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.