Questions and answers about consultation fees

Fees for medical consultations

The fee schedules proposed by the medical federations stipulate that office-based physicians may charge patients a compensatory fee for a missed appointment, in accordance with the Code of Ethics of Physicians.

Here are the rules set out in the Code of ethics of physicians:

patients are given precise information about the charges for missed appointments when the appointment is booked;
the physician is able to demonstrate that he/she was unable to use this appointment time for other professional activities;
the amounts claimed are reasonable;
the patient is allowed to cancel the appointment with 24 hours' notice;
it is not an act of God or force majeure that prevented the patient from keeping the appointment.
It is advisable to keep a written record of the precise information obtained when the appointment is made.

The applicable policy must be posted in the physician's office, in compliance with the Health Insurance Act and the Code of ethics of physicians.

An itemized bill must be provided to the patient if any charges are made by the physician.

Even if all the above rules have been complied with, the patient may contest the compensatory fees billed by the physician in accordance with the Règlement sur la procédure de conciliation et d'arbitrage des comptes des médecins.

Under the Code of ethics of physicians, physicians are obliged to provide medical follow-up for their patients, even if they have not paid the compensatory fees charged.

Access to the file is free of charge. What's more, since the Act respecting health information and social services came into force on July 1, 2024 (section 66), physicians can no longer charge fees for transcription, reproduction and transmission, despite section 95 of the Code of ethics of physicians.

Charging fees for reviewing and pre-sorting documents relevant to the request is no more acceptable, nor is charging fees for transcribing an illegible note.

It should also be noted that a physician may not charge a fee for reproducing the documents to be provided when referring a patient to a physician, health care professional or institution (requests for consultation, transfers for treatment, requests for diagnostic tests, etc.).

Change in physician status

In Quebec, all physicians are deemed to be participants in the health insurance plan. They therefore practice their profession within the framework of the Health Insurance Act.

Physicians are remunerated in accordance with an agreement between the federations of physicians and the Minister of Health and Social Services. Fees are paid by the Régie de l'assurance maladie du Québec (RAMQ).

Withdrawal or non-participation:

The law allows physicians to opt out of the health insurance plan. A disengaged physician practises his or her profession without respecting the rules of the health insurance plan. However, he or she accepts to be remunerated according to the fee schedule set out in the agreement. Patients must pay the doctor for the consultation, and can then claim the fees from the Régie de l'assurance maladie du Québec.

Non-participating physicians practise their profession without being bound by the statutory health insurance plan. All patients pay their own fees, which are not subject to any specific schedule or tariff. The physician must, however, act in accordance with articles 104 to 106 of the Code of ethics of physicians concerning the rules governing the fixing of fees.

Any dispute relating to the doctor's fee account may be submitted by the patient to the account conciliation and arbitration mechanism, in accordance with the applicable regulations.

To find out whether a doctor is disengaged or non-participating, you can contact the Régie de l'assurance maladie du Québec.

Here are their telephone numbers:

Montreal area: 514 864-3411 Quebec City area: 418 646-4636
Toll-free line: 1 800 561-9749
An up-to-date list is also available on the RAMQ Web site

Consult this fact sheet for more information (in French only).

Doctors can't abandon their patients when they retire, for example. He must help him find another doctor.
Doctor

During this transition, the doctor must continue to monitor his patients. He must also continue to follow up on the examinations and other consultations he has ordered for his patient, until such time as he has received confirmation that another doctor can take over. In the absence of such confirmation, the doctor may even, in certain cases, be called upon to follow up his patient free of charge.
Surgeon

Surgeons must also ensure that their patients awaiting surgery are not penalized by their change of status. He must take concrete steps to avoid increased waiting times for these patients.
Physician within a group

If the attending physician changes his or her status while practicing within a group, there is no obligation for group members to follow their colleague's patients who do not wish to consult him or her.

However, group members retain certain obligations relating to the keeping, possession, maintenance, access and communication of the medical records of patients of the doctor who has changed his or her status and left the group. They must also comply with the provisions of the Code of Medical Ethics governing relations between colleagues.
Patient follow-up

Patients must also be notified of this change in status within a reasonable timeframe and by the means most appropriate to their physician. The latter could also send a personalized notice to regular patients.

Finally, patients who wish to be followed by a new doctor participating in the health insurance plan should not have to pay for photocopying and transmission of their medical records to the doctor who will be following them from now on.

Consult this fact sheet for more information (French only)

Telephone follow-up with patients

As a general rule, doctors must be diligent in their dealings with patients. The doctor assesses the time to call the patient back on a case-by-case basis, and must take into account the information obtained when the call is taken, hence the importance for his staff of properly documenting the calls received. Physicians can also agree with their patients on a period of time dedicated to the return of non-urgent calls.

The physician cannot entrust medical activities to another person or professional. Thus, it is up to the physician or authorized professional to announce a new diagnosis or an abnormal result to a patient, since follow-up will be required after the announcement. However, another member of the team (secretarial or other) could tell the patient that a result is normal, without engaging in a discussion on the subject.

Any communication with the patient or a third party must be summarized or recorded in the medical record, in accordance with article 6, paragraph 13.2 of the Regulation respecting the records, places of practice and cessation of practice of a physician. The telephone conversation must be dated (article 4.11 of the practice guide La rédaction et la tenue des dossiers par le médecin en milieu extrahospitalier.

If the nature of the telephone conversation resembles a medical consultation, a note is mandatory. All telephone orders must be recorded in the file.

General questions

The physician may recommend massage therapy, osteopathy or reflexology if the indication for this type of care is supported by the medical literature and is part of an established treatment plan.

The physician must first be convinced of the relevance of these treatments, based on medical indications justifying this therapeutic approach. The physician cannot recommend such treatments simply because they are reimbursed by an insurance company.

If these treatments are indicated for the patient and are medically justified, the doctor must fill out the relevant forms and other documentation to enable the patient to benefit from a benefit to which he or she may be entitled.

Under no circumstances may the physician issue a certificate of convenience or produce any document containing data he or she knows to be erroneous.

As the practice of massage therapy is not governed by a professional order in Quebec, physicians must exercise circumspection and ensure appropriate medical follow-up with regard to their patients' state of health.

Consult this fact sheet for more information.

An employer who requires a medical ticket must demonstrate the necessity of obtaining this information in the performance of the employment contract. This must demonstrate that the legitimate interest of the company takes precedence over the rights granted to the employee by the Quebec Charter of Rights and Freedoms. The important principle to consider is that an individual's state of health is an integral part of his or her private life, and is protected by the charters and by all social legislation.

A distinction must be made between short-term absence (a few days) and long-term absence (more than a few weeks).

Certificates must be legible and meet minimum standards. They must contain at least the following information
Certificate issue date;
Patient's surname, first name and address;
Information required by the employer for the performance of the employment contract (for example, frequent absenteeism, long-term absence, etc.);
Date of start and, if possible, end of disability;
Type of disability;
Physician's signature and office address.

If the employer is also the insurer, it has the right to request the relevant information to determine whether or not to compensate the employee for the absence.