Obtain information on covered services
RAMQ pays for services covered by the Health Insurance Plan when rendered to insured persons. Health professionals participating in the plan cannot bill you for these services. As well, you cannot be billed for any costs related to covered services, also called "accessory costs".
However, you can be billed for certain other services: all services that are not covered and those offered by professionals who practise their profession outside the scope of the plan.
Covered services are paid by RAMQ. They may be rendered at a number of different places (hospitals, CLSCs, medical clinics or pharmacies, for example).
- Medical procedures such as surgery
- Medical examinations
- Eye drops
- Diagnostic mammogram
- Opening a file
- Radiographies prescribed by a physician, specialized nurse practitioner, dentist or physiotherapist
- Urine and glycemia tests
- Vaccinations provided under the Québec Immunization Program
In general, you cannot be billed for an administrative procedure related to a covered service provided by a physician participating in the public plan. Conversely, you may be billed for it if:
- The request is not related to the provision of health services
- It is performed at your request by a third party, such as an insurer, an employer, a non-participating health professional or the Société de l’assurance automobile du Québec
- You do not have to pay for a renewal of a prescription when you visit a physician participating in the public plan if the physician provides you with covered medical services at the same time. However, you may have to pay for a renewal of a prescription if you do not visit the physician at all or if this service is the only purpose of your visit.
- You never have to pay for the replacement of a lost prescription.
- You do not have to pay for the writing of a report, recommendation or attestation, the copying of a medical record or the transfer of a record if they are related to a covered service provided by a participating physician.
- Exceptions: these services may be billed to you if they are for yourself or for a third party.
- You usually have to pay for a medical certificate (form) to be completed by a physician. Fees billed for this service are not reimbursable.
- Exceptions: the completion of certain medical certificates and related examinations, if required, are covered. The forms required as part of a request for authorization to RAMQ are also covered. You cannot be billed for their completion.
Wrongfully billed fees (accessory costs)
Wrongfully billed fees are costs related to covered services for which the professionals are being paid by RAMQ. Since January 26, 2017, such costs can no longer be billed, by regulation.
One exception only remains: a professional can bill you for the transportation of samples. However, the amounts billed may not exceed the following amounts:
- $15 for the transportation of a sample that includes blood
- $5 for the transportation of any other sample (culture for a bacteriological examination, for example)
You may be billed for these fees only once per sample collection session, even if there is more than one sample to be transported.
Professionals who participate in the public plan and those who do not
Some professionals practise their profession outside the scope of the plan. This determines how they are remunerated. For more information, consult the webpage Professionals offering covered services.
You must pay for services that are not covered by the Health Insurance Plan. Services that are not tied to preventing, healing or curing illnesses or diseases are among such services. In addition, some services are not covered in a medical clinic whereas they are when rendered in a hospital.
- Medical examination for employment or insurance
- Charge for a missed appointment
- Services rendered for cosmetic reasons
In medical clinics only:
- Echography conducted by a physician other than a radiologist
- Magnetic resonance imaging (MRI)
- Services rendered by the following professionals: acupuncturist, audiologist, chiropractor, occupational therapist, physiotherapist and psychologist
- Services offered by professionals not participating in the plan
- Computerized axial tomography (CAT)
Verification of your invoice
Whenever a health professional requires payment, be sure to:
- receive a detailed invoice
- fully understand it and ask questions, as needed
- pay only for non-covered services
If you believe that you were wrongly charged, keep the invoice and proof of payment. Then, submit a request for reimbursement.
Fees billed by health facilities
RAMQ does not administer the fees billed by health facilities (hospitals, CLSCs, residential and long-term care centres, rehabilitation centres, for example). The rules governing them are different. Claims or complaints concerning these fees must be sent to the service quality and complaint commissioner of the facility in question.
Exception: If you did not present your valid Health Insurance Card at the time of a consultation with a participating health professional and were therefore billed for a professional fee (salary), you may be eligible for a reimbursement.
Medical clinics' obligations: waiting rooms and invoices
Medical clinics and specialized medical centres have certain obligations to fulfil with respect to information displayed in their waiting rooms. They must also provide you with a detailed invoice for any payment required.
Display in the waiting room
- Charges that can be billed to you
- Cost of non-covered medical services rendered by the physician
Information on the detailed invoice
- Fee charged you by the physician
- Cost of each non-covered service that the physician rendered to you
You can report wrongdoing, such as the following:
- Fees illegally billed to insured persons
- A breach of the laws and regulations by a healthcare professional or worker, or other service provider
Frequently asked questions
No. We do not reimburse fees billed by health facilities. To make a claim or file a complaint concerning a health facility, you will need to contact the service quality and complaint commissioner of the facility in question.
However, if the physician of a health facility bills you for their fees (their salary), fill out a request for reimbursement online.
We are unable to dedicate sums to persons who have paid for non-covered services and therefore cannot reimburse you the costs associated with the service.
No. We do not cover the cost of transport by ambulance. For more information on the cost of ambulance transport as well as the government exceptional assistance measures, please consult the webpage Cost of ambulance transportation on the Québec.ca website.