Medical upselling in Canada can cost patients thousands of dollars

Lois Cooper says she was upsold thousands of dollars in extra services at a private, for-profit clinic, and when she started to ask questions, the doctor told her to leave. She's not the only Canadian who's gone through the questionable practice.

It's the pile of bills that sums up her medical journey.

"This is the note that I made when I got the phone call in January," said the 75-year-old from Gravenhurst, Ont. "And I was told there'd be a $150 fee.... That was the beginning of starting to pay for stuff."

Cooper had a macular hole in her right eye and needed medically necessary surgery called a vitrectomy, a procedure where the surgeon removes the gel-like substance around the eye called the vitreous and replaces it with another solution.

Cooper was referred to a private, for-profit clinic north of Toronto, but before the operation started, she was asked to sign off on optional tests, services and procedures.

In later appointments following the surgery, the doctor told her that she would need to keep her face down for two weeks — and that would require the rental of a special wedge type of pillow. He also recommended glasses that would refract her vision. Months later, he recommended laser surgery for eye floaters, which Cooper said didn't work. He even said he detected a mass behind her other eye that would require further surgery.

A second opinion from a doctor in Toronto revealed there was no mass in her eye.

When Cooper asked questions, she was shown the door — but not before she was on the hook for close to $8,000 for appointments, equipment rentals and procedures.

Cooper was upsold.

"I wouldn't have spoken out if I hadn't heard Premier [Doug] Ford say that these private clinics won't charge you money, won't charge extra," she told CBC News. "It feels like it's my public duty to say that's not true."

Upselling, according to Dr. Danyaal Raza, a family doctor at St. Michael's Hospital in Toronto, occurs when a patient is asked to pay for extra services that are uninsured when they're undergoing a procedure that should be publicly covered.

It's different from extra billing. That's when a private, for-profit clinic would bill the province for a procedure that's covered by government health insurance while also billing the patient.

Health Canada reports show that between April 2019 and March 2020, private, for-profit clinics upsold and illegally charged Canadians to the tune of tens of millions of dollars.

In early March, the federal government announced that it was going to cut more than $82 million in transfer payments to the provinces in cases where patients were asked to pay out of pocket for care that should have been covered in 2020-21.