In Ontario, most people are covered by OHIP, which is the Ontario Health Insurance Program. Basically, when you see a Doctor or other health care professional, you present your OHIP card, and the service provider bills OHIP for their services - you don't pay anything. Well, that is the way it works in most cases - there are some services that are not covered by OHIP.
Anyway, the other day I got to wondering if there was any way to reconcile what OHIP is being billed vs what services I actually got. I wanted to see if the health care practioners were being honest, and not billing for services I never got. I also wanted to see exactly how much they were charging OHIP for their services. For example, how much if any, is my doctor billing OHIP for prescription refills made over the phone by my drugist.
After searching the various OHIP website pages, I could not find anything. So, I sent off a note to the main contact listed for OHIP explaining that I wanted to see my OHIP records for 2009 and 2010 year-to-date. To my surprise, I got a reply which detailed the process:
Thank you for your e-mail sent to ServiceOntario for the Ministry of Health and Long-Term Care.
A Personal Claim History (PCH) is a summary or listing of all services received under a person's Ontario Health Insurance Plan (OHIP) health card number. It is not an individual's personal medical record history, but rather, a payment record of medical claims submitted by health care providers against a specific health number.
A PCH may include details such as: date service was received, fee paid to the health service provider, health number, patient's name, fee schedule code, health care provider's name, date the claim was approved for payment by the ministry, etc.
The ministry's databases keep fee for service records for seven years, plus the current year.
This signed request must be made in writing (no special form is required) and include the following information:
- health card number
- date of birth
- time frame of history
- mailing and physical address (if different)
- signature and date
The request can be sent to:
Ministry of Health and Long-Term Care
Personal Health Information Office
Corporate Administration Services
49 Place d'Armes, 4th Floor
P.O. Box 48
Kingston ON K7L 5J3
There is no fee for this service when the request is performed by the original cardholder.
Thank you again for your inquiry.
Customer Service Agent
ServiceOntario -- making it easier
Visit us at: www.ServiceOntario.ca
So, I sent off a letter today, requesting my history of OHIP billings for the past year and a half. Now I wait for the reply.
I post this here for all people of Ontario: you should be requesting a similar history and comparing it to your actual medical services that were rendered to you. No one else is going to audit your records.