Fees billed by a physician
When you visit your doctor, he/she or a third party may require that you pay a fee. Most doctors accept the Health Insurance Card as payment for their fees. They are known as participating physicians. The Régie de l'assurance maladie du Québec remunerates them for the health services they render to their patients. Since they are paid by the Régie, these doctors cannot bill their patients for insured services, except where stipulated by the applicable law. Here are some examples of fees for which you may or may not be billed:
Examples of fees for which you may not be billed
Whether in a clinic, hospital or CLSC, participating physicians cannot bill you for the following:
- medically required surgery;
- the opening, management or computerization of medical records;
- diagnostic or therapeutic procedures;
- staff remuneration (secretarial work, archiving, filing, sterilization, housekeeping or assistance provided to doctors in treatment or operating rooms);
- materials used (syringes, needles, gastric rings, dressings, capsules taken for video of digestive endoscopy or any disposable materials);
- materials or products used to sterilize medical instruments;
- use of medical equipment or instruments, known as a "technical support centre", used in operating rooms;
- rental or upkeep of facilities;
- use of new technology that is not considered experimental;
- shorter wait times on waiting lists;
- lump sums required in advance for services not yet rendered.
Examples of fees for which you may be billed
Participating physicians are entitled to bill you in certain cases:
Even if you present your Health Insurance Card to benefit from covered healthcare services, you may still be billed for some services. Doctors are allowed to receive financial compensation for:
- filling out certain medico-administrative forms;
- prescription drugs and anesthetics administered in a private medical office, such as substances used when local anesthesia is necessary for minor surgery.
It is legal for these fees to be charged. Doctors can require them under an agreement concluded between the Minister of Health and Social Services and medical federations. Nevertheless, when they work in a private office or specialized medical centre, doctors must display, in the waiting room, the rates for services, supplies and other charges.
When a doctor bills you for certain fees, it is important that you:
- inform yourself as to what exactly the fees are for;
- make sure you obtain an invoice detailing the amounts billed for each service or product supplied.
When requesting a reimbursement from the Régie, you will have to submit the invoice along with proof of payment.
Doctors who don't participate in or have opted out of the Health Insurance Plan
Although very few in number, some doctors, who have opted out of the Health Insurance Plan, do not accept the Health Insurance Card as payment for their fees. Instead, they bill their patients for their services. The patients, upon presentation of a form obtained during the appointment, receive from the Régie an amount equivalent to the fee billed. They then pay the doctors. Doctors who have withdrawn from the Health Insurance Plan are required to inform their patients of their status.
Other doctors, also very few in number, are known as "non-participating physicians:" they do not accept the Health Insurance Card, and the Régie is not able to issue reimbursements for the cost of their services. They, too, must inform their patients of their status.
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 transferred a copy of my medical record to another clinic. Do I have to pay for this service?
Your doctor is entitled to bill you for that service.
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;
- an application for disability benefits with the Régie des rentes du Québec;
- a report for the Public Curator from the director general of an institution;
- the Commission 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. How does this work?
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.
I had to pay to have a prescription renewed. How is this possible?
If you consult your doctor for the sole purpose of having a prescription renewed, he/she may request that you pay.That service is not insured by the Health Insurance Plan, and your doctor is therefore not remunerated by the Régie in this given situation.
The same holds true if you call your doctor to ask him/her to renew your prescription.
Since it is increasingly difficult to find a family doctor, must I pay to get one?
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). 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.