Year 2 Highlights 2017/18

Fairness in charging semi-private/private co‑payments

elderly man looks disconcerned signing a form held by hospital staff


A complainant contacted the Patient Ombudsman office after receiving a bill from the hospital for a private room co-payment.

The complainant was admitted to the hospital requiring emergency surgery. He was very ill at the time of his admission and did not remember requesting a private room or signing any forms. When the complainant contacted the hospital he was told that the hospital had a signed request form for a private room dated the day of admission and that the account would be sent to collections if he did not pay their bill.

What we did

Patient Ombudsman called the patient relations department of the hospital. The hospital agreed that greater care should be taken to ensure patients are aware that they are signing forms with financial repercussions. At the time of admission, particularly emergency admissions, patients are often under stress or not well enough to read complicated forms and make informed decisions.

The hospital and Patient Ombudsman shared the same view of fairness and as a gesture of good faith the hospital waived the fees for the complainant. The hospital also advised Patient Ombudsman that it had reviewed its procedure. Members of the billing team must now consult with a member of the clinical care staff to make sure the patient is well enough before asking them to sign any financial documents that would commit them to expensive co-payments.

For hospital patients with Ontario health insurance coverage (OHIP), healthcare, food and accommodation in a standard room (four beds) is provided at no additional charge. Patients have the option of requesting premium or preferred accommodation in a private (one bed) or semi-private (two beds) room, for which they will be charged a co-payment. The co-payment rate varies from hospital to hospital, but will generally be hundreds of dollars each day. An extended stay in hospital can result in a bill of thousands of dollars.

At the time of admission, patients are generally asked about the type of accommodation they would like and will be presented with a form to sign guaranteeing that they will pay the premium if they request a semi-private or private room. Patients may have supplemental insurance they pay for privately or receive as a benefit through their employer that covers all or part of the cost of semi-private or private hospital rooms. However, many people are not fully aware of the details of their plan and what is covered and what is not.

Sometimes patients who request a standard room may be placed in a semi-private or private room when no standard beds are available. Other times, the hospital care team may decide that a private room is necessary because a patient has an infectious disease or other special need. In these situations, the premium co-payment should not be charged to the patient.

In our second year, Patient Ombudsman received 91 complaints from patients or caregivers about bills received for hospital-based services. Almost half of these were from patients and caregivers who felt they had been unfairly charged co-payments for private or semi-private rooms. People often commented that they didn’t recall a discussion about charges, didn’t remember signing a form or their requests to change their level of accommodation back to a standard room wasn’t acted on. Sometimes patients reported they were presented with forms when they were very ill and they didn’t feel they were able to make an informed decision.

Hospitals generally relied on having a signed form to justify the billings. Some hospitals were willing to set up payment plans on compassionate grounds, while others referred unpaid bills directly to collections agencies, which can have a devastating impact to a patient’s credit rating.

In reviewing documentation related to these complaints, Patient Ombudsman examined the forms patients had signed. Frequently the forms were complicated, with lots of fine print. It was not unusual for the forms to address multiple decisions in addition to liability for accommodation co-payments. Patient signatures were not always dated so it was challenging to determine when accommodation change requests were made. In ten cases after reviewing the complaints with Patient Ombudsman, hospitals agreed to waive or adjust the fees.

Tips for patients and caregivers

  • If you or your loved one has private health insurance, make sure you know what it covers
  • If you’re presented with a form in hospital, make sure you understand what you’re signing. You can choose not to sign if you’re unsure
  • Don’t be afraid to ask questions or seek further information
  • If you’re not well enough to have the conversation, ask the hospital staff person to come back at another time

Suggestions for hospitals

  • Review your accommodation forms to ensure that they are clear and easy to understand. Consider consulting with your patient advisors when developing forms
  • Ensure patient or caregiver signatures are dated to avoid any confusion
  • Make sure patients know who to contact if they have any questions, want to change their accommodation or discover that they don’t have supplemental insurance coverage
  • Check with the patient’s care team to confirm they are well enough to understand the implications of signing for premium accommodation
  • If English or French is not the primary language, the use of an interpretation service or asking a family member to help with translation will help the patient make an informed decision
  • Consider checking back with patients the day after admission to ensure they understand what they have agreed to