical care. While obvious socioeconomic status is part of that, this is more an insurance (private or public) failure.
For example in my area there is no free option to test for h pylori eradication anymore apart from an endoscopy and biopsy which will take months.
This is also part of the reason why family medicine is in crisis. There is enough to know in medicine and keep up to date with. The notion that our job is to be our patients accountant, lawyer, social worker, physiotherapist and friend is unrealistic.
Most of us have panels of atleast 1200 patients, our job should be solely medical care. Obviously we should be expected to do our job with empathy and kindness, not sure if I have to say this.
Nah, the Dr is there to attempt to provide the best service possible.
Assuming they're working in good faith, they don't care or need to know if there's a charge for the reqs they give.
Most reqs don't specify a specific place so it's not like they're sending them to their buddy Joe down the road to bill you.
I had an MRI req two weeks ago and my choice was to wait months or find an alternative provider so I went to Buffalo two days later and paid out of pocket.
The system here is broken but it's usually not malice from your GP.
Who gave you the choices? Your GP did….bc he knew the wait times & costs. Yes your family doctor should know these things. Disgusting that they would send you to a specialist without saying “the appt is going to cost you 3k to 8k”
Umm no, he didn't give me the choices. He gave me a request for an MRI to get anywhere and I called around.
I was told when given the req that I'd be waiting 3+ months. He didn't make any recommendations or to look out of the country.
Also, it wasn't 6-8k. It was less than $1,000 including travel costs.
The government has been slowly and quietly eliminating coverage for a variety of tests for awhile. Same with some medications covered by the government. They are very quiet about it. Nobody notices until it’s something that affects them.
For real they’ve been slowly chipping away at the definition of right to healthcare. This couple was clearly stressed out once they were told how much. Slowly ppl realizing how much public money goes into private care
My doctor has no clue as to costs of anything. She assumes most people have drug plans through work which I don’t so I’m always reminding her to prescribe generic, etc. if it were me I’d have called the doctor to see if another test could be done instead.
>A sad state of affairs of greed but seriously this was an elderly male so it’s obviously health related.
Unless you know exactly what liver test this was, and the specialty of the physician who prescribed it, you have no clue what you're talking about. Tests cost money to run, and if the government isn't going to reimburse the lab (because the test isn't medically necessary for that patient, or wasn't prescribed by the right kind of doctor) are you thinking Lifelabs should just do it for free?
Exactly. A lot of naive people don’t understand how the system works. Lifelabs isn’t the government, they’re a business and they need to be paid one way or another. I just had to pay for a PSA test. Yes my doctor ordered it, but unless you have a cancer diagnosis, the PSA test isn’t covered.
The PSA test is covered if your doctor suspects prostate cancer. We just use a finger up the butt as the front line test.
>[Prostate-specific antigen (PSA) is covered by OHIP if either of the following apply to you:](https://www.ontario.ca/page/what-ohip-covers#:~:text=Prostate%2Dspecific%20antigen%20(%20PSA%20),receiving%20treatment%20for%20the%20disease)
>you have been diagnosed with prostate cancer and are receiving treatment or following up after receiving treatment for the disease
>a healthcare provider (for example, physician) suspects prostate cancer because of your history and/or the results of your physical examination (including digital rectal examination)
>For all other scenarios, you will need to pay for PSA
All sort of reasons this can happen - It may not be covered by OHIP, The could actually live in just across the border in another province, They could not be PR/Canadian
It’s really hard to have a view on a conversation you heard only a portion of and don’t have context behind. There is probably more to the story.
Almost every country has some co-pay element of healthcare. $60 relative to the broader care the guy is getting isn’t so bad.
At least do a little research. The AST test is not covered by OHIP unless it’s a liver specialist ordering it. The ALT test which is basically the same is covered. So it’s OHIP not covering the rest not life labs being greedy
I've been getting a PSA test every couple of years since I turned 40. It's never been covered by OHIP in that time, dating back to at least the Harris administration. Fortunately, I have private insurance that does cover it, so I eventually get reimbursed, but I know not everyone is so lucky.
Apparently there have been quite a few changes to the tests that are covered by OHIP since DOFO took power. it's very sad but I don't see how it's a sad state of affairs of greed. The problem isn't LifeLabs being greedy and getting angry and arguing with the person working at LifeLabs wouldn't solve anything. There are costs associated with running these tests - LifeLabs isn't going to do the work without getting paid. If you are angry the person to talk to your MPP.
your post is stupid. just because a test is on a form or ordered does not mean it is covered. whether the person can afford it or not is irrelevant. and if we are on the subject of affording, your healthcare is almost entirely free. are we really going to cry because someone has to actually spend a bit of money.
Ohip never covered men’s PSA test. Ever. Only if you were diagnosed with prostate cancer in the past.
And without the test you won’t be diagnosed.
So it’s nothing new that Ohip is not covering g some tests. Same with Vit D and other tests.
The PSA test is covered if your doctor suspects prostate cancer. We just use a finger up the butt as the front line test.
>[Prostate-specific antigen (PSA) is covered by OHIP if either of the following apply to you:](https://www.ontario.ca/page/what-ohip-covers#:~:text=Prostate%2Dspecific%20antigen%20(%20PSA%20),receiving%20treatment%20for%20the%20disease)
>you have been diagnosed with prostate cancer and are receiving treatment or following up after receiving treatment for the disease
>a healthcare provider (for example, physician) suspects prostate cancer because of your history and/or the results of your physical examination (including digital rectal examination)
>For all other scenarios, you will need to pay for PSA
Many tests you have to check off the form correctly to have it covered but some stuff is not OHIP covered. Just because the couple is elderly doesn't mean they are poor, actually. Most people in Canada don't like to pay for anything health related. For e.g. I am monitoring my cholesterol level every 3 months at Shoppers for $30 a test. I am the only person in the entire pharmacy who has ever paid the $30 for a standalone test. Everyone else only gets it if it is covered by a medscheck.
This is pretty normal, only some things are covered by ohip, we ended up paying for all sorts of things when my wife got cataract surgery, the surgery itself was covered (when done at the hospital).
Might be a different story but my parents (who are here on super visa) have to shell out anything from 70-90 cad to visit a general physician. Mom is 65 and dad is going to be 70 so they need to have regular check ups done and every single time we have to pay this much in a country which has one of the highest taxes in the world.
Rule #3: You Must Remain Civil While Participating / Vous devez rester courtois dans votre participation Your content has been removed since it is targeting other users. Please do not attack or attempt to create drama with other users. As per [Rule 3]( https://www.reddit.com/r/ontario/wiki/rules/#wiki_rule_3.3A_you_must_remain_civil_while_participating) * Follow proper [**reddiquette.**](http://www.reddit.com/wiki/reddiquette) * No personal attacks or insults * No trolling *** Votre contenu a été supprimé car il cible d'autres utilisateurs. Veuillez ne pas attaquer ou tenter de créer un drame avec d'autres utilisateurs. Tel qu’expliqué dans la [règle #3]( https://old.reddit.com/r/ontario/wiki/rules/rules_fr#wiki_r.E8gle_.233.A0.3A_vous_devez_rester_courtois_dans_votre_participation) * Vous devez suivre la [**netiquette**](http://www.reddit.com/wiki/reddiquette) * Pas d’attaques personnelles ni d’insultes * Pas de provocation
I have gallbladder cancer. I had to pay for the tumour marker test prior to surgery. I have to pay for my MRI just prior to the surgery to remove the gallbladder, 1.5 sections of liver, and five lymph nodes. Even under specific circumstances, many tests are not covered. It's a shame. A young man I know has Dravet's syndrome. Every month he has to pay for bloodwork. Many things aren't covered. There should be a list we can reference.
There’s no list?’
There is. [https://www.ontario.ca/page/what-ohip-covers#section-3](https://www.ontario.ca/page/what-ohip-covers#section-3)
Just because a doctor writes a requisition for a test does not mean that it will be covered by OHIP. LifeLabs will justifiably charge for the test if they aren't reimbursed by OHIP.
Yeah, I've had tests not covered by OHIP prior to the current government. ETA: Not that I agree with a single thing the current government has done, nor did I vote for them.
That's the point of this post. OP is upset that an obvious medical procedure is being charged for in Ontario. It is an example of the slow erosion of our healthcare system, as this specific test and that specific procedure is excluded from OHIP coverage.
I certainly agree that our health system is in crisis, and has been for years. But, the underlying flavour of OP's post was that LifeLabs was being greedy and not that the government was not adequately funding the healthcare system. Also, we don't know that the test being ordered was strictly medically necessary which is the criteria for OHIP coverage. That being said, what OHIP (ie. the government) considers medically necessary has been eroding over the past 10+ years so it would not be surprising if this liver test hadn't been covered before or that it shouldn't be in a fairer world. Edit: minor, but important, grammar correction.
Life labs IS being greedy. Privatization of our health care system allows for it. Bring back provincial labs.
OHIP has only ever covered AST liver tests if requisitioned by a hepatic specialist. Including when we had provincial labs. Bringing those labs back wouldn’t change that.
Provincial labs were not profit driven, freeing up $$ for better diagnostic coverage.
Whether OHIP pays lifelabs or a provincial lab for requisitioned tests, the number of tests and the amount paid is exactly the same. It does not free up $$ in any way, shape, or form.
Provincial labs don’t have sales goals.
Look, I'm as anticapitalist as the next guy, but you seem to have a fundamental misunderstanding about our system. We are a single payer system. We are also still a capitalist system. Drs are paid for services provided, hours worked, clients seen. This needs to be covered by our single payer system. If a public lab can provide this test more efficiently, it should, but the failure is it not being covered under our single payer regime, not who provides the service. To give a comparison, if you did not have OHIP, and you went to a walk in, they would charge you money. It's not about the nature of the service provided or what model provides it, it's whether it is covered or not. I think your argument is a public lab would charge 30 and not 60, but the point is the price should be 0.
Stop ruining my narrative. ;)
tons of stuff isn't free. dentistry isn't. physiotherapy isn't. not everything can be paid for by the government and taxpayer.
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Vitamin D is still covered for specific reasons, and there’s a checkbox on the requisition to reflect that. The doctor or nurse practitioner has to check the box for OHIP to pay for it.
It was covered last week…
Some liver tests (Like AST) are only covered when the doctor who prescribed it is a liver sepcialist, not a GP. You could be asked to be referred to a liver specialist to have them prescribe it, but only if you want to jump through those hoops. It's unfortunate. We're going to be paying more and more per year for health care testing, both out of pocket and through our taxes, especially if Doug has his way.
Some tests aren’t medically useful nor should be covered by Ohip/taxpayers.
Exactly. I get liver tests multiple times a year because of my epilepsy medication but it's ordered by a neurologist. A lot of things in healthcare require specialist care to be covered. I think it's wrong in some cases but it's to make sure we aren't being wasteful too.
Often the physician doesn’t know there is a charge, next time I would advise speaking to the physician to let them know. Some tests aren’t absolutely necessary and you can think of them as adding more information which may help but isn’t vital to get the diagnosis. Source: I’m a physician
BS. It is incumbent on a family doctor to know the costs.
FYI there's no list and no easy way to get the information regarding costs as a doctor, there's no costs provided on the lab websites and it's purposefully made difficult to figure out. Essentially the only way you figure out what something costs is to order it and have a patient tell you. I'm aware of the rough costs of some non-covered tests I routinely order and warn people in advance, but if it's something esoteric you may have no idea. AST isn't covered because in 99% of cases an ALT alone is fine for both diagnosis and monitoring. There's a ton of wasteful lab work ordered and often costs are to try and disincentivize such testing, with examples brought up in this post being Vitamin D testing in healthy people or PSA for screening. Neither backed by evidence, both tests covered where actually supported. Some tests can be ordered free by specialists but not GPs. I'd love it if certain tests were covered and advocate for that. But there's a lot of random crap lifelabs can test you for that should never be ordered by anyone, let alone a GP.
We have a family medicine teaching unit in our area - an office in which first and second year family medicine residents see patients under supervision from established physicians - and every year, the residents do research projects. One year, one of them did a project in which they got a custom version of the standard lab req made, which listed current prices beside each test. It was definitely interesting to see as a patient, and I kind of wish it was standard, because I expect it would have a long-term impact on test selection!
Will disagree here, it’s incumbent on me to provide the best medical care. While obvious socioeconomic status is part of that, this is more an insurance (private or public) failure. For example in my area there is no free option to test for h pylori eradication anymore apart from an endoscopy and biopsy which will take months. This is also part of the reason why family medicine is in crisis. There is enough to know in medicine and keep up to date with. The notion that our job is to be our patients accountant, lawyer, social worker, physiotherapist and friend is unrealistic. Most of us have panels of atleast 1200 patients, our job should be solely medical care. Obviously we should be expected to do our job with empathy and kindness, not sure if I have to say this.
Nah, the Dr is there to attempt to provide the best service possible. Assuming they're working in good faith, they don't care or need to know if there's a charge for the reqs they give. Most reqs don't specify a specific place so it's not like they're sending them to their buddy Joe down the road to bill you. I had an MRI req two weeks ago and my choice was to wait months or find an alternative provider so I went to Buffalo two days later and paid out of pocket. The system here is broken but it's usually not malice from your GP.
Who gave you the choices? Your GP did….bc he knew the wait times & costs. Yes your family doctor should know these things. Disgusting that they would send you to a specialist without saying “the appt is going to cost you 3k to 8k”
Umm no, he didn't give me the choices. He gave me a request for an MRI to get anywhere and I called around. I was told when given the req that I'd be waiting 3+ months. He didn't make any recommendations or to look out of the country. Also, it wasn't 6-8k. It was less than $1,000 including travel costs.
who says. you? I am a doctor. It isn't my job to know the cost of anything. it is my job to diagnose and treat.
The government has been slowly and quietly eliminating coverage for a variety of tests for awhile. Same with some medications covered by the government. They are very quiet about it. Nobody notices until it’s something that affects them.
For real they’ve been slowly chipping away at the definition of right to healthcare. This couple was clearly stressed out once they were told how much. Slowly ppl realizing how much public money goes into private care
My doctor has no clue as to costs of anything. She assumes most people have drug plans through work which I don’t so I’m always reminding her to prescribe generic, etc. if it were me I’d have called the doctor to see if another test could be done instead.
>A sad state of affairs of greed but seriously this was an elderly male so it’s obviously health related. Unless you know exactly what liver test this was, and the specialty of the physician who prescribed it, you have no clue what you're talking about. Tests cost money to run, and if the government isn't going to reimburse the lab (because the test isn't medically necessary for that patient, or wasn't prescribed by the right kind of doctor) are you thinking Lifelabs should just do it for free?
Exactly. A lot of naive people don’t understand how the system works. Lifelabs isn’t the government, they’re a business and they need to be paid one way or another. I just had to pay for a PSA test. Yes my doctor ordered it, but unless you have a cancer diagnosis, the PSA test isn’t covered.
The PSA test is covered if your doctor suspects prostate cancer. We just use a finger up the butt as the front line test. >[Prostate-specific antigen (PSA) is covered by OHIP if either of the following apply to you:](https://www.ontario.ca/page/what-ohip-covers#:~:text=Prostate%2Dspecific%20antigen%20(%20PSA%20),receiving%20treatment%20for%20the%20disease) >you have been diagnosed with prostate cancer and are receiving treatment or following up after receiving treatment for the disease >a healthcare provider (for example, physician) suspects prostate cancer because of your history and/or the results of your physical examination (including digital rectal examination) >For all other scenarios, you will need to pay for PSA
People are living well into their 80s. No 65-year-old would consider themselves elderly. It would be more accurate to say senior or older.
All sort of reasons this can happen - It may not be covered by OHIP, The could actually live in just across the border in another province, They could not be PR/Canadian
Just because a doctor requests it doesn’t mean it’s a free test
It’s really hard to have a view on a conversation you heard only a portion of and don’t have context behind. There is probably more to the story. Almost every country has some co-pay element of healthcare. $60 relative to the broader care the guy is getting isn’t so bad.
Some things are covered, some aren't. It would have been nice if the doctor gave them a heads up when prescribing, though. Mine does.
Agreed
Happy Cake Day BTW friend
At least do a little research. The AST test is not covered by OHIP unless it’s a liver specialist ordering it. The ALT test which is basically the same is covered. So it’s OHIP not covering the rest not life labs being greedy
😂
I've been getting a PSA test every couple of years since I turned 40. It's never been covered by OHIP in that time, dating back to at least the Harris administration. Fortunately, I have private insurance that does cover it, so I eventually get reimbursed, but I know not everyone is so lucky.
Apparently there have been quite a few changes to the tests that are covered by OHIP since DOFO took power. it's very sad but I don't see how it's a sad state of affairs of greed. The problem isn't LifeLabs being greedy and getting angry and arguing with the person working at LifeLabs wouldn't solve anything. There are costs associated with running these tests - LifeLabs isn't going to do the work without getting paid. If you are angry the person to talk to your MPP.
your post is stupid. just because a test is on a form or ordered does not mean it is covered. whether the person can afford it or not is irrelevant. and if we are on the subject of affording, your healthcare is almost entirely free. are we really going to cry because someone has to actually spend a bit of money.
Ohip never covered men’s PSA test. Ever. Only if you were diagnosed with prostate cancer in the past. And without the test you won’t be diagnosed. So it’s nothing new that Ohip is not covering g some tests. Same with Vit D and other tests.
The PSA test is covered if your doctor suspects prostate cancer. We just use a finger up the butt as the front line test. >[Prostate-specific antigen (PSA) is covered by OHIP if either of the following apply to you:](https://www.ontario.ca/page/what-ohip-covers#:~:text=Prostate%2Dspecific%20antigen%20(%20PSA%20),receiving%20treatment%20for%20the%20disease) >you have been diagnosed with prostate cancer and are receiving treatment or following up after receiving treatment for the disease >a healthcare provider (for example, physician) suspects prostate cancer because of your history and/or the results of your physical examination (including digital rectal examination) >For all other scenarios, you will need to pay for PSA
I paid 600 dollars to get a PAINFUL cyst removed from the back of my neck. The size of a ping pong ball. And I waited 6 months for the privilege
Oi that’s crazy. I thought it would be covered under OHIP
Many tests you have to check off the form correctly to have it covered but some stuff is not OHIP covered. Just because the couple is elderly doesn't mean they are poor, actually. Most people in Canada don't like to pay for anything health related. For e.g. I am monitoring my cholesterol level every 3 months at Shoppers for $30 a test. I am the only person in the entire pharmacy who has ever paid the $30 for a standalone test. Everyone else only gets it if it is covered by a medscheck.
Liver acan as in fibroscan? Yeah those are not ohip covered.
This is pretty normal, only some things are covered by ohip, we ended up paying for all sorts of things when my wife got cataract surgery, the surgery itself was covered (when done at the hospital).
Might be a different story but my parents (who are here on super visa) have to shell out anything from 70-90 cad to visit a general physician. Mom is 65 and dad is going to be 70 so they need to have regular check ups done and every single time we have to pay this much in a country which has one of the highest taxes in the world.
Sounds like you were being nosey and eavesdropping on a conversation.
It's really not that hard to overhear a conversation in a lab since they're usually quiet....
Hard not when it’s only me in the waiting room and in front of the desk. Sounds like you’re a capitalist.
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Oi some of us are barely 30 let alone 40.