Bad medicine: Doctor block fees

Doctors are asking patients for an annual fee to cover uninsured services. Here’s why that cost isn’t likely to work in your favour.

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by David Hodges
November 9th, 2012

From the November 2012 issue of the magazine.

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Patient consulting doctor
I recently received a letter from my family physician asking me to pay an annual fee—in my case, $90 individually or $185 for the family—to cover services like skin tag removal or doctor-written sick notes. Chances are a similar letter has arrived in your mailbox, too.

Your provincial health plan doesn’t pay for those types of uninsured services, meaning doctors can charge you directly—with costs ranging from $20 to $200, depending on the service. But rather than billing them individually as necessary, many doctors are now asking you to pay an upfront fee (often referred to as a “block fee”) to cover these services for a year.

First things first: you don’t have to pay the block fee. Legally, your doctor can only ask. But if you’re trying to determine if it’s worth it, or if you’re concerned you may sour your relationship with your doctor by not doing so, you’re not alone, says Dr. Danielle Martin, chair of the medical reform lobby group Canadian Doctors for Medicare.

“There are all sorts of ethical and professional issues associated with block fees that make them potentially very problematic,” Martin says. “There is a very real risk that people could be confused and feel that the fee is mandatory. They might feel that their care will be negatively affected, or their family doctor might be mad if they don’t pay the fee.”

The risk for such misunderstandings is likely greatest among immigrants, lower income earners and seniors, she adds. “It’s less likely to be true among the savvy, educated upper-middle class portion of the population who ironically are the people who could probably afford to pay the block fee.”

A cash cow for doctors

Martin notes a main reason doctors ask for this type of payment is they make more money charging a flat rate than they do charging for services one by one.

Toronto family physician Jonathan Marcus, who writes and speaks about doctor practice management, says on his blog doctormarcus.ca that “in many medical practices block fees have the potential to be the largest uninsured revenue source, easily amounting to tens of thousands of dollars per year.” He encourages physicians to explain to their patients that “block fees are common in medical practices.”

Martin, however, sees little value for patients. “Some family doctors tend to imply in these letters to patients that you will save money by paying this block fee. I think the number of patients for whom that is actually true is very small.”

Many doctors who ask patients to pay block fees say the money will be used to offset the high costs of running their practices, she says. “To what degree the patients of physicians should be responsible for paying the overhead costs of their practices is open to debate.”

Do the math

All of this is not to say you would never benefit from paying a block fee, Martin adds, but you have to add up all the numbers first. For instance, if your family anticipates needing many uninsured services in the year to come, it could be worth it. Maybe you’ve got two kids going to summer camp who will require doctors’ notes (at $55 each) certifying they have no health concerns. Or perhaps you’re taking several medications and it costs you $20 each time you have one renewed by fax or phone. You might find a block fee is cheaper than paying for those services individually. The fee is also an allowable medical expense for tax purposes.

But don’t assume all uninsured services are covered by the block fee. “It’s important to read the fine print and understand what’s going to be included, or what isn’t going to be included,” Martin cautions.

Moreover, if you don’t pay the block fee, that doesn’t necessarily mean your physician will charge you for a simple uninsured service like signing a form, says health-care systems policy analyst Sholom Glouberman of the Patients’ Association of Canada. “The money-grubbing aspect of this is quite unseemly,” he says.

7 comments on “Bad medicine: Doctor block fees

  1. Wow. Do doctors not make enough already? This is pretty disgusting, trying to take money from patients who would spend more by paying these fees than by paying for individual services. I've never even needed a doctors note or skin tag renewal, so I would definitely refuse and requests to pay these fees.

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  2. as always this is misrepresentation of physicians by non-physicians. do doctors make enough already , well in terms of inflation ? i make less than 20 years ago inflation adjusted. my average income increase is 1 percent per year over 30 years, not including when the rae government took back 10 percent for a few years.don't feel sorry for us, but get your facts straight, the above article was one-sided. thank you

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  3. I have administered these plans for a large number of doctors for a number of years. The letters stress that a patient's relationship with their dr. will not change no matter what decision they make and I have never had the experience of an office treating a patient differently. The letters indicate that the patients have a choice and when inquiries are made we always advise patients to review the list of services prior to making a decision. As representatives of the doctor, we have even talked some patients out of purchasing the plan as it does not appear to be to their benefit. Rather than again taking a hit at doctors for expecting to get paid for services rendered…lets educate people about taking responsibility and asking questions!!!!

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  4. How about us disabled people who are on a small pension and this fee is unfair for us to pay. My family doctor waived the fees for me right away and helps me out alot because I am disabled. Also elderly people can't afford such a fee either. Our pension just covers the basics like rent and food and travel to our many appointments. It also covers basic cable in my case and internet and phone. But it is very hard to pay for extra. Even a meal out taxes us when we pay 850 rent and so forth.
    I think doctors need to do more for the disabled like Dr. Pitt is for me. I thank God for him everyday and I also say thanks to Dr.Pitt too.

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  5. Darleneartist, i think not just elderly people can't afford this, but also a lot of young people as well. For a lot of young families even these mentioned 185$ can be a lot of money. What if the have several kids? In that situation it's even worse for them..

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  6. seeing that always this can be misrepresentation regarding doctors through non-physicians. complete medical doctors make sufficient already, nicely when it comes to inflation? my partner and i make under twenty years ago inflation modified. my own typical profits raise is actually 1 per cent per year over thirty many years, not including if the rae federal government required back again ten percent a couple of many years. tend not to feel sorry for individuals, but get a facts directly, these article ended up being one-sided.

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  7. Approved by the College of Physicians of Ontario: "Patients may need some services that are not covered by the Ontario Health Insurance Plan (OHIP). Examples of these types of uninsured services include sick notes for work; copy and transfer of medical records; and prescription refills over the phone.

    Physicians are entitled to charge patients for uninsured services, which take physician time and resources. To make it more economical and/or convenient for those patients who may use many uninsured services, physicians may offer patients a block fee. "
    http://www.cpso.on.ca/policies/policies/default.a
    An Atlanta pediatrician

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