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Thursday, March 15, 2018

 
 
 

 
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Changes to Insurance Act will allow insurers to demand more information from treatment providers

An amendment is in process under Ontario’s Insurance Act to allow insurers to refuse to pay for treatment plans until the treatment providers produce reasonable information.

Ontario Regulation 194/11 will take effect on July 1, 2011 and gives insurers the authority to request information from treatment providers, who will have 10 business days to produce it after receiving the request. This information includes:

• the originals of any treatment confirmation form, treatment and assessment plan, assessment of attendant care needs and other documents giving rise to the claim for payment;
• a statutory declaration as to the circumstances that give rise to the invoice, including particulars of the goods and services provided; and
• the name and full address of the provider, and of every provider that provided any of the goods or services referred to in the invoice.

If the information is not provided the insurer does not have to pay the outstanding invoice and no interest will be accrued on information not provided within the 10 day framework. Furthermore, the outstanding payment cannot be mediated if the information has not been provided to the insurer, if the information requested by the insurer is reasonable.

We encourage all health providers to ensure that they provide all reasonable information requested by the insurer in a timely manner. If you are not sure if the information is reasonable, we recommend discussing the insurer’s request with your patient’s legal representative.

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