A family member contacted Patient Ombudsman to complain that she received a bill for several thousand dollars following her mother’s stay in hospital.
When she followed up with the hospital, she was advised that two months after her mother’s admission, she had been deemed “alternative level of care” (ALC). Since the mother remained in hospital until her discharge to long-term care several months later, she had been charged the Chronic Hospital Care Co-Payment. The daughter indicated that she had never been informed about the co-payment and had not signed any forms agreeing to pay on her mother’s behalf.
What we did
Patient Ombudsman contacted the hospital and asked for an explanation of the co-payment charge and all supporting documentation. After reviewing the documents, Patient Ombudsman remained concerned that there was insufficient evidence that the co-payment requirement had been explained to the daughter and that she had agreed to pay. The hospital agreed with Patient Ombudsman’s analysis, waived the co-payment costs and reimbursed the daughter for the amount she had already paid. The hospital also acknowledged that there was an organization-level problem with their communication and documentation about ALC designation. The hospital indicated that they had formed a working group to improve their processes and provide clearer information to patients and families.
In year 3, Patient Ombudsman received 105 complainants related to patients’ allegations that they had been unfairly charged fees by public hospitals. Eighteen of the complaints were from or on behalf of patients who were charged the chronic care co-payment. A number of other enquiries appeared to relate to the chronic care co-payment, but Patient Ombudsman was not able to confirm this as the complaints were premature to our office and were referred back to the hospitals so that they could try to resolve the concern.
While not a large number, there was a high level of consistency in what Patient Ombudsman heard from patients and caregivers. Patients expressed confusion about why they are asked to pay for hospital care and did not remember receiving an explanation about the charges.
Ministry of Health policy permits hospitals to charge a co-payment for patients who require complex continuing or chronic care and are “more or less permanent residents of the hospital”. This includes patients who have been deemed ALC and are waiting in hospital for long-term care home placement. The co-payment is not for care, it is intended to cover the cost of food and accommodation and is aligned with the co-payment charged to residents of long-term homes. The co-payment can be reduced for low-income patients based on a formula outlined in the ministry policy. Some hospital patients, including patients in psychiatric hospitals and patients receiving palliative care are not required to pay the co-payment.
Given the lack of general public awareness of the co-payment policy it is important that patients and/or their substitute decision makers are fully advised about the implications of their transition to chronic care, have the opportunity to apply for a rate reduction, and when appropriate, have the opportunity to arrange a reasonable payment plan.
Tips for patients and caregivers
- Consider being proactive and ask the hospital about any fees you may be required to pay while you or your loved one is in hospital.
- Ask to be informed about any changes to the patient’s status while in hospital, including ALC designation.
- Make sure you read and understand any forms you are asked to sign and don’t be afraid to ask questions.
- If you receive a bill that you don’t understand, follow up with the hospital finance department and the patient relations representative.
Suggestions for HSOs
- Review your communication and documentation protocols related to co-payments and ALC designation to ensure they are clear and aligned with Ministry policy.
- Make sure patient forms related to co-payments are clear and easy for patients and families to understand.
- Ensure that there is clarity in the respective roles of patient relations and finance departments in dealing with complaints from patients and families about co-payments and other fees.
- Ensure that patients know where to start if they have a concern.