Ottawa plans to crack down on doctors charging for medically necessary healthcare
A rising number of companies offering Canadians faster access to health care at a higher price is prompting the federal government to crack down on the practice, CBC News learned.
Health Secretary Jean-Yves Duclos is calling on provinces to stop charging patients for medically necessary treatments – and warns Ottawa will reclaim state medical transfer payments if charges continue.
“I am very concerned by the recent surge in reports of patient fees for medically necessary services,” Duclos said in a letter sent to all provincial and territorial health ministers on Thursday. Federal officials provided a copy to CBC News.
“Regardless of where in the country Canadians live or how they receive necessary medical care, they need to be able to access these services without having to pay out of their own pocket.”
Companies that bill patients for virtual visits to a family doctor are the top targets of the federal crackdown, according to a senior government official.
Although Canada’s healthcare law prohibits “insured persons” from billing for medically necessary services, companies across the country offering online doctor appointments and charging fees of $50 to $100 per visit have exploded in recent times raise.
Companies that charge a fee circumvent the Canadian health care law ban by connecting the patient to a doctor in another province. Under the Medicare rules in the province where the doctor practices, the patient would not technically be considered an “insured person.”
Some critics have called this a loophole in Canada’s health care law.
In his letter, Duclos says expanding access to health care via virtual platforms must “remain true to the spirit and intent of Canada’s Health Care Act.”
Duclos says he will provide provinces and territories with a document clarifying that fees for medically necessary services are not allowed, regardless of where the patient lives.
“The complexities of modern family health, virtual and surgical care, including their delivery across multiple jurisdictions, and the expansion of the scope of health workers’ responsibilities should not be used to allow for these fees,” the letter reads.
“As our healthcare system evolves, it must respect the Canada Health Act.”
One of the largest providers charging for virtual medical care is Maple, which bills itself as “Canada’s top-rated virtual care app” and charges $69 or more for an appointment.
“We only charge for our services when they are not covered by provincial health plans,” the company’s website says.
“We would love to be consistently eligible for public reporting across Canada, and we are working hard to ensure Maple is included in provincial reporting as soon as legislation permits.”
Duclos’ letter does not say whether the Trudeau administration will take action against other instances of doctors charging for medically necessary treatments, as recently revealed by CBC News:
Duclos’ move comes at a time of increasing debate about the role of the private sector in providing publicly funded healthcare in Canada, particularly as provinces grapple with surgical backlogs and staffing shortages due to the COVID-19 pandemic.
In Parliament, the New Democrats have repeatedly argued in recent weeks that the Trudeau administration is allowing increasing privatization of the healthcare system and that for-profit companies are playing an increasing role in care.
The federal government last month reached an agreement with the provinces and territories for a 10-year augmentation of their annual Canada Health Transfer Funding Arrangement.
Duclos’ letter warns that those referrals could be reduced if patients are billed for medical care.
“Canadians pay for their healthcare services through their tax dollars and should not be asked to pay through patient fees again if they need to access those services,” writes Duclos.
“If there are cases of patient fees for these services, I will seek a reduction in government health transfers by an equivalent amount.”
Different provinces have different approaches to covering virtual doctor appointments, and some of the rules have changed as the COVID-19 pandemic abates.
For example, since last December, the Ontario Health Insurance Plan (OHIP) will only cover the cost of virtual or phone consultations if the patient has an ongoing relationship with a doctor. “Virtual walk-in clinic visits” – with a doctor that the patient has not seen in person – are not covered.
That move hampered the business model of another company that offers virtual appointments — Rocket Doctor, which now charges $55 for a doctor’s visit.
“Unfortunately, virtual primary care and emergency care are no longer services patients can access free of charge at Rocket Doctor,” the company’s website reads, prompting patients to sign a petition demanding the repeal of this policy.