Charging for Uninsured Professional Services

I am with Alberta Precision Lab services and we frequently observe that a practitioner charges for their services to the patients in the setting of when uninsured services are provided but not for any related cost for provide diagnostic testing they ordered. Can the revised standard give clarification about how any diagnostic tests ordered as part of an uninsured visit, during which the practitioner charges for their services, should be covered? E.g. should the practitioner charge for those and then pay DI or APL? At least clarity that also any diagnostic test should be charged to the patient under the same terms would be helpful, since there is no reliable way for APL to know in every case that a practitioner orders lab test during an uninsured or medically no necessary visits/patient encounter.

Thank you for the opportunity to comment on Charging for Uninsured Professional Services SOP. It is clear and an improvement on the previous document. I wonder about how best to ensure that undergraduate and postgraduate health professionals are made aware of these and other documents. While the "devil in the details" may be disarming, the CPSA's SOP approach is vital to quality, safety and quality improvement. Who within the CPSA and our respective medical schools are collaborating on this?

Thank you for the opportunity to provide feedback on Consultation 31.
I support the proposed revisions as they emphasize fairness, transparency, and accountability in the physician–patient relationship.
In particular, clarifying expectations for uninsured professional service charges and non-treating medical examinations will help reduce misunderstandings and maintain patient trust.
The focus on professional responsibility and compliance with the Health Information Act when responding to third-party requests is also commendable.
Overall, these updates strengthen ethical standards and support both patient-centered care and professional integrity within Alberta’s medical community.

My primary concern with this is the placement of the clause highlighting that fees for uninsured services must take into account patients' ability to pay - it's been moved from section 1.3 to 6.c. in the proposed structure, effectively de-emphasizing it. Unfortunately many Government of Alberta social programs require forms (such as Alberta Works medicals, or applying for disability tax credit forms for AISH recipients) which are not reimbursed. I have seen multiple patients reporting charges of over $100 for completing these forms; while this does accurately reflect the time and effort that goes into these forms, Alberta Works and AISH recipients are definitionally living in poverty, and these charges represent a substantial proportion of their income. This is done under the current standard, and I fear that moving this clause further down the "batting order" will increase the number of charges which are unsustainable to patients.

Thanks for the opportunity to review the proposed standard. I have 2 pieces of feedback:
1. The AMA has not updated the guide for uninsured services since 2018. It would be necessary to confirm with the AMA that they have plans to keep this document current before tying it to a standard - to my knowledge, there have not been any plans to update the AMA guide, though that may change if you have discussions with them about this draft standard.
2. The piece about requiring a 24 hour messaging service or voicemail is overly prescriptive (also outdated) and unnecessary. Appointments are generally booked online in our office these days and can be cancelled online as well. We have not had an answering machine accept messages for many years now as patients would leave inappropriate information on there waiting for a call back rather than seeking appropriate after hours care. It was dangerous and so we stopped accepting messages, though they are still given a message about how to access after hours care. We always made exceptions for patients that called early Monday morning to cancel - they were not charged if they weren't able to notify us because we were closed. Less prescriptive solutions and language would be preferable here please.

Regarding charging fees for cancelling appointment with less than 24 hours notice, this allows patients to call on a Friday at 6PM to cancel an appointment on Monday at 8AM. The reason I charge fees isn't to make money - it serves as a reminder to patients that physicians are not taxpayer employees. Physicians, their staff, and their patients deserve to be respected by their patients. It is not OK to cancel at the last minute or no-show. I would never do that to my family, friends or my physicians. Last minute cancellations and no-shows reduce our ability to care for other patients and contributes to longer wait times. Changing this recommendation is in the best interests of the majority of patients. Fees should be chargeable when patients cancel with less than 3 business days notice.

Regarding the section about refusing care for a patient who has outstanding fees, I think this should apply only to urgent or emergent problems. This section goes on to refer to another standard that says we can refuse to book subsequent appointments if we sever the relationship. Some patients just need to be reminded that the physician-patient relationship is a two-way street - it must be respectful in both directions. Charging patients is a tangible reminder that there is a consequence for being disrespectful. But, once that's acknowledged, I am happy to keep caring for them with re-established mutual respect. I shouldn't have to fire them, and a fee serves to help correct the course of our professional relationship. And, remember, at the end the day, physicians can only afford their overhead when they see patients. That is the system in which we work. A standard that facilitates bad patient behaviour is not how one supports and reinforces the need for the relationship to be mutually respectful. While these comments apply to a minority, it is a large enough proportion such that it's not acceptable for the College to compel physicians (and indirectly, their other patients) to suffer the consequences of those that are unwilling to be respectful.