Hospital-ity fee

Ministry of Health and Long-Term Care

Date: 2011

A woman complained to the Ombudsman after she received a bill for $1,879 in co-payment charges from the hospital where her 94-year-old mother had been for about a month before she died in April 2010. Ombudsman staff contacted the Negotiations and Accountability Management Division of the Ministry of Health and Long Term Care, whose staff obtained records from the hospital and reviewed the charges.

The Health Insurance Act allows hospitals to charge a co-payment fee to a patient whose doctor has determined that the patient requires complex continuing care and is essentially a permanent resident of the institution. The co-payment is the patient’s contribution toward accommodation and meals and is charged at a rate of $1,619.08 per month or $53.23 per day while the patient awaits transfer to a “complex continuing care” or long-term care bed.

Upon reviewing the hospital’s records, the Ministry determined that the co-payment fee should not have been charged between March 13 and April 6 because the woman’s mother had been receiving treatment during this time. In its decision, the Ministry noted that the hospital had contravened the Health Insurance Act and the Commitment to the Future of Medicare Act. The hospital agreed to reduce the co-payment charges from $1,879 to $624.