When a recent CBC news story highlighted Dr. Jane Healey's care for a dying newborn, the story resonated far beyond pediatrics. It shed light not only on the compassion at the heart of medicine, but also on the difficult reality that some of the most critical care can go unpaid.
We spoke with Dr. Healey to learn more about her experiences with denied claims and systemic billing challenges.
The CBC article highlights the fact that you weren’t renumerated for the work involving this particular newborn patient. Why was the claim rejected?
The claim was rejected because of long‑standing systemic issues within Ontario’s Infant Registration Program, particularly the use of the Pre‑Assigned Health Number (PAHN) for newborns. It is a complex and deeply flawed process.
There is no way for physicians to validate a PAHN at the time of service. When caring for a newborn in hospital, physicians must bill using the PAHN issued at birth. However, there is no mechanism to confirm whether that PAHN will ultimately be registered and accepted by the Ministry of Health. The registration process involves multiple steps that depend on both hospital staff and parents completing forms accurately and submitting them correctly. Any breakdown in this process, such as missing information, errors, or forms not reaching the Ministry, results in the PAHN never being registered. Months later, the associated claims are rejected.
When a claim is rejected because a PAHN was not registered, the responsibility shifts entirely to the physician to obtain the correct health card information from the family. This is often impossible due to incorrect or missing contact information, language barriers, or families who cannot be reached or decline to share updated information for privacy reasons. Even when the correct number is eventually obtained, the Ministry’s shortened 3‑month submission window, reduced from six months, means the claim may already be considered stale dated and rejected again requiring a more time-consuming and administratively burdensome process of resubmission.
The “Good Faith” claims payment policy, which allowed physicians to be paid for services when eligibility problems could not be detected at the time of care, was discontinued in 1998. This was because means to validate existing health cards became available. Since then, there has been no mechanism for physicians to receive payment for newborn care if the PAHN is later rejected without involving the family, even when the physician could not have known about the eligibility issue in advance.
In this specific case, the infant’s terminal condition meant the focus was entirely on palliative care. Hospital staff did not approach the family to complete the PAHN paperwork. My attention was on caring for the baby and supporting the family, not administrative procedures. When all of my claims for this infant’s care were rejected months later, my only option was to contact the grieving family and ask them go to ServiceOntario to register their deceased baby for a health card. That was not something I was willing to do, and as a result none of my care was compensated.
Physicians should never be placed in a position where they must choose between distressing a grieving family and being paid for the care they provided. Yet this has been the reality for pediatricians throughout my twenty years in practice. Pediatricians are repeatedly unpaid for some of the most difficult and emotionally demanding situations because of this systemic issue.
The Infant Registration Program in Ontario is quite complex – it’s a challenging thing to get right. What do you feel is causing issues?
The Infant Registration Program in Ontario remains fundamentally unchanged despite years of advocacy and attempts at collaboration by the OMA with the Ministry of Health. Although the Ministry has periodically stated that improvements have been made, such as policy adjustments or reminders issued to hospitals, these actions have not resulted in meaningful, real‑world change for physicians. Newborn claims continue to be rejected, and the Ministry’s efforts have not translated into any tangible improvement for those providing care.
The core problems persist because the process is almost entirely outside of a physician’s control. Physicians cannot validate a newborn’s Pre‑Assigned Health Number at the time of service, and they have no ability to ensure that the registration steps carried out by hospital staff and families are completed correctly. As a result, the same systemic failures continue to occur, and physicians continue to bear the consequences.
As a billing provider, we have seen many claims for newborns returned refused on error reports, with little our billing agents can do outside of following up with ServiceOntario. As Chair of the OMA’s Pediatrics Section you have been advocating for change. What would you like to see done to make the system work better for everyone?
At the Pediatrics Section, we have been working closely with the OMA to keep this issue at the forefront. Billing rejections for newborns are specifically highlighted OMA’s current “We Won’t Give Up” campaign , which calls for practical solutions that ensure physicians are paid for the care they provide and that families are not left navigating a system that does not function reliably.
This issue was also addressed in the recent Physician Services Agreement arbitration process. The arbitrator, William Kaplan, directed the Ministry to prioritize this problem and to work with the OMA to resolve these longstanding challenges on an expeditious basis, with the option of returning to the arbitration board after January 1, 2026 if necessary. Despite this clear direction, we are still waiting for a solution. I know that the OMA’s Negotiations Task Force is working hard on this file, and I am encouraged to see the issue highlighted so prominently. I hope this will finally bring some accountability on the part of the Ministry.
What we need is a process that is transparent, reliable, and fair. Physicians should be able to focus on caring for patients rather than tracking down administrative information that is outside of their control. Families should not be repeatedly contacted for the same details, and grieving families should never be contacted at all. Most importantly, newborns should receive the coverage they are entitled to without unnecessary barriers.
The OMA and its Pediatrics Section will continue to advocate for meaningful change until the system works better for everyone involved.
And it’s not just a financial challenge. Across the country, billing has emerged as most time-consuming and challenging non-clinical task for physicians. This type of administrative burden affects physician wellness and patient care. How do you navigate this reality and what advice would you give to early-career physicians struggling with work-life balance or systemic barriers?
It has unfortunately become part of the job to spend many hours dealing with billing rejections and other administrative tasks. The burden is not evenly distributed. For some patient populations the problem is far worse, and this creates a disproportionate impact on the physicians who care for them. I worry that this can disincentivize physicians from working with certain groups, often the most vulnerable, because constant rejections and unpaid work are simply not sustainable. This includes pediatricians and family physicians who see many newborns, as well as physicians caring for unhoused patients or patients with mental health conditions who may struggle to keep their health card valid and updated.
For early‑career physicians, my advice is to learn how to work as efficiently as possible within the current system by understanding where the barriers lie. In some cases, there are small steps that can reduce rejections, such as working with hospital unit clerks to ensure newborn PAHN forms are completed correctly. These steps do not solve the systemic problem, but they can help reduce the number of preventable rejections.
I would also encourage early‑career physicians to support the advocacy work being done by their colleagues. At the Pediatrics Section, we continue to push for solutions to newborn billing rejections, and this work is strengthened when more physicians lend their voices. Getting involved, even in small ways, helps build momentum. The stronger and more unified the advocacy, the more likely it is that meaningful change will occur.
Most importantly, I would remind early‑career physicians that none of these administrative burdens reflect a personal failing. They are symptoms of a system that needs to be fixed. Staying connected with colleagues, sharing strategies, and participating in collective advocacy can make the work more manageable and help protect physician wellness in the long term.
Have you faced any other situations where you or your colleagues have difficulties getting renumerated because of systemic limitations?
Physicians in every area of medicine experience challenges with OHIP rejections. Pediatricians face some unique ones because the many varied pediatric practices are all grouped together under a single Pediatrics (26) specialty within the OHIP system. Pediatricians work in a wide range of clinical areas, including subspecialty care, primary care, mental health and behavioural care, neonatology, and pediatric critical care. In the adult system, these areas are separated into distinct OHIP specialties, which allows for far greater flexibility and far fewer billing conflicts.
In pediatrics, subspecialists such as cardiologists or nephrologists usually bill as pediatricians. This often leads to rejected consultation claims because of the way the OHIP system processes same‑day services. When two different pediatricians, even if one is a subspecialist, see the same patient on the same calendar day, the system frequently interprets this as two pediatricians billing for the same service and automatically rejects one of the claims. This does not happen in the adult world, where subspecialties are recognized separately and the system can distinguish between, for example, a cardiologist and a nephrologist seeing the same patient on the same day.
Avoiding these rejections requires additional administrative work. Claims must be flagged for manual review, and consultation notes must be included to prove that two different subspecialists were involved. This is time‑consuming and unnecessary, and it reflects a structural problem in the Schedule rather than any issue with the care provided.
Until these systemic limitations are addressed, pediatricians will continue to face avoidable barriers to being paid for the work they do, particularly in complex cases that require multidisciplinary pediatric expertise.
