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 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 introduce a more restrictive framework for the billing of insured persons for covered services provided by health professionals who are subject to the application of an agreement.
Under the Act: "No payment may be charged to or received from any insured person, directly or indirectly, for costs incurred for insured services provided by a health professional who is subject to the application of an agreement or by a professional who has withdrawn. Such costs include those related to
- the operation of a private health facility or a specialized medical centre within the meaning of the Act respecting health services and social services;
- services, supplies, medications and equipment required to provide an insured service, as well as to perform diagnostic tests related to such a service
In addition, directly or indirectly requiring an insured person to pay for access to an insured service, and granting an insured person privileged access to such a service in exchange for payment, are prohibited." Health Insurance Act (Chapter A-29)
If you have questions about the nature of certain fees for which you were or will be billed, please mail your request to the address below, along with the relevant documents (invoices, receipts or other).
Direction des affaires professionnelles
Régie de l'assurance maladie du Québec
Case postale 6600
Québec (Québec) G1K 7T3
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
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 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.
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.