What can you be billed for? A guide to Quebec's ban on medical user fees

Quebec's ban on extra-billingfor health care services goes into effect today, meaning you won't have to pay auxiliary feesfor everything from nasal drops to ultrasounds.

The policy applies to servicescovered by the Quebec's health insurance board, theRgiede l'assurancemaladieduQubec (RAMQ).

"Medical services won't be charged," Health Minister Gatan Barrette told reporters Wednesday, adding that doctors who don't follow the rules will face penalties.

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Some examples of fees which areto be abolished include:

• Eye drops: $20 to $300.
• Inserting an IUD: $125 to $200.
• Instruments and medicationfor acolonoscopy: $500.

Ultrasounds in private clinics, which were not previously covered by RAMQ, will now be covered, Barrette said Wednesday.

What's not included?

The change doesn't mean you won't have to fork over cash for anythingat your next visit to the doctor.

Some practicesaren't covered by the new rules, such as feesto fill out medical forms, which can cost as much as $80.

Doctorswill also be allowed to chargefor thetransport of biological samplesfrom a private clinic or specialist, to a maximum of $15 for a blood sampleand $5 for all other kinds of samples.

Fees breach of Canada Health Act

The practice of charging extra fees has been a sore spot for defenders of universal, accessible health care for at least 15 years.

Two years ago, the Pointe-Saint-Charles community medical cliniclaunched an online registryto track what it called illegal and abusive medical billing, compiling more than 500 complaints and concluding that "billing patients directly for medically necessary services is not a marginal practice."

Patients' rights lawyer Jean-Pierre Mnardestimated last spring that Quebecershave been paying between $50 million and $70 million in extra fees.

He said it's a practice that hasspread across Canada, but he called Quebec "the worst offender."

In November 2015,the Quebec government passed Bill 20, a controversial health reform law which included an amendment to permit and regulate auxiliary fees a move which groups such as Quebec Doctors for Medicaresaid violatedthe Canada Health Act.

In medicine, we shouldn't be talking about a business model. It should be about a model of patient care.- Dr. Isabelle Leblanc, president of Quebec Doctors for Medicare

Partly in response to Bill 20, last May a coalition of health groupslaunched legal action against the federal government to compel it to enforce the Canada Health Act.

By September, Barrette backed down, announcing that an end to user fees "illustrates our commitment to the accessibility of our health care network."

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Public impact?

Barrette has faced criticism for proceeding withthe ban on user feeswithout first reaching agreements with doctors and pharmacists as tohow they are tobe compensated for the loss in revenue.

Dr. Isabelle Leblanc, president of Quebec Doctors for Medicare, agrees the transition to the ban has been badly handled, although she has little sympathy for doctors who complain their business model is under attack.

"In medicine, we shouldn't be talking about a business model," she said. "It should be about a model of patient care."

She said some patients might have trouble getting appointments for some diagnostic tests or procedures, because specialists have decided not to take appointments until their financial issues are settled.

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"I doubt it will last long," she predicted. "As doctors, it's our job to provide patient care if not, someone has to intervene."