FM Private and OHIP billing

[Determinance 0]

I'm a bit confused as to the regulations surrouding billing (not exclusive to GPs, I guess any specialty that can start their own clinic and offer private services would have the same conundrum).

So obviously private billing is allowed-- so long as the service being billed for is not covered by OHIP-- for example, cosmetics bills entirely private.

I'm also quite certain a physician would be allowed to bill both privately and publicly, i.e. a GP could do both hospitalist work and cosmetics on the side.

But what about billing both privately and publically under the same clinic? I.e. could a GP open a clinic that does both medical work as well as cosmetics?

[Determinance 0]

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[JohnGrisham 1,700]

51 minutes ago, Determinance said:

I'm a bit confused as to the regulations surrouding billing (not exclusive to GPs, I guess any specialty that can start their own clinic and offer private services would have the same conundrum).

So obviously private billing is allowed-- so long as the service being billed for is not covered by OHIP-- for example, cosmetics bills entirely private.

I'm also quite certain a physician would be allowed to bill both privately and publicly, i.e. a GP could do both hospitalist work and cosmetics on the side.

But what about billing both privately and publically under the same clinic? I.e. could a GP open a clinic that does both medical work as well as cosmetics?

Yes, in most provinces there is no reason you cant do both public and private pay work in the same clinic. It happens all the time with the simplest things like forms. 

[Determinance 0]

4 minutes ago, JohnGrisham said:

Yes, in most provinces there is no reason you cant do both public and private pay work in the same clinic. It happens all the time with the simplest things like forms. 

I was just thinking about that actually, that charging the patient for filling out forms would be private billing in a public clinic. Good to get clarification though that there's no technicalities with the higher-end stuff

[Snowmen 587]

You can privately bill in a public-billing clinic for services that are not covered by public billing.

[medicallyricalmiracle 151]

9 hours ago, JohnGrisham said:

Yes, in most provinces there is no reason you cant do both public and private pay work in the same clinic. It happens all the time with the simplest things like forms. 

this was what i was about to say. Family docs charge for giving 'doctors notes' all the time. They also charge incoming med students a crap ton for filling out their immunization forms too lmao

[shikimate 202]

OMA published a guide to un-insured services, and have suggested prices for various procedures. https://content.oma.org//wp-content/uploads/private/PhysiciansGuideToUninsuredServices.pdf

There are lots of instances where one might bill outside of OHIP. Some are other insurances, like non-ON provincial insurances, WSIB, travel insurance, international student health insurance etc. Others are services not covered by insurance, like physical exams for insurances, fitness for return to work etc. Others might be travelers and foreigners paying cash.

Of course unless you own the clinic, you'll have to give a percentage of your private billing for overhead. Also remember you might not get paid by someone for all your non-insured billings.

[Determinance 0]

39 minutes ago, shikimate said:

OMA published a guide to un-insured services, and have suggested prices for various procedures. https://content.oma.org//wp-content/uploads/private/PhysiciansGuideToUninsuredServices.pdf

There are lots of instances where one might bill outside of OHIP. Some are other insurances, like non-ON provincial insurances, WSIB, travel insurance, international student health insurance etc. Others are services not covered by insurance, like physical exams for insurances, fitness for return to work etc. Others might be travelers and foreigners paying cash.

Of course unless you own the clinic, you'll have to give a percentage of your private billing for overhead. Also remember you might not get paid by someone for all your non-insured billings.

This is really helpful, thanks!