In This Issue:

• ​The Per Visit Cost To See A Doctor In Ontario [<2 min]
• ​What Are Medical Codes And How Do They Apply To Your Care? [<1 min]
• ​Why Your Family Doctor Only Addresses One Issue Per Visit [And Why I Don't Blame Them] [<2 min]

The Cost To See A Doctor In Ontario

In Ontario, the Ontario Health Insurance Plan (OHIP) covers the cost of medically necessary services for residents, including visits to family doctors, specialists, walk-in clinics, and emergency departments.

While Ontario patients do not pay out-of-pocket for these insured services, it is insightful to understand the approximate fees that OHIP reimburses healthcare providers per visit so that we can make better decisions when it comes to seeking the appropriate level of care and avoiding unnecessary ER visits (i.e., for things like the uncomplicated flu):

1. Family Doctor Visits: OHIP reimburses family physicians approximately $37.95 per patient visit.
2. Specialist Consultations: Specialists receive higher fees due to their advanced training and expertise. The reimbursement varies based on the specialty and complexity of the consultation, with fees typically ranging from $75-$150 per visit. ​
3. Walk-In Clinic Visits: Physicians in walk-in clinics bill OHIP on a fee-for-service basis, similar to family doctors. The reimbursement per visit is comparable, around $37.95, but can vary depending on the services provided during the visit.
4. Emergency Room (ER) Visits: ER physicians are compensated based on the complexity and urgency of the cases they handle. The fees can vary widely, with OHIP reimbursements ranging from $50 to over $200 per visit, depending on the level of care required. ​

The actual reimbursement can vary based on specific circumstances, such as the complexity of the case, additional procedures performed, and the time of the visit (e.g., after-hours services may have higher fees). For more detailed information, you can refer to the OHIP Schedule of Benefits and Fees.

What Are Medical Codes And How Do They Apply To Your Care?

The standardized medical codes used by healthcare providers around the world to classify and document medical diagnoses are ICD-10 codes, which stand for International Classification of Diseases (10th edition). Every symptom, condition, or disease you visit the doctor for is assigned a specific ICD-10 code, which is then used for:

• Billing and reimbursement: In Ontario, doctors submit these codes to OHIP to be paid for the visit.
• Tracking and data collection: The codes help monitor health trends, public health issues, and disease prevalence.
• Medical records and continuity of care: ICD-10 codes create a standardized language for communication between providers, ensuring accurate documentation of your health history.

Why Your Doctor Only Addresses One Issue Per Visit [And Why I Don't Blame Them]

Ever felt frustrated when your family doctor only addresses one health concern per visit? Here’s why this happens.

Doctors in Ontario use ICD-10 codes to classify and bill for every condition they diagnose. For example, if you visit your doctor for back pain, they assign a specific code linked to that complaint. OHIP reimburses them $37.95 per visit, regardless of whether they discuss one or five issues.

The $37.95 fee is meant to cover the entire consultation, including:

1. The time spent with you, which includes their assessment and diagnosis.
2. Charting and documentation of the visit.
3. Billing submission with the appropriate ICD-10 code.

Here’s why they focus on one issue at a time:

1. Billing limitations: Because OHIP only reimburses the doctor per code a visit, doctors aren’t paid for the extra time or complexity, even if you have multiple concerns.
2. Accurate coding: Each diagnosis needs a specific ICD-10 code for proper billing. If multiple issues are addressed, doctors must still select one “primary” code for billing.

While it may be frustrating to the patient, I don't blame family doctors. With 10-15 minute appointments, there’s rarely enough time to thoroughly assess multiple issues. Multiple concerns require more time, investigation, and documentation than a standard 10-15 minute appointment allows. Addressing multiple concerns leads to rushed care and doesn’t generate more income. To stay on time and provide quality care, most doctors focus on one issue at a time.

Until next time,

Dr. Dominika Zarzeczny Naturopathic Doctor ​ 📧 hello@drdominika.com​ 🌐 www.drdominika.com​ ​​​

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