Charging for Uninsured Professional Services
Under Review: No
Issued by Council (Charging for Uninsured Medical Services): January 1, 2010
Reissued by Council (Charging for Uninsured Professional Services): September 9, 2014
- Amounts charged for uninsured professional services1 including block fees2 must reasonably reflect physician professional costs, administrative costs and the patient’s ability to pay. When asked, a regulated member must be able to account for the fee charged for the service.
- A regulated must inform a patient or third party of any fee to be charged before the provision of an uninsured professional service.
- A regulated member’s agent may give preliminary information to a patient about the billing policies in his or her medical practice, but the regulated member remains responsible for the final decision and explanation to the patient when the patient disputes a fee or requests clarification.
- A general notice to patients in a regulated member’s office is not sufficient by itself to fulfill the requirements in clauses (2) and (3).
- A regulated member may not demand payment from an individual patient in advance of urgently required uninsured professional services that are not readily available elsewhere.
- A regulated member must not charge a fee to the patient in advance for “being available” to render professional services.
- If a regulated member offers a block fee option the physician must:
- allow the patient the choice of paying the block fee or for each professional service individually as provided;
- provide the patient with the block fee option in writing;
- ensure the patient is given sufficient information to make an informed choice, including:
- a list of fees that will be charged individually for each professional service if the patient declines the block fee option; and
- a copy of this standard.
- If a regulated member offers a block fee option, the regulated member must not:
- refuse to provide an insured professional service because a patient has not paid a block fee for uninsured services;
- include in a block fee any service for which the regulated member is compensated through any other means, including any charge for a professional service which is included as part of an insured professional service.
- promise or provide preferential services to a patient who paid a block fee.
1. A professional service includes both medical and non-medical services.
2. For the purpose of this standard a block fee is a fixed fee for all designated uninsured services provided during a specified time period.
The CPSA Standards of Practice are the minimum standards of professional behaviour and ethical conduct expected of all physicians registered in Alberta. Standards of practice are enforceable under the Health Professions Act and will be referenced in the management of complaints and in discipline hearings. About the CPSA Standards of Practice