Non-OHIP patients

Patient billing information for admitted patients who do not have OHIP (Ontario Health Insurance Plan) coverage

We understand that being admitted to the hospital is a challenging time for our patients and their families. We also know that billing for hospital visits can be confusing. We have prepared this information to answer the most commonly asked questions about billing.

I don’t have OHIP (Ontario Health Insurance Plan) coverage. Do I have to pay my hospital charges directly?

All patients not covered under OHIP are required to pay directly for the care provided.

There are exceptions that apply:

Visitors from another Canadian province

If you are a visitor from another province we will bill your provincial health insurance plan. To qualify you must:

• Provide a valid health card from your home province at the time of registration
• Complete a Declaration of Hospital Insurance Coverage Under Interprovincial Agreement

Refugee patients

If you have refugee status we will submit a claim on your behalf to Medavie Blue Cross. To qualify you must:

• Provide a valid Refugee Protection Claimant Document at the time of registration

Member of the Canadian Armed Forces

If you are a member of the Canadian Armed Forces we will submit a claim on your behalf to Medavie Blue Cross. To qualify you must:

• Provide a Medavie Blue Cross Identification Card issued by Veteran’s Affairs Canada

Patient receiving WSIB benefits

If you were injured at work and your treatment at SHSC is related to your work injury, you must provide your WSIB claim number when you receive treatment. If you are treated in the Emergency Department for work-related injury and you have not submitted a claim with WSIB, you must tell your health care team that this was a work-related injury and complete a form. Your employer should complete WSIB Form 7 and you should complete WSIB Form 6.

Ambulance services and assistive devices such as crutches, canes, splints, casts etc. are payable by the patient. SHSC does not bill directly to the insurance.

Ambulance services

Hospitals are required to bill a co-payment charge to patients for the use of an ambulance, in accordance with provincial legislation in Ontario (Health Insurance Act, Regulation 552).

The following rates are set by the Ontario Ministry of Health and Long-Term Care:

For a patient with a valid Ontario health number - $45
For a patient who does not have a valid Ontario health card, from another province, refugee and WSIB claimant - $240

I don’t have OHIP (Ontario Health Insurance Plan) coverage and I am not part of one the exemptions listed above, what do I do?

All patients not covered under OHIP are required to pay directly for the care provided.

As an inpatient you will be charged a daily per diem. The daily per diem rates cover the cost of your Hospital stay with the exception of physician fees, diagnostic imaging exams (such as CAT scan and MRI) and specialized procedures or tests. These items will be charged in addition to the daily hospital rate.

Physician fees are incremental and are charged directly to you by the consulting physician(s). Physician fees are NOT included on your hospital bill.

The daily per diem rate depends on the type of care you require.

Our current standard ward daily per diem rates are:

*Prices are subject to change

Preferred accommodation is an extra charge.

Who do I speak with?

Shortly after your admission a member of our accommodation team will visit you and provide information regarding your stay. You may be required to fill out paperwork and provide additional documents related to your hospital stay.

Since you are being admitted:

You are required to provide a $10,000 deposit at the time of admission. Valid forms of payment include credit card (Visa, Mastercard, American Express, Discover) and Interac.

A finance representative will visit you (or your designate) directly to take your payment and provide a detailed explanation of the Hospital’s billing procedures.

Why am I being asked for a $10,000 deposit?

The hospital is funded by Canadian provincial health insurance plans for qualified residents of Canada. These provincial health plans are paid for by Canadian taxpayers.

Patients that are not covered by Canadian provincial health plans are expected to pay their hospital bills directly since the Hospital does not have the resources to provide care free of charge.

The care that is being provided to you is costly and requires payment at the time the care is provided. The $10,000 deposit represents the typical cost of 2-3 days inpatient stay. Collection of the deposit is hospital policy.

What if I have insurance coverage?

If you have travel insurance or another form of insurance coverage that could contribute to the cost of your stay in the hospital please provide all necessary information to our accommodation coordinators upon their visit. You may also reach out to our accommodation coordinators team by email at accommodations@sunnybrook.ca.

Do I still have to pay the deposit if I have private insurance coverage?

In some cases we can work with your insurance company to bill them directly for the cost of your care. However, in many cases private insurance is subject to deductibles, coverage limits and exclusions for pre-existing conditions. As a result of these common situations we require a $10,000 deposit from all patients including those who have insurance.

You are responsible for paying for the cost of your care including any charges not recovered from your insurance carrier.

If your insurance company covers the full cost of your Hospital bill your deposit will be refunded to you.

If you have private insurance coverage you should verify your coverage and submit your insurance claim to your insurer as soon as possible to facilitate reimbursement of your out of pocket costs.

What if my final bill is less than the $10,000 deposit I paid? How can I obtain a refund?

Your final hospital charges will be calculated the day following your discharge from the hospital.

Following discharge your refund will be made to your credit card assuming your balance is fully paid. Otherwise a cheque will be issued and mailed to your home address within 10 days of discharge.

What if my bill is higher than $10,000?

A finance representative will keep in contact with you during your stay if charges are reaching or exceeding $10,000 as you will be required to make an additional payment.

What if I am unable to pay a portion of my bill?

You must immediately notify your patient accounts representative of your specific situation as it is Hospital policy to obtain payment for the cost of care provided. Depending on your reason for admission you may be entitled to government funding related to your patient care. Please visit the Ministry of Health OHIP Bulletin website for more information. Please be aware that all posted information is subject to change without warning.

Who can I call for additional information?

A Patient Accounts representative will provide you with their contact information when they come to visit you. However, at any time you can contact our non-OHIP coordinator at 437-230-7686 between 8:00 a.m. to 4:00 p.m. Monday to Friday or email non-ohip-billing@sunnybrook.ca.

I need a copy of my health record to facilitate my insurance claim. How can I get one?

You can request a copy of your health records at:

Health Records and Patient Registration Department
Room E123
2075 Bayview Avenue

Toronto, Ontario M4N 3M5
Phone: 416-480-4433

There is an administrative cost for requests that are required for purposes other than continuing patient care. A prepayment fee must be submitted with your written request.