OHIP · Ontario
OHIP Reimbursement, Denials & Appeals in Ontario
Ontario's Health Insurance Act is complicated, and the government enforces it strictly. Without coverage, individuals can face bills in the tens of thousands of dollars. We help clients pursue OHIP reimbursement, negotiate hospital bills, and appeal denied claims.
Book a ConsultationCan I get OHIP reimbursement for emergency care outside Canada?
In some cases, yes — we've helped clients who required emergency surgery outside of Canada receive full reimbursement from OHIP.
Whether a claim is reimbursed can depend on technical details — even where the care was provided, for example, has affected the outcome of past cases. See our blog post on OHIP coverage outside Ontario for a real example of how this has played out.
What if a hospital bills me directly for OHIP-covered care?
We've helped Canadians who were billed by hospitals negotiate their invoices.
A direct bill doesn't necessarily mean it's owed, or owed at that amount. We can help you understand what's actually being charged and why, and negotiate on your behalf.
Can I appeal a decision if OHIP denies my claim?
Yes — we bring cases before OHIP's review committee. We generally don't pursue further appeals to the Health Services Appeal and Review Board (HSARB), since the majority of those cases aren't successful.
Before taking on a file, we often perform preliminary research and inquiry to assess whether a case is likely to succeed. It's genuinely difficult to hear that OHIP follows the Health Insurance Act strictly, regardless of how compassionate or sympathetic the circumstances are — we understand how frustrating that can feel when what you're going through is real and serious. Because of this, we decline many files, not because we don't want to help, but because we'd rather be honest with you upfront than take your case knowing it's unlikely to succeed.
Why does it matter to get legal advice early in an OHIP matter?
Having a lawyer involved early can help you avoid irreversible mistakes — decisions or missed deadlines that are difficult or impossible to undo later.
Because the rules are applied strictly, steps taken (or not taken) early in the process can shape what's still possible down the line.
How Lisa Feldstein Law Office Can Help
Focused experience in Ontario health and caregiver law
Lisa Feldstein has focused her legal practice on family caregivers since 2013. She is an Adjunct Professor of Health Care Law at York University, and has been published and interviewed in outlets including the Canadian Journal of Family Law, CTV, and the National Post.
We help clients in a variety of situations involving the Ontario Health Insurance Plan, from reimbursement claims to representation before OHIP's review committee.
Frequently Asked Questions
OHIP: common questions
Do you take every OHIP case that comes to you?+
No. We often perform preliminary research and inquiry first, to assess whether a case is genuinely likely to succeed, and we decline files where it isn't. We know that can be a hard thing to hear, and we try to be honest with you as early as possible rather than take on a case we don't believe will succeed.
Will OHIP make an exception for compassionate reasons?+
Generally, no — OHIP follows the Health Insurance Act strictly, regardless of how sympathetic or difficult the circumstances are. We know firsthand how painful that can be to hear when what you're dealing with feels urgent and deeply personal, and we try to help you understand, with compassion, what the law does and doesn't allow.
I was billed for care I thought was covered by OHIP — what now?+
We can help you understand the bill, whether it's accurate, and negotiate with the hospital or provider on your behalf.
How early should I get legal advice on an OHIP issue?+
As early as possible. Steps taken — or missed — early in the process can affect what options remain available later.
Related Legal Topics
You may also find these pages useful
Dealing with a denied OHIP claim or an unexpected hospital bill?
Book a ConsultationLisa Feldstein Law Office Professional Corporation
Richmond Hill, Ontario L4B 3P4
Canada
Tel: 416-937-8768
