Sunday, April 18, 2010

Paying For Healthcare

In the 25+ years I have practised medicine, I have rarely had to charge a patient for anything. While I bill each patient individually, my bill goes either to the provincial health plan, Workers Compensation Board or in the case of the military to Blue Cross.

25 or so years ago Canada passed the Canada Health Act. One of the provisions of the CHA was portability. This means that while health care is a provincial responsibility, one provinces coverage has to be honoured in another province. In response to this, 9 of the 10 provinces agreed to reciprocal billing. What this means is that if I see a patient from Saskatchewan, rather than sending a bill to Saskatchewan, I send the bill to Alberta Health which pays me and bills Saskatchewan on my behalf. This is done electronically and painlessly.

As I mentioned one province decline this arrangement. Quebec. This would be fine if I could easily send a bill to Quebec and expect to be paid. Unfortunately Quebec usually does not pay for its residents when they travel out of province, when they do they pay pitifully low rates, even less than what they pay their own doctors. I once got a cheque from Quebec for $7 for an evening emergency visit. I thought about sending it back, reasoning they obviously needed the $7 more than I did. Alberta however is a long way away from Quebec so I usually don't have to deal with this.

A couple of weeks ago while covering the case room, I got a phone call from the nurses. They told me that a young lady from Quebec was in labour, might need an epidural in the future, and possible might need a Caesarian Section. They asked my to visit the lady and tell her what the fees might be. Now her Obstetrician who is Quebecoise, speaks French knows who to phone in Quebec and what forms need to be filled out and had already arranged for HER fees to be covered. Naturally she hadn't done this for me or any of my colleagues.

Anyway I visited her and through an interpreter (she actually didn't speak French or English) that I would not deny her any essential service based on her ability to pay, but however a labour epidural is not an essential service and if she wanted to have one, it would cost her $100 which is what I get paid for an Albertan and this would have to be paid in advance. I told her that there would be other fees that I would invoice her for and that if she required a C/S it would cost $300 which is roughly what I get for a C/S. I did tell her that she would eventually get reimbursed for at least part of it. Now I didn't feel comfortable doing this but my time is valuable. If the OB had approached me and asked me nicely, I might have taken my chances with billing Quebec but while she was pre-arranging her fees, she didn't both asking about anaesthesia fees.

What happened, was that my intervention stopped the poor lady's early labour, she was sent home and I am sure one my other colleagues had to have the same talk with her sometime later.

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