Fees for Services not Insured by the RAMQ
Forms
Administrative Fees
Annual block fee***
Medication and medical supplies (amount indicated or cost according to use)
Hourly Fee
Consults for non-residents of Québec
Notes
* Québec has not signed the interprovincial agreement providing for full payment of professional fees, making it prudent to bill the patient directly.
Patients who believe that they have been billed for services that are insured under the Health Insurance Act can make a written claim for reimbursement to the Régie de l’assurance maladie du Québec within a year of making the payment. When the Régie is of the opinion that a patient has been billed for amounts that are not allowed, the Régie reimburses the patient and recovers the same amount from the professional or third party in question.
** A physician would be justified in charging a cancellation fee to any patient who had been informed in advance that there would be a charge of X dollars for cancelling an appointment less than 24 hours prior to it. Of course, this will not apply in the case of extenuating circumstances. On the other hand, a physician may be required to provide proof that he/she incurred a loss of income. As well, the physician must endeavour to respect scheduled appointments with patients.
* The physician is free to charge directly to the patient’s province of origin.
*** The Code of Ethics does not prohibit the possibility of a physician charging his/her patients an annual block fee for services that are not insured by the RAMQ, on the condition that certain precautions and rules are followed. This annual block fee could cover the cost of all the non-insured services for a patient or his famiily, regardless of the number of non-insured services provided by the physician during the year.
In this case, there must be a written contract, to which a patient may subscribe for a fixed period (1 year), at a fixed cost (for example, $100), and a fixed scope (for non-insured services that are listed in the contract). The policy concerning the block fee must be posted, in conformity with the Loi sur l’assurance maladie.
To avoid invalidating the doctor-patient relationship, it is recommended that the physician appoint a member of his/her staff to ensure that the patient gives free and informed consent before signing the contract. The patient must be given an explanation of the nature of the block fee, what services it covers, and which non-insured services are excluded from it. The contract must include a cancellation clause, which the patient can apply at any time before two-thirds of the fixed period of the contract has elapsed, with reimbursement by the physician of a sum proportional to the time remaining in the contract.
No service insured by the RAMQ or fees inherent to an insured service can be included in such a contract.
These agreements may in no way influence the professional practice of a physician, both in terms of the quality of care and his/her availability.
SOURCES :
Loi sur l’assurance maladie, art. 22.0.0.1
Le Collège, Vol. XXXIX, no 3, Octobre 1999
It should be noted, however, that at present the RAMQ is of the opinion that the block fee is contrary to the Loi sur l’assurance maladie. It has informed us that it will reimburse the cost of block fees to all patients who make such a request to it and that, where applicable, it will recover the sums from the honoraria that it pays to the physicians in question. The FMOQ does not share the RAMQ’s legal interpretation in this matter and therefore intends to challenge it.
Administrative Services
Telephone consultations.
Before incurring costs, patients should be informed that a fee will be charged.
Renewal of prescription without a medical visit.
Prescriptions should generally be made after an assessment by the physician. Depending on the type of prescription and the circumstances, a recent exam may be a sufficient basis for renewal or it may be reasonable to renew without the benefit of a new assessment if an office visit is scheduled shortly, for a known and non-urgent condition where, for example, interruption of drug therapy may harm the patient. A physician must be especially careful when prescribing psychoactive substances without the benefit of a fresh assessment.
Additional Fees
We remind you that you must always inform your patient before providing services for which the patient will be billed.
Section 1.1.4 of the general preamble prohibits billing a patient for unlisted additional fees. Hence the Cytobrosse® cannot be billed.
CSST. Some regional CSST offices reimburse physicians directly for additional fees rather than reimbursing the patient; check locally.
Hourly Fee
Medical-administrative tasks
Time spent on administrative work on a patient’s file for the patient or for a third party. Example: writing a summary of the file, selection of relevant elements. Hourly fee: $150 for the first half-hour and $125 for each additional half-hour
Medical-legal tasks
Time spent preparing a file that is or may be the subject of litigation. Example: writing a medical opinion for a divorce case, a termination of employment, a court case. Hourly fee: $325
Expertise
Time spent on professional services required as an expert, in particular writing of a report. Hourly fee: $390
It should be noted that a prior agreement is required to be able to charge such fees.