Physicians charging for uninsured professional services

CPSA recognizes that access to health care is a top priority for Albertans and that recent concerns have arisen over patients being presented with the option to pay membership fees for certain services.

Government legislation determines which medical services are publicly funded and which can be provided privately for persons considered insured under the Canada Health Act (CHA) and the Alberta Health Care Insurance Act (HCIA). While CPSA does not make these determinations or oversee physician billing, we do outline the expectations for charging for uninsured professional services through a standard of practice, which highlights:

• Fees charged for uninsured professional services must reasonably reflect the physician’s professional costs, administrative costs and the patient’s ability to pay.
• Patients must be directly informed of any fee before the physician performs the uninsured professional service. A general notice to patients in a doctor’s office is not sufficient to fulfill this requirement.
• Physicians may not ask patients to pay in advance for urgently required uninsured professional services that are not readily available elsewhere, nor may they charge the patient a fee in advance for being available to provide professional services.
• If the physician offers a block fee option (a fixed fee charged to patients to pay for one or more uninsured professional services provided during a specified time period, like a membership fee):
  • Physicians must allow patients the choice between paying the block fee or for each individual professional service, provide the block fee option in writing, and ensure the patient is given sufficient information to make an informed choice.
  • Physicians must not refuse to provide an insured professional service because a patient has not paid a block fee for uninsured services, include in a block fee any service for which the physician is compensated through any other means (such as an insured professional service), or promise or provide preferential services to a patient who paid a block fee.

As noted above, it goes against CPSA’s Charging for Uninsured Professional Services standard to charge insured persons, as defined by the CHA and HCIA, a fee for insured professional services. It is not against CPSA’s standard to charge for uninsured services.

CPSA has a duty to act if a regulated member is practising in contravention to CPSA’s Standards of Practice. We prefer an education-based approach, often working one-on-one with physicians to ensure they understand our standards and have the opportunity to become compliant. While rare, we do have the authority to initiate a formal complaint. If a complaint is initiated, we follow our complaints process based on options outlined in the Health Professions Act (HPA). Under legislation, CPSA is unable to share information about specific complaints in our complaints process, including whether or not a complaint has been filed.

The vast majority of physicians practising in Alberta are professional and CPSA thanks them for their continued adherence to their professional responsibilities outlined in CPSA’s Standards of Practice.

Resources:

• Charging for Uninsured Professional Services standard
• Advice to the Profession on Charging for Uninsured Professional Services