Doctors Should Be Careful When Sending Out Fee Letters

Following a recent article in the National Post describing a patient's upset on receiving a letter from her doctor relating to fees, Elyse Sunshine commented to Advocate Daily that when sending our letters to patients about fees for uninsured services, doctors need to have regard to the College's Policy on Block Fees and Uninsured Services.  While it is acceptable to charge reasonable fees for appropriate uninsuredservices, it is important that this is done (and seen to be done) properly.  

Toronto health lawyer Elyse Sunshine says it’s nothing new for doctors to charge annual fees to cover uninsured services but it’s important for doctors to carefully word any requests for said fees to ensure patients understand what they cover.

“Physicians would do well to review the College of Physicians and Surgeons of Ontario policy on Block Fees and Uninsured Services when sending out letters to patients,” she tells AdvocateDaily.com. “Physicians should get advice on these issues and have regard to the College’s policy.”

Sunshine, partner at Rosen Sunshine LLP, weighs in on the issue after the National Post published a story about a woman who was upset about a letter she received from her doctor asking for an annual $150 fee. The letter from Wellpoint Family Practice noted new cuts to doctors’ fees, the clinic’s after-hours service and quality of care in making the request, says the article.

“This year, more than ever, I’m asking each and every one of you to pay the annual fee so that I can continue to provide the level of service you come to expect,” says the letter from Dr. Nandini Sathi at Wellpoint. “The fee is good value and avoids the delays that occur when we must request payments from you for individual services.”

Yet, some patient and health-care advocates are taking issue with the tone of the letter sent out by Wellpoint, says the Post.

Sunshine, without commenting specifically about the Wellpoint policy, says the fees — whether they are called block fees, annual fees or fees for uninsured services — aren’t new. She notes that doctors are permitted under the College of Physicians and Surgeons guidelines to charge them as long as they are for services that aren’t covered under the Ontario Health Insurance Program (OHIP) such as doctor’s notes and the filling out of insurance forms.

“It’s fairly routine that doctors request that patients pay for uninsured services, and usually patients have the choice to pay an annual or block fee for all such services over the course of a year or to 'pay as they go.' These fees have been around for a while now,” she says.

Sunshine says it’s important to note that it is up to the patient as to whether they choose to pay such an annual fee.

“Patients are supposed to be given a choice,” she says. “You can either pay the annual fee or alternatively, if you don’t want to pay an annual fee, if you utilize those uninsured services, then you’ll be asked to pay for them as you go.”

Sunshine says some people opt to pay the annual fee as opposed to paying for each individual service that isn’t covered by OHIP because it can be the less-expensive and more convenient option.

“For example, prescription renewals without seeing your doctor is a very common type of service that would be included in an annual fee," she says. "If you were on a chronic medication and if the physician charged $30 every time you were to call for a renewal and then you needed a sick note (for which the physician charged $50), it may make more sense for you to pay an annual fee for these uninsured services for $150. It certainly makes sense to pay an annual amount if you were a user of these services. But of course if you don’t use them, you would be paying for nothing.”

Sunshine says physicians cannot refuse to provide care if patients don’t pay the annual fee.

She says physicians have to be careful “not to mix apples and oranges,” and should avoid including political information about issues such as government cutbacks in drafting letters to patients about annual fees.

“It could result in confusion amongst patients,” Sunshine says.

“Talking about government cutbacks in a letter where a physician is asking that patients pay an annual fee may give patients the wrong impression that this fee is to compensate doctors because the government has reduced their fees. The purpose of the annual fee is to fairly pay our busy and hardworking physicians for services they provide that are not (and never have been) funded by OHIP. It is not a cash grab for doctors and should not be inadvertently portrayed that way.”