Reimbursement of medical costs for care received in Ontario
The RSMO reimbursement program allows the processing of invoices submitted by Ontario physicians or by their billing agencies for specialized medical services provided to Outaouais patients (region 07) where such care is not available in the region. The RSMO handles:
For billing by Ontario physicians:
- Evaluates payment requests submitted by Ontario physicians or their billing agencies.
- Authorizes or refuses payment of invoices submitted.
For hospitalisation in an Ottawa hospital:
- Issues stay authorizations for elective surgeries for which patients obtained prior referral by an Outaouais specialist.
- Authorizes payments for invoices submitted by Ontario physicians or their billing agencies at the OHIP rate.
- In partnership with the RAMQ, at a minimum 70-30 ratio, reimburses OHIP for payments of invoices authorized by RSMO.
Program access criteria and procedures:
For a payment to be eligible under the RSMO program, the patient must:
- Hold a valid health insurance card
- Be a resident of the Outaouais
- Have obtained a consultation request in Ontario from an Outaouais medical specialist referring him to another specialist in the same discipline in Ontario.
Before confirming a first appointment, the patient referred must check with the requested consulting physician in Ontario to see if the physician accepts the RAMQ card and/or if he bills RSMO.
Procedure for appointment with specialist:
- A consultation request in Ontario by a medical specialist in the Outaouais is required in order to obtain an appointment with an Ontario specialist. The Outaouais medical specialist or his team will handle the referral request to the Ontario medical specialist if the requested service is not available in the Outaouais.
- The administrative team at the medical specialist’s clinic to whom a referral request is made by the Outaouais physician schedules an appointment for you. Note that RSMO has no control over waiting periods before you can receive an appointment with the consulting physician in Ontario.
Procedure for elective hospital stays:
- The Admitting department of the Ontario hospital involved in the treatment submits a stay application to RSMO, which assesses the request before the patient is admitted.
- Generally, fees for specialized care received from a physician in the Ontario boarder region are assumed by the CISSS de l’Outaouais via RSMO. Nevertheless, an Ontario physician may opt out of using the RSMO program and bill the client directly even though a consultation request may have been sent in by an Outaouais medical specialist. In such cases, the client must pay the consultation fees and then submit an application for reimbursement to the RAMQ. It is therefore important that a client referred to a physician in Ontario ensure that the physician to whom he is referred uses the RSMO program for billing.
- A patient who chooses to receive care in Ontario without receiving an Ontario consultation request from an Outaouais specialist may expect to pay all, or at least a significant part, of the physician’s professional fees.