Medical Fees

Insured services

Anyone who lives in Quebec is covered by the Régie de l’assurance maladie du Québec (RAMQ). If you have a health insurance card, you can receive medical care covered by the RAMQ free of charge.

Uninsured services and incidental fees

Some services are not insured by the RAMQ. These services may not be covered or may be incidental to a service that is covered and may be billed by the physician. They include, for example, photocopying costs, the cost of an intrauterine device or some vaccines administered at the physician’s office.

The Regulation abolishing accessory costs related to the provision of insured services and governing transportation costs for biological samples came into force on January 26, 2017. This regulation abolishes all incidental fees or “accessory costs” related to the provision of insured services. Physicians may no longer charge fees for medications or anesthetic agents used during a medical consultation.

Transportation costs

According to the Regulation, patients may now only be charged fees for the transportation of biological samples.

Under the Regulation, fees may only be charged to an insured person for the transportation of biological samples collected at a private health facility or a specialized medical centre, since transportation costs are not covered by the RAMQ. However, a maximum of $15 can be billed to the patient for the transportation of biological samples including blood samples. A maximum of $5 can be billed for the transportation any other biological sample. These fees may only be charged once per sample when samples are transported to a given laboratory.

Posting of fees

The Health Insurance Act stipulates that a physician “must post in public view [...] the tariff of fees that the physician may charge an insured person [...] and the tariff of fees for medical services rendered by the physician that are non-insured services”. To find out more about the services covered and fees charged, go to the RAMQ website.

The Code of ethics of physicians stipulates that a physician must display, for public view, in the waiting room of the place where he practices the price of any uninsured services, supplies and medical care that he charges for. The physician must also provide an itemized invoice that shows the fee charged for each service.

Private medicine

For uninsured services or services provided by a physician who does not participate in the health insurance plan, the fees charged can vary widely, just like those of a lawyer, an architect or any other professional working under the rules of free competition. Physicians may, within limits, bill patients using their own fee schedule. In this case, be it cosmetic surgery, orthopedics, ophthalmology or another activity sector, the patient must make his own assessment and be vigilant, as when purchasing any goods or services, professional or otherwise.

Contesting fees

A patient who feels they have been wronged and would like to contest the fees charged by their physician may obtain information from and request a conciliation of accounts by the Collège’s Inquiries Division. This may be related, for instance, to fees for uninsured services or care provided by non-participating physicians.

In very specific situations, if a patient paid sums of money to a physician, such as an advance payment, and they were used by the physician for purposes other than those intended, they may file a claim for compensation.

QUESTIONS AND ANSWERS

Are physicians allowed to charge a fee for a missed appointment?

While a missed appointment fee is included in the fee schedules proposed by the medical federations, physicians with an office-based practice must comply with certain ethical guidelines if they intend to charge patients a compensatory fee for a missed appointment:

a) The patient must be given specific information about the missed appointment fee when he makes the appointment;
b) The physician must be able to prove that he could not fill the appointment time with other professional activities;
c) The fee charged must be reasonable;
d) The patient must be allowed to cancel his appointment up to 24 hours before;
e) The patient must not have missed his appointment due to unforeseeable circumstances or force majeure.

It is highly advisable to keep a written record of the specific information the patient was given when he made the appointment. The missed appointment fee policy must be posted in accordance with the Health Insurance Act and the Code of ethics of physicians.

If a fee is charged, the physician must provide the patient with an itemized invoice. Even if all the above rules were followed, in the event of a dispute concerning the compensatory fee charged by the physician, the patient may submit the account to the syndic in accordance with the Regulation respecting the conciliation and arbitration procedure for the accounts of physicians. The mere fact that the patient did not pay the compensatory fee does not in itself exempt the physician from the ethical obligations that bind him to his patient, in particular with respect to follow-up.

SOURCES
Code of ethics of physicians, ss. 104 to 106
Health Insurance Act, s. 22.0.0.1

2015-04-07
CMQ resource: Inquiries Division (extension 4787)

Legal note
This information sheet presents the general context in which the answers provided may apply but does not constitute a medical or legal opinion. There may be specific aspects in each particular situation that influence a physician’s conduct. Anyone who has questions about subjects that are directly or indirectly related to this information sheet should contact the Collège at the number provided.

Download the information sheet (In French only)

What is the status of physicians in Quebec with respect to the health insurance plan?

In Quebec, every physician is considered to participate in the health insurance plan. Physicians practice their profession within the framework of the plan established by the Health Insurance Act. They are remunerated by the Régie de l’assurance maladie du Québec (RAMQ) in accordance with the fee schedule set out in an agreement between the medical federations and Minister of Health and Social Services

However, the Act allows a physician to choose not to participate in the health insurance plan or to withdraw from it. To do so, he must send the form provided for in the agreement to the RAMQ by registered mail. His decision becomes effective on the 30^th day after the form was mailed.

A physician who has withdrawn practices his profession outside the framework of the plan but agrees to be remunerated in accordance with the fee schedule provided for in the agreement and the cost of his fees is paid to his patients by the RAMQ. A non-participating physician practices his profession outside the framework of the plan established by the Act. All his patients are solely responsible for paying his fees which are not subject to any specific scale or fee schedule. Non-participating physicians must, however, comply with sections 104 to 106 of the Code of ethics of physicians which set out certain guidelines with respect to fees.

In the event of a dispute concerning a physician’s fees, the patient may submit the account to the accounts conciliation and arbitration procedure in accordance with the applicable regulations.

To find out if a physician has withdrawn or is a non-participating physician, contact the Régie de l’assurance maladie du Québec at 514 864-3411 (Montreal), at 418 646-4636 (Quebec City) or at 1 800 561-9749 (toll free). An updated list is also available on the RAMQ website.

SOURCES
Health Insurance Act, R.S.Q. A-29
Regulation respecting the application of the Health Insurance Act, c. A-29, r.5
Code of ethics of physicians, ss. 104 to 106

2009-01-26
CMQ resource: Inquiries Division (extension 4787)

Download the information sheet (in French Only)

Fees charged to patients for access to their medical record

Consult the article published in the journal Le Collège in winter 2009 on this topic, which sets out the rules applicable to requests made to physicians in private practice.

Excerpt from the article:

[Translation] If a patient wishes to obtain a copy of their medical record, a physician in private practice may charge a reasonable fee that does not exceed the cost of copying or transcribing the documents and the cost of sending the patient a copy of the documents.

Therefore, since it is an ethical obligation, the physician must not make a profit when he charges a fee, irrespective of whether or not he participates in the public health insurance plan.

What physicians may not charge for

Charging a fee for reviewing and pre-sorting documents relevant to the request is unacceptable, as is charging a fee for retranscribing an illegible note.

Note also that a physician may not charge a fee for copying documents that are provided when he refers his patient to a physician, a professional or an institution (consultation requests, transfer for treatment, requests for diagnostic tests, etc.).