Additional Fees and Charges
There may be times when you are required to pay additional fees to your doctor or other medical service provider for items that are not covered under the Medical Services Plan (MSP). The following information explains when an additional fee or charge is permitted for a service provided, as well as what “extra-billing” means and when a patient should not be charged any additional fees. Find out what to do you if you are a patient and you think you have been charged an extra fee that you should not have to pay.
Prohibition Against Extra Billing for Medical Services, Facilities and Materials
The Medicare Protection Act protects patients from being charged an extra amount for physicians' services and fees in connection with the delivery of medical services that are benefits of MSP. Moreover, a person acting on behalf of a patient must not be charged for any benefit or billed any additional cost in place of the patient for medical services that are benefits of MSP. Operating under the authority of the Medicare Protection Act and the direction of the Medical Services Commission, MSP pays for insured medical services (also know as "benefits") provided to residents of British Columbia. The Act establishes rules regarding billing for services provided by physicians who are enrolled with MSP. In general, patients (or their representatives) must not be charged for benefits. The Act also prohibits anyone from charging patients for “materials, consultations, procedures, use of an office, clinic, or other place, or for any other matters that relate to the rendering of a benefit” unless specifically permitted by the Medical Services Commission.
Patient Charges That Are Not Permitted
Patient charges are not permitted in the following categories:
- 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
The prohibition against extra billing for medical services, facilities and materials does not apply to uninsured services, such as cosmetic surgery, or services that are not medically required, such as exams for a driver's licence, medical notes for employment, camp, etc. The charges for these uninsured services, including related pre-operative and post-operative visits, are the responsibility of the patient.
Permitted Patient Charges
Patient charges are permitted in the following categories:
- Therapeutic drugs, such as those used for allergy injections and cortisone injections
- Devices, such as pessaries, IUDs, crutches, splints, braces, and tensor bandages
- Material upgrades where the cost of the upgrade is significant relative to the cost of the standard item, such as fibreglass instead of plaster casts
- Extensive dressings and special bandages, such as dressing for a major burn
Some physicians elect to charge their patients an annual, enrolment, or registration fee. Patients cannot be denied service for choosing not to pay these fees. An annual fee is generally meant to cover uninsured services over the course of a year. Patients should be given the option to pay for these uninsured services through an annual fee or individually as they occur. If a physician charges an annual fee, a record detailing what the fee includes must be provided to the patient. The College of Physicians and Surgeons of B.C. has issued rules to physicians governing annual fees. Patients of physicians charging these fees may request a copy of the rules from their physician.
Notifying Patients of Permitted Charges
When direct charges are permitted, the physician must inform the patient (or the person being charged on behalf of the patient) of the charge before the service is provided. The charge to the patient (or the person being charged on behalf of the patient) can only be made on a cost-recovery basis, which means that a direct sale must be a not-for-profit transaction.
Physicians enroled with MSP may choose to be "opted-in" or "opted-out".
Opted-in physicians are paid directly by MSP for their services. A physician who is opted-in to MSP may not charge a patient for an insured benefit.
Opted-out physicians bill patients directly for their services, then the patients may claim reimbursement from MSP. By law, an opted-out physician may not charge a patient more for an insured benefit than the prescribed MSP amount.
In some cases, certain additional costs can be charged to the patient.
Physicians Who Are Not Enroled
Services provided by a physician who is not enroled with MSP or whose enrolment has been cancelled by MSP are not insured and will not be reimbursed by MSP. However, unenroled physicians in B.C. may not charge for the provision of an insured service any amount that is more than the rate payable by MSP if they were enroled, so long as the service is provided in a hospital, a continuing care facility, publicly funded community care facility or assisted living residence, or a health authority as defined by legislation.
Reimbursement of Inappropriate Charges
Changes to the Medicare Protection Act effective October 1, 2018 introduce new protections for MSP beneficiaries (or those who pay for insured services on behalf of beneficiaries). A beneficiary (or the person who pays for the insured service) may request a refund from the Medical Services Commission.
If it is determined through an investigation conducted on behalf of the Medical Services Commission that extra billing has occurred, the person who paid the charge will be entitled to a refund. The practitioner or clinic who levied the charge will be asked to refund the amount directly to the person who paid the charge. If this does not occur, the person who paid the charge and the Medical Services Commission may agree to enter in to an assignment of debt agreement. Upon executing this agreement, the Medical Services Commission will reimburse the person who paid the charge for a portion of that charge and recover the amount from the practitioner or clinic who imposed the charge.
The Beneficiary Services and Strategic Priorities Branch investigates reports from patients about charges they believe contravene the Medicare Protection Act on behalf of the Medical Services Commission. If you believe you have been charged inappropriately for an insured MSP benefit you can request further investigation by submitting the details in writing to the address below. Be sure to include your Personal Health Number, a detailed description of the service(s) received, copies of medical records, and all invoices and receipts confirming payment.
Administrator - Extra Billing
Beneficiary Services and Strategic Priorities Branch
PO Box 9649 STN PROV GOVT
Victoria, B.C. V8W 9P4
Fax: (250) 952-3268
Given the sensitivity of documentation required for extra billing investigations, it is not recommended to submit these documents by email. However, general inquiries can be sent to MSC@gov.bc.ca.