Charging for Uninsured Professional Services

College of Physicians and Surgeons of Alberta Are You Up to Standard?, Messenger

In establishing standards of practice, the College is compelled not only by the Health Professions Act (which gives us our mandate) but also by the entire suite of health-related provincial and federal legislation.

The Canada Health Act and the Alberta Health Care Insurance Act (HCIA) provide the legislative framework for payment of health services; this includes billing. The College’s standard Charging for Uninsured Professional Services seeks to clarify how this legislation affects physicians.

These are the key points:

  • You cannot charge an insured person for any medically required service listed in the Schedule of Medical Benefits (SOMB)
  • You cannot charge an individual insured person a fee to be available to provide an insured service (i.e., a block fee)
  • There may be times you need to provide a medically required service before and irrespective of determining whether a patient is insured, such as in an emergency situation

When can you charge? You can charge non-insured persons for services. You can also charge insured persons a fee for medically required services that are non-insured or only partially publically funded under the HCIA. Finally, you can charge for professional services that are not medically required, such as copying a patient’s record. In all cases:

  • The fee must be reasonable, considering both the nature of the service provided and the ability of the patient to pay.
  • The patient must be informed of the fee in advance.

For more on this, see the Charging for Uninsured Services standard of practice and advice documents, as well as advice on Insured Persons.