Charging For Uninsured Professional Services

1. Amounts charged for uninsured professional services¹, including block fees², must reasonably reflect physician professional costs, administrative costs and the patient’s ability to pay. When asked, a regulated member must be able to account for the fee charged for the service.
2. A regulated member must inform a patient or third party of any fee to be charged before the provision of an uninsured professional service.
3. A regulated member’s agent may give preliminary information to a patient about the billing policies in his or her medical practice, but the regulated member remains responsible for the final decision and explanation to the patient when the patient disputes a fee or requests clarification.
4. A general notice to patients in a regulated member’s office is not sufficient by itself to fulfill the requirements in clauses (2) and (3).
5. A regulated member may not demand payment from an individual patient in advance of urgently required uninsured professional services that are not readily available elsewhere.
6. A regulated member must not charge a fee to the patient in advance for “being available” to render professional services.
7. If a regulated member offers a block fee option the physician must:
   1. allow the patient the choice of paying the block fee or for each professional service individually as provided;
   2. provide the patient with the block fee option in writing;
   3. ensure the patient is given sufficient information to make an informed choice, including:
      1. a list of fees that will be charged individually for each professional service if the patient declines the block fee option; and
      2. a copy of this standard.
8. If a regulated member offers a block fee option, the regulated member must not:
   1. refuse to provide an insured professional service because a patient has not paid a block fee for uninsured services;
   2. include in a block fee any service for which the regulated member is compensated through any other means, including any charge for a professional service which is included as part of an insured professional service.
   3. promise or provide preferential services to a patient who paid a block fee.

1. A professional service includes both medical and non-medical services.
2. For the purpose of this standard a block fee is a fixed fee for all designated uninsured services provided during a specified time period.