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.