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Illegal or abusive fees

 

Invoicing multiple fees during medical consultations represents a severe sprain on the public health system. In this sense, the fundamental values of justice and equity, which underlie the accessibility of health care, regardless of the ability to pay, are hampered. Direct patient billing for medically necessary services is not a marginal practice. It affects both general practitioners and specialists. For this reason, we provide patients with a tool - the Accessory Fees Monitoring Registry -, which makes it possible to denounce billing acts and make their own case heard.

Know what to do during a medical consultation

Don’t hesitate to assert your point of view if you feel that some fees are unfair and if you think you are facing illegitimate medical billing. Here are some questions that you can help you to react in a medical clinic to challenge any kind of billing.

Before the consultation (at reception):

Is the physician remunerated by the Régie de l’assurance maladie du Québec or non-participating ?

Before accepting fees :

Why do I pay this amount ?

This treatment, equipment or service is not covered by the Health Insurance Card?

Can I see the fee list displayed in the Clinic?

If you accept fees :

Can you give me a detailed invoice?

If you can’t pay fees or refuse :

Is it possible to access this treatment, equipment or service for free in the public health network?

Be attentive during the consultation, take notes and review your invoice in order to challenge any fees that you feel are illegal or illegitimate. Take the time to report them in the Registry

 

FACING BILLING? WHAT YOU CAN DO

At all times:

- Ask to speak to the professional to find out if the procedure or test is "medically required" by your condition.

- Make sure this fee is indicated on the price list displayed in the clinic. The fee charged to you should be listed with the amount.

- If you pay, ask for a detailed invoice. It will be easier for you to obtain information and recourse afterwards.

The professional asks you to pay and you cannot or do not want to pay:

- If you do not intend to pay, you can try to negotiate with the professional a reduction or the abolition of expenses by explaining your financial situation if necessary.

- You have the right to request a detailed estimate of the care and associated fees on paper. With this estimate in hand, you can contact the relevant professional order to ask questions about the legality of the fee and/or request an account reconciliation. This is possible even in the case of legal billing:

o College of Physicians: conciliation of account:

http://www.cmq.org/page/fr/conciliation-des-comptes.aspx (French only)

o College of pharmacists: request an inquiry: https://www.opq.org/en-CA/grand-public/apply-and-procedures-in-the-quest/

o Order of optometrists: file a complaint: https://www.ooq.org/public/protection-public/office-of-social-session-and-process-disclaimer

o Order of dentists: contest fees: http://www.odq.qc.ca/ProtectionofthePublic/Fileacomplaint/Contestingfees/tabid/527/language/en-US/Default.aspx

To get a reimbursement for a covered service that has been paid:

You will need to send a letter by mail along with your invoice to the RAMQ: http://www.ramq.gouv.qc.ca/en/citizens/health-insurance/healthcare/Pages/reimbursement.aspx . You have 5 years after the date of payment to do so.

To report a practice that seems fraudulent:

You may report the illegal practice of a physician, pharmacist, optometrist, dentist or clinic, even if you have not been billed personally (as a witness):

- Anonymously report wrongdoing to the RAMQ: http://www.ramq.gouv.qc.ca/en/regie/Pages/reporting-wrongdoing.aspx . Note that it is possible for you to report wrongdoing in parallel with a refund request.

- You can fill out the fee monitoring registry anonymously: www.ccpsc.qc.ca/en/registry . This allows us to draw up a statement of the billing situation and claim changes from the organizations concerned.

- You can file a complaint (confidential):

o If you think that the doctor has failed in his obligations, in particular by not displaying the list of fees charged or by billing an illegal fee, you can file a complaint (no refund possible): http://www.cmq.org/page/en/formulaire-plainte.aspx

o College of pharmacists: request an inquiry: https://www.opq.org/fr-CA/grand-public/demande-et-processus-d-enquete/

o Order of optometrists: file a complaint: https://www.ooq.org/public/protection-du-public/bureau-du-syndic-demande-et-processus-denquete

o If you think that the dentist has failed in his professional obligations, you can make a complaint (no reimbursement possible): http://www.odq.qc.ca/ProtectionofthePublic/Fileacomplaint/Makingacomplaint/tabid/521/language/en-US/Default.aspx

Need help?

You can get help from the Support and Complaint Support Center to assist you in your queries by calling 1-877-767-2227 or http://fcaap.ca/caap/ .

 

Have you been a victim of such abuses ? Get the facts and know your rights !

For more information, contact Stéphane Defoy at the Pointe-Saint-Charles Community Clinic: 514-937-9250 ext. 7279