practice partner
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The purpose of this column is to answer questions about issues that we either hear about frequently, or that
have a wide applicability across the profession. If you have any questions or topic suggestions for this column,
please email them to [email protected], or contact the Physician Advisory Service.
Paying for
uninsured services
Block fee payment must be
patient’s choice
photo: istockphoto.com
W
e often receive inquiries regarding
block fees and uninsured services from
both physicians and patients. The
principles and policies surrounding
block fees are sometimes misunderstood, so this column
will address some of the more frequently asked questions pertaining to block fees.
Physicians are permitted to charge patients a reasonable fee1 for uninsured services such as sick notes for
work, copies of medical records, and prescription refills
over the phone. Some physicians elect to offer patients
a block fee to make it more economical and/or convenient for those patients who may use many uninsured
services. A block fee must cover a specified period of
time (3-12 months) and list the specific services included. Block fees are intended to provide patients with
an option to pay for a group of uninsured services they
might use over the course of a set period. Block fees
cannot be mandatory and must not impact a patient’s
access to or quality of health care. Patients must always
have the option of paying for uninsured services on
a pay-per-service basis, as well as the opportunity to
rescind their decision to pay a block fee within a week
of their original decision.
We have seen examples of letters sent by physicians to
patients encouraging them to sign up for a block fee in
order to help the physician/clinic provide better quality
care to patients, or to assist in purchasing new equipment. This type of letter is inappropriate because it
conflicts with the spirit of the policy and regulations on
block fees. Opting to pay a block fee must be voluntary, and physicians must not coerce or unduly pressure
patients into choosing a block fee.
Some physicians elect to use a third party to administer their block fees or payment for uninsured services.
This is permissible, however, physicians must recognize
that the third party is acting as their agent, and are
responsible for ensuring that these parties adhere to the
same standards required of physicians. This means that
any third party breaches are the responsibility of the
physician. Any communication to patients must identify the fact that a third party is involved.
If you have any questions about block fees or any
other practice related matter, please contact the Physician Advisory Service. Our Advisors are available to
speak with you weekdays from 8:00 a.m. to 5:00 p.m.
1
In January 2015, the Ontario Medical Association published a new guide
for billing such services - Physician’s Guide to Uninsured Services.
Issue 1, 2015 Dialogue
Issue1_15.indd 33
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2015-03-19 11:18 AM