Questions and answers about consultation fees
While a missed appointment fee is included in the fee schedules proposed by the medical federations, physicians with an office-based practice must comply with certain ethical guidelines if they intend to charge patients a compensatory fee for a missed appointment:
- The patient must be given specific information about the missed appointment fee when he makes the appointment;
- The physician must be able to prove that he could not fill the appointment time with other professional activities;
- The fee charged must be reasonable;
- The patient must be allowed to cancel his appointment up to 24 hours before;
- The patient must not have missed his appointment due to unforeseeable circumstances or force majeure.
It is highly advisable to keep a written record of the specific information the patient was given when he made the appointment. The missed appointment fee policy must be posted in accordance with the Health Insurance Act and the Code of ethics of physicians.
If a fee is charged, the physician must provide the patient with an itemized invoice. Even if all the above rules were followed, in the event of a dispute concerning the compensatory fee charged by the physician, the patient may submit the account to the syndic in accordance with the Regulation respecting the conciliation and arbitration procedure for the accounts of physicians. The mere fact that the patient did not pay the compensatory fee does not in itself exempt the physician from the ethical obligations that bind him to his patient, in particular with respect to follow-up.
Read the fact sheet to find out more (in French only).
When a patient wishes to obtain a copy of his or her medical record, a physician in private practice may charge a reasonable fee not exceeding the cost of reproducing or transcribing the documents and the cost of transmitting a copy.
Because this is an ethical obligation, physicians must not make a profit when they charge such fees, whether or not they are participating in the public health insurance plan.
What is not payable
Charging a fee for reviewing and pre-sorting documents relevant to the claim is not acceptable, nor is charging a fee for transcribing an illegible note.
It should also be noted that a physician cannot charge a fee for reproducing documents when referring a patient to a physician, a professional or an institution (requests for consultation, transfer for treatment, requests for diagnostic tests, etc.).
Change in physician status
In Quebec, all physicians are deemed to be participants in the health insurance plan. They therefore practice their profession within the framework of the Health Insurance Act.
Physicians are remunerated in accordance with an agreement between the federations of physicians and the Minister of Health and Social Services. Fees are paid by the Régie de l'assurance maladie du Québec (RAMQ).
Withdrawal or non-participation:
The law allows physicians to opt out of the health insurance plan. A disengaged physician practises his or her profession without respecting the rules of the health insurance plan. However, he or she accepts to be remunerated according to the fee schedule set out in the agreement. Patients must pay the doctor for the consultation, and can then claim the fees from the Régie de l'assurance maladie du Québec.
- Non-participating physicians practise their profession without being bound by the statutory health insurance plan. All patients pay their own fees, which are not subject to any specific schedule or tariff. The physician must, however, act in accordance with articles 104 to 106 of the Code of Ethics of Physicians concerning the rules governing the fixing of fees.
Any dispute relating to the doctor's fee account may be submitted by the patient to the account conciliation and arbitration mechanism, in accordance with the applicable regulations.
To find out whether a doctor is disengaged or non-participating, you can contact the Régie de l'assurance maladie du Québec.
Here are their telephone numbers:
Montreal area: 514 864-3411 Quebec City area: 418 646-4636
Toll-free line: 1 800 561-9749
An up-to-date list is also available on the RAMQ Web site
Consult this fact sheet for more information (in French only).
Doctors can't abandon their patients when they retire, for example. He must help him find another doctor.
During this transition, the doctor must continue to monitor his patients. He must also continue to follow up on the examinations and other consultations he has ordered for his patient, until such time as he has received confirmation that another doctor can take over. In the absence of such confirmation, the doctor may even, in certain cases, be called upon to follow up his patient free of charge.
Surgeons must also ensure that their patients awaiting surgery are not penalized by their change of status. He must take concrete steps to avoid increased waiting times for these patients.
Physician within a group
If the attending physician changes his or her status while practicing within a group, there is no obligation for group members to follow their colleague's patients who do not wish to consult him or her.
However, group members retain certain obligations relating to the keeping, possession, maintenance, access and communication of the medical records of patients of the doctor who has changed his or her status and left the group. They must also comply with the provisions of the Code of Medical Ethics governing relations between colleagues.
Patients must also be notified of this change in status within a reasonable timeframe and by the means most appropriate to their physician. The latter could also send a personalized notice to regular patients.
Finally, patients who wish to be followed by a new doctor participating in the health insurance plan should not have to pay for photocopying and transmission of their medical records to the doctor who will be following them from now on.
Consult this fact sheet for more information (French only)
Telephone follow-up with patients
A doctor, a group of doctors, a medical service or department has an ethical obligation to follow up on a patient's condition following an intervention.
A policy for responding to patient calls must be drawn up, and patients must be informed in advance. Patients must also be informed of alternative means of communication (e.g. e-mail).
As a general rule, doctors must be diligent in their dealings with patients. The doctor assesses the time to call the patient back on a case-by-case basis, and must take into account the information obtained when the call is taken, hence the importance for his staff of properly documenting the calls received. Physicians can also agree with their patients on a period of time dedicated to the return of non-urgent calls.
The physician cannot entrust medical or other procedures outside their field of competence to non-physicians. It is the responsibility of the physician or authorized professional to inform a patient of a new diagnosis or an abnormal result, since follow-up will be required. However, another member of staff (secretarial or other) may inform the patient that a result is normal, without engaging in a medical discussion on the subject.
Any communication with the patient or a third party must be summarized or recorded in the medical record, in accordance with article 6, paragraph 13.2 of the Regulation respecting the records, places of practice and cessation of practice of a physician. The telephone conversation must be dated (article 4.11 of the practice guide La rédaction et la tenue des dossiers par le médecin en milieu extrahospitalier.
If the nature of the telephone conversation resembles a medical consultation, a note is mandatory. All telephone orders must be recorded in the file.
The physician may recommend massage therapy, osteopathy or reflexology if the indication for this type of care is supported by the medical literature and is part of an established treatment plan.
The physician must first be convinced of the relevance of these treatments, based on medical indications justifying this therapeutic approach. The physician cannot recommend such treatments simply because they are reimbursed by an insurance company.
If these treatments are indicated for the patient and are medically justified, the doctor must fill out the relevant forms and other documentation to enable the patient to benefit from a benefit to which he or she may be entitled.
Under no circumstances may the physician issue a certificate of convenience or produce any document containing data he or she knows to be erroneous.
As the practice of massage therapy is not governed by a professional order in Quebec, physicians must exercise circumspection and ensure appropriate medical follow-up with regard to their patients' state of health.
An employer who requires a medical ticket must demonstrate the necessity of obtaining this information in the performance of the employment contract. This must demonstrate that the legitimate interest of the company takes precedence over the rights granted to the employee by the Quebec Charter of Rights and Freedoms. The important principle to consider is that an individual's state of health is an integral part of his or her private life, and is protected by the charters and by all social legislation.
A distinction must be made between short-term absence (a few days) and long-term absence (more than a few weeks).
- Certificates must be legible and meet minimum standards. They must contain at least the following information
- Certificate issue date;
- Patient's surname, first name and address;
- Information required by the employer for the performance of the employment contract (for example, frequent absenteeism, long-term absence, etc.);
- Date of start and, if possible, end of disability;
- Type of disability;
- Physician's signature and office address.
If the employer is also the insurer, it has the right to request the relevant information to determine whether or not to compensate the employee for the absence.