Private Pay Imaging Services: What to Confirm Before Booking

Overview

Most medically necessary diagnostic imaging services are covered by OHIP when ordered by a licensed physician or authorized healthcare provider.

Some services may not be covered by OHIP. These may include exams requested for screening, prevention, body composition, or other reasons that do not meet OHIP coverage criteria. Patients without OHIP coverage may also need to pay privately.

Because private-pay services, pricing, and location availability can change, always confirm details before booking. Uninsured Services

What You Need to Know

• Most medically necessary imaging services are OHIP-covered when the correct criteria are met.
• Some services may be private pay.
• Patients without OHIP may need to pay for imaging.
• Private-pay imaging may still require a valid requisition.
• Pricing should be confirmed before booking.
• Location availability may vary.
• Preparation instructions may differ depending on the exam.
• Private-pay imaging should not replace medical advice from your healthcare provider.

Before You Book

Before booking a private-pay imaging service, confirm:

• Whether the exam is covered by OHIP or private pay
• The current cost
• Whether a requisition is required
• Whether GNMI can help with the requisition process, if applicable
• Which location offers the service
• Whether an appointment is required
• What preparation instructions apply
• What is included in the fee
• How and when results are provided
• Whether reports are sent to a physician

Requisition Requirements

Even when an exam is private pay, a requisition may still be required. A requisition helps make sure the correct imaging test is performed and that results are sent to an appropriate healthcare provider.

If you do not have a requisition, contact GNMI before booking to confirm what options are available.

OHIP-Covered Versus Private Pay

An exam may be OHIP-covered when it is medically necessary and ordered by an authorized healthcare provider.

An exam may be private pay when:

• It is not medically indicated
• It is requested for screening or preventative reasons
• It is not covered by OHIP
• The patient does not have valid OHIP coverage
• The service falls outside OHIP eligibility criteria

Do not assume a service is covered or private pay based only on the exam name. Coverage can depend on the reason for the test, the requisition, and eligibility criteria.

Results and Reports

Ask how your results will be handled before booking.

Confirm:

• Who receives the report
• Whether the report goes to your referring physician
• Whether you can request a copy
• Whether images are available
• Expected report timing
• Whether follow-up with your doctor is needed

Safety Notes

Private-pay imaging is still medical imaging. Safety screening and preparation instructions still matter.

Tell GNMI before booking if you:

• Are pregnant or might be pregnant
• Are breastfeeding
• Have implants, medical devices, or metal in your body
• Have kidney concerns
• Have had prior reactions to contrast
• Are diabetic
• Take medications that may affect preparation
• Need accessibility support

When to Contact GNMI

Contact GNMI before booking if:

• You want to know whether an exam is OHIP-covered or private pay
• You need current pricing
• You do not have a requisition
• You want to know which location offers the service
• You are unsure which imaging test you need
• You have safety concerns
• You need preparation instructions
• You need results sent to a physician