Uninsured Services

 

Dear Patient:

This letter and enclosed information sheet is to notify you of our office policy on uninsured services. OHIP does not pay for all services that patients request from physicians. Services that OHIP does not pay for are called “uninsured services” and physicians are prohibited from billing OHIP for these services. Every effort has been made to account for most of the commonly requested services in the enclosed information sheet. If the uninsured service you require is not listed, please communicate this to me or my office staff for further clarification. To help speed up our service, please let my office staff know when you are booking your appointment that you are requesting a service that appears on the list or a service for which you have been charged in the past by this office or another physician’s office. The fees contained in the enclosed list are in accordance with the 2018 edition of the OMA Physician’s Guide to Uninsured Services.

All uninsured services must be paid in full when rendered; office staff will provide a receipt upon settlement of your account. Should you be unable to pay for the uninsured service at the time it is provided, please let my office staff know when and how you intend to settle your outstanding account. We will make every effort possible to assist you in the settlement of your outstanding account. Note that our office accepts credit / debit / and cash payments.

Please acknowledge receipt and acceptance of the above office policy by signing below. Should you have any further questions, please contact your Patient Services Associate at (647) 345-8486.

 

ITEM	PRICING
Back to work note, sick note or daycare note (free of communicable disease)	$20
Referral for massage / chiro / orthotics / chiropody / physio	$20 per referral
Transfer or reproduction of Medical Records	$30 (first 20 pages) + $0.25 per page thereafter + physician’s hourly rate (after first 15 minutes)
Uninsured medical appointment (patient not covered by OHIP)	$125
Ministry of Transportation Driver’s Medical	$150
FORMs
Forms for schools, camps, pre-school, daycare, university/educational institutions	$27.40
Forms for pre-employment certification of fitness/fitness clubs or hospital/nursing home employee	$36.60
Revenue Canada, Federal Disability Tax Credit	$46.70
Short Term Disability Forms	$60
Travel Cancelation Form	$30
PROCEDURES
Liquid Nitrogen Treatment (for lesions not covered by OHIP)	$20 per lesion
Skin tag removal	$50 per lesion
Benign lesion excision removal	$80 per lesion
TB skin test (for employment purposes only)	$65 (+cost of tubersol to be purchase from pharmacy)
Pap not covered by OHIP (procedure fee only)	$51.9 *lab fee is separate
INSURANCE
Insurance Certificate OCF- 3 Disability Certificate	$139.90
Insurance Certificate OCF-18 Treatment Plan	$139.90
Insurance Certificate OCF-19 Determination of Catastrophic Impairment	$114.80
Insurance Certificate OCF-23 Treatment Confirmation	$138.80
Attending Physician’s Statement	$139.85
Insurance Medical Examination (assessment and report)	$228.35