Private for-profit clinics are taking advantage of patients in B.C. For years, they've unlawfully billed patients, charging fees in exchange for faster access to our doctors.
Now, a growing public backlash against one private clinic's legal attack on Canadian Medicare is pushing this issue front and centre. Still, many people don't realize the problems caused by for-profit care until they hear the story of someone who has had a negative experience.
If you've been charged fees at a private for-profit clinic, your story could help people understand how for-profit care is bad for patients and for public health care.
Have you paid out-of-pocket for medically necessary care?
- Anil had surgery in a private for-profit surgical centre. MSP covered the surgery but Anil was charged out-of-pocket for medical supplies and equipment used in his surgery, including alcohol swabs, instruments, sutures, and bandages.
- Sandra's family physician referred her to a private for-profit clinic for knee surgery. The clinic doctor billed the province for the surgery, but the clinic also charged Sandra an additional $1500 per knee "facility fee."
Have you paid a fee for faster access to medically necessary care?
- Anika needed back surgery. Her family doctor booked her an appointment with a surgeon in 18 months. Anika called a private for-profit surgical centre and was told that she could see the same surgeon in 2 weeks for an "independent medical exam" if she paid $450. She decided to pay. When she saw the surgeon, she was told she could have surgery in 2 weeks if she paid $8,000. Anika paid that too.
If you answered "yes" to any of these questions, you have been charged unlawfully for care.
It's unlawful for doctors to charge patients for medically necessary care. Share your story today.
WHAT IS A PATIENT'S RIGHT WHEN IT COMES TO MEDICAL SERVICES IN BC?
In B.C., medically necessary hospital and physician services are insured benefits under the Medical Services Plan (MSP) and are 100 per cent paid for by government. This right is protected under the Canada Health Act and the BC Medicare Protection Act.
Physicians may not charge patients any extra amount for services that are MSP benefits, provided by physicians who are enrolled with MSP.
WHAT IS MSP?
The BC Medical Services Plan is the public insurance plan that provides medical coverage to all eligible residents of B.C.
WHAT IS AN INSURED BENEFIT UNDER MSP?
All legal residents of BC enrolled with MSP are insured for the following benefits:
- all medically necessary hospital and physician services;
- diagnostic x-ray and laboratory services when ordered by a physician, podiatrist, dental surgeon or oral surgeon;
- dental and oral surgery when medically required to be performed in a hospital and surgical podiatry;
- medically necessary eye examinations;
- supplementary benefits for B.C. residents who qualify for MSP premium assistance (physiotherapy, chiropractic, naturopathy, massage therapy, acupuncture, and non-surgical podiatry for up to a combined total of 10 visits per calendar year. MSP will contribute $23 toward the cost of each of the 10 visits).
WHAT IS NOT INSURED UNDER MSP?
- routine physical examinations performed for reasons other than medical necessity;
- medical examinations, certificates or tests required for life insurance, a driver's licence, school, immigration, employment;
- cosmetic surgery for the alteration of appearance when not medically necessary;
- restorative or other dental work performed in a dental office;
- eyeglasses, hearing aids, and other equipment or appliances;
- counsellors or psychologists;
- routine eye examinations for beneficiaries between the ages of 19 and 64;
- chiropractic, physiotherapy, naturopathy, massage therapy, acupuncture, and non-surgical podiatry services for persons not receiving premium assistance; and
- ambulance service, though the government subsidizes fees
MSP is administered by Health Insurance BC (HIBC). For more information, visit www.hibc.gov.bc.ca.
IS A PHYSICIAN/CLINIC ALLOWED TO CHARGE A PATIENT A FEE MORE THAN THE MSP RATE FOR INSURED SERVICES?
By law, a physician enrolled and opted-in with MSP may not charge the patient anything for medically necessary care. A physician enrolled and opted-out may charge a patient directly, but may not charge more than the MSP rate (so that the patient can be fully reimbursed by MSP).
Additionally, a physician is also not permitted to charge a patient for any of the following:
- consumables, such as examining gowns, tongue depressors, chemstrips, and dipsticks for urinalysis
- rental charges for instruments or equipment used by the physician in rendering the service
- tray fees
- facility fees
CAN A PHYSICIAN CHARGE A FEE IN EXCHANGE FOR QUICKER ACCESS?
By law, a physician enrolled and opted-in with MSP may not charge the patient for quicker access.
WHAT DOES IT MEAN WHEN A PHYSICIAN IS "ENROLLED" and OPTED-IN?
If physicians are "enrolled" and "opted-in", then they are paid directly by MSP and may not charge patients for an insured benefit. Most physicians in BC are "enrolled" and "opted-in" in MSP.
WHAT DOES IT MEAN WHEN A PHYSICIAN IS "UNENROLLED" or "OPTED-OUT"?
If physicians "opt-out", they are still "enrolled" and may bill patients directly for their services up to the amount paid by MSP, and then the patient claims full reimbursement from MSP. By law, the physician may not charge the patient more for an insured benefit than the prescribed MSP amount, so the patient can be fully reimbursed by MSP.
If physicians are "unenrolled", then they may not bill MSP for anything, and they may charge patients whatever they wish for their services.
Very few BC doctors are "opted-out" and even fewer are "unenrolled".
CAN A PATIENT FILE A COMPLAINT IF CHARGED EXTRA FEES?
If a patient has been charged out-of-pocket for a medical service that is covered under MSP, that patient can file a complaint and demand reimbursement from the physician. The provincial Medical Services Commission (MSC) is responsible for facilitating reasonable access throughout B.C. to quality medical care, health care, and diagnostic facility services for residents covered under MSP, and for managing the provision and payment of medical services in an effective and cost-efficient manner.
The MSC administers the Medical Services Branch Extra Billing Review Process. The Medical Services Branch investigates reports from patients about charges they believe contravene the Medicare Protection Act. If a patient wishes to have charges for insured MSP benefits investigated, the patient can submit the details in writing to the address below. They must include their Personal Health Number and any documentation and receipts.
Administrator - Extra Billing
Medical Services Branch, Ministry of Health
3rd Floor, 1515 Blanshard St.
Victoria, B.C. V8W 3C8
Email: MEDSERVE@gov.bc.ca Fax: 250-952-3133