My Eye Exam Was Covered by OHIP. Why Is There a Bill?
OHIP pays for the examination — but not for the imaging and testing that modern optometry requires to meet its duty of care. Here's what's on your bill and why.
Updated · Dr. David Wilkinson
You booked your appointment, showed your OHIP card, had your eyes examined — and then received a bill. This is one of the most common sources of confusion and frustration for Ontario patients, and it deserves a clear explanation.
The short answer: OHIP covered your examination. It did not cover everything that happened during your visit.
What OHIP actually pays for
When an optometrist bills OHIP for your exam, they are billing for the professional service of examining your eyes — assessing visual acuity, eye health, and any conditions that may be present. OHIP reimburses a defined fee for that service.
What OHIP does not reimburse is the diagnostic testing that makes a thorough eye exam thorough.
The gap between coverage and care
OHIP's optometry fee schedule was written at a time when an eye exam meant a slit lamp and a set of lenses. It was not designed around the diagnostic tools that modern optometry depends on.
Today, a full-scope eye exam routinely includes:
- OCT (optical coherence tomography) — cross-sectional imaging of the retina and optic nerve, capable of detecting glaucoma and macular disease years before symptoms appear
- Retinal photography — a wide-field image of the retina that creates a documented baseline and allows changes to be tracked over time
Neither of these is covered by OHIP. The equipment costs hundreds of thousands of dollars, requires trained staff to operate, and the images require clinical interpretation. OHIP's fee schedule does not account for any of this.
The result is a gap: OHIP pays for the exam, but not for the testing that meets the current standard of care.
Why practices charge for it anyway
An optometrist has a duty of care to their patients. That duty is defined by the profession's standard of care — not by what OHIP happens to reimburse.
If imaging is clinically indicated and an optometrist doesn't perform it because it isn't covered, they may be practising below the standard of care. That's a regulatory and liability issue, not just an inconvenience.
Put simply: a practice that limits its examinations to what OHIP covers may not be giving you the exam the profession requires.
What you should expect
Ontario's regulations require that patients be informed of uninsured fees before those services are provided. If a clinic is charging for imaging, they should tell you before your appointment — or at the latest, at check-in.
If you were charged for something you weren't told about in advance, you have grounds to raise it with the clinic and, if necessary, with the College of Optometrists of Ontario.
If you were told and simply surprised — that's a communication gap worth raising with the clinic directly.
Before your next appointment
A few questions worth asking when you book:
- Is my exam covered by OHIP?
- Are there any fees beyond the OHIP-covered examination?
- What diagnostic imaging is included, and what does it cost?
Most clinics are happy to answer these questions in advance. Getting clarity before you arrive avoids surprises at the desk — and helps you make use of any extended health benefits you may have.
Key takeaway
OHIP coverage and the full cost of a thorough eye exam are not the same thing. The gap between them is real, and it exists because diagnostic technology has advanced faster than OHIP's fee schedule. Understanding what's on your bill — and why — is the first step to navigating it.
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Book an appointment →Frequently Asked Questions
- Can an optometrist charge me extra if my exam is covered by OHIP?
- Yes. OHIP covers the professional examination fee, but it does not cover diagnostic imaging such as OCT scans or retinal photography. These are billed separately and are not governed by OHIP's fee schedule.
- Is it legal for optometrists to charge for services beyond OHIP?
- Yes. Optometrists are permitted to bill patients directly for uninsured services — services that fall outside OHIP's defined coverage. Diagnostic imaging, contact lens assessments, and certain specialty tests are common examples.
- Do I have to pay for the extra tests?
- Diagnostic imaging is part of the standard of care at most full-scope optometry practices. You can ask your clinic what fees apply before your appointment. Clinics are required to inform patients of uninsured charges before performing those services.
- Will my insurance cover the extra charges?
- Many extended health benefit plans include coverage for vision care beyond OHIP. Check your plan documents or contact your benefits administrator — some plans reimburse diagnostic imaging fees, particularly when related to a diagnosed condition.
- Why doesn't OHIP cover these tests?
- OHIP's fee schedule for optometry was established decades ago and has not kept pace with advances in diagnostic technology. OCT imaging, for example, did not exist when many of the current OHIP billing codes were written. The equipment and the expertise to interpret the results are real costs that fall outside what OHIP reimburses.
Author
Dr. David Wilkinson, OD, FAAO — Pending clinical review
Optometrist, Spadina Optometry
A Toronto native and Fellow of the American Academy of Optometry, Dr. David Wilkinson has been part of our optometric practice since earning his OD from the Illinois College of Optometry in 2007. A certified clinical investigator with a special interest in contact lenses and myopia management, he serves as a part-time Clinical Instructor at the University of Waterloo's Waterloo Eye Institute and previously spent nearly a decade as Practice Advisor at the College of Optometrists of Ontario.