Fees billed by a physician
Most doctors accept the Health Insurance Card as payment for their fees. They are known as participating physicians and are subject to the application of an agreement. The Régie de l'assurance maladie du Québec remunerates them for the covered health services they render to their patients. Since they are paid by the Régie, these doctors cannot bill their patients for covered services, except where stipulated by the applicable law.
On November 10, 2015, the Health Insurance Act was amended. The new provisions introduced a more restrictive framework for the billing of insured persons for covered services provided by healthcare professionals who are remunerated by the Régie. The services that medical clinics, their staff, and healthcare professionals are allowed to bill are now greatly restricted. With the new provisions, they are only permitted to bill patients for the cost of anesthetic agents, drugs and IUDs (intrauterine devices).
Physicians practicing in a private office or in a specialized medical centre are required to post the following in the waiting room:
- the fees for which they can bill insured persons
- the fees for the medical services they provide that are not covered
When physicians bill insured persons, they must hand them a detailed invoice indicating the fees they are allowed to bill and the fee they bill for each medical service they provide that is not covered.
The billing schedule posted in the waiting room and the invoice handed to the insured persons must mention the possible means of recourse with the Régie.
When a physician bills you, it is important that you:
- make sure you understand the items billed to you
- make certain that you obtain an invoice detailing the amounts requested for each service or supply
If you consider that you have been wrongfully charged, you will have to present this invoice and proof of payment when you apply for a reimbursement from the Régie.
Please note that clinics and physicians are not allowed to ask you to pay a fee as a condition for gaining access or quicker access to a physician.
If you have any questions of the types of fees billed, write to us at the following address:
Direction des affaires professionnelles
Régie de l'assurance maladie du Québec
Case postale 6600
Québec (Québec) G1K 7T3
It is important that you attach the relevant documents to your application (invoices, receipts, etc.). Effective December 7, 2015, you have 5 years from the date of payment of services to file a request for reimbursement.
When the Regulation abolishing accessory costs related to the provision of insured services and governing transportation costs for biological samples is in effect, only those fees set out in the Regulation will be authorized.
Doctors who don't participate in or have opted out of the Health Insurance Plan
Some doctors do not participate in the Québec Health Insurance Plan. They are known as non-participating physicians. They do not accept the Health Insurance Card as payment for their services and are not remunerated by the Régie. They bill their patients directly and set their own rates. The Régie is not able to issue reimbursements for the cost of their services.
Other doctors have withdrawn from the Health Insurance Plan and bill their patients. With these doctors, the patients must submit to the Régie the form handed to them during the medical visit. Thereafter, the Régie will reimburse them according to the rates in effect and they will be able to pay their doctor.
Frequently asked questions
I was charged to have a medical record opened at my doctor's office. Is this legal?
No. Neither doctors nor clinics are entitled to charge for opening, managing or computerizing your medical record.
My doctor charged me because I did not keep an appointment. Is he/she allowed to do so?
Yes. Your doctor is entitled to bill you when you fail to keep an appointment.
I needed to have a form filled out by my doctor, who charged me for the service. Is this legal?
Yes. Your doctor is entitled to request compensation from patients for completing most medical forms.
However, there are exceptions, such as forms concerning:
- an attestation of death
- a medical-legal report for a victim of sexual assault
- an evaluation of a person experiencing a loss of autonomy
- a report for the Public Curator from the director general of an institution
- the Commission des normes, de l’équité, de la santé et de la sécurité du travail
My doctor billed me for local anesthesia administered at his/her clinic. Yet, at hospitals every service seems to be provided free of charge. Why is this?
When an anesthetic agent is used, for instance for a minor procedure, doctors who practice in a clinic are entitled to request compensation from their patients.
However, when the anesthesia is performed in a hospital, it bears the costs, which is why patients do not have to pay.
Is it possible that I pay my doctor for a given service and he/she also remunerated by the Régie for the same service?
That would be illegal. When doctors are paid by the Régie for a service they render, they are not allowed to request or receive remuneration other than that provided by the Régie.
My new doctor wants to bill me for accepting me as a patient. Is he entitled to do so?
It is illegal for a doctor or clinic to charge anyone a fee to obtain access or priority access to them. Whether the doctor or clinic charges you for registration or to enable you to obtain certain compulsory services for which you are required to pay (e.g. a checkup in the form of blood tests or a consultation with another health professional), such a practice is prohibited.
When a doctor is allowed to bill for a service, who determines the amount?
The Régie does not establish the amounts requested of patients. If you consider that an amount charged to you is unreasonable, you must contact the Collège des médecins (French only). It is the Collège that holds the authority in matters of fee conciliation, whereas the Régie is responsible for addressing cases where physicians' billing does not comply with the agreements and the Act.
Doctors who practise in a private medical office or in a specialized medical centre are required to display, in the waiting room, the rates for services, supplies and other charges.