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“Extra-billing” – the two definitions

Stethoscope prescribing treatment to patient for doctor with pen writing recipe on clipboard in hospital.

“Extra-billing” is a term that comes up frequently in health care discourse in Canada – especially in British Columbia.

So what does it mean?

Patients should note that the B.C. government and the Canada Health Act have two very different definitions.

This table demonstrates the difference:

Scenario
B.C. Government’s Position
Canada Health Act
A patient doesn’t want to wait a long period of time to get a hip operation, knee surgery, etc. from the public health care system in B.C. The patient then decides to pay for the procedure at a private clinic and the clinic does not bill the government for the procedure.
This is extra-billing
This is NOT extra-billing

As a bit of background to this post, earlier this year I kept seeing the term “extra-billing” and it seemed to have different meanings depending on who was using it.

I contacted the B.C. government to try to learn more about what they defined as “extra-billing” and which activities they were trying halt through their enforcement of the province’s Medical Protection Act.

During a phone conversation with a staff person at B.C.’s Medical Services Commission, I asked lots of questions about what does/does not count and took lots of notes from the conversation. I then sent the notes to the commission to make sure my notes were accurate (you can see my email with the commission if you click here).

Here’s what they confirmed:

Scenario 1: A patient is deemed by a physician to require an MRI. The patient chooses to go to a private clinic and pays $1,000 and the clinic does not bill the government. Currently the government does not consider this to be extra-billing. 

However, if section 18.1 of the Medicare Protection Act is allowed to be enforced, the above scenario would be considered extra-billing and not allowed.

Scenario 2: A patient is deemed by a specialist to require hip surgery. The patient chooses to go to a private clinic and pays $10,000 for hip surgery and the clinic does not bill the government. Currently the government considers this to be extra billing.

The government is currently trying to further prohibit (eg. through Bill 92 – fines, ability to refund patients, etc.) private clinics charging patients for hip surgery and other insurable benefits (e.g. orthopaedic procedures).

Scenario 3: A patient is deemed by a specialist to require hip surgery. The patient decides to pay $10,000 for hip surgery at a private clinic and the clinic also charges the government. The government considers this to be double billing.

If you look at the Canada Health Act, however, you’ll find a completely different definition of “extra-billing:”

“extra-billing means the billing for an insured health service rendered to an insured person by a medical practitioner or a dentist in an amount in addition to any amount paid or to be paid for that service by the health care insurance plan of a province; (surfacturation)”

The key difference of course is this wording in the Canada Health Act – “in addition to any amount paid or to be paid” by the provincial government.

Basically, the CHA does not allow a clinic to take money from a patient and the provincial government for the same procedure.

Conversely, the provincial government is aiming to take the situation one step further – prohibiting clinics from taking money from patients period. That means B.C. patients could face a 2-3 year wait for surgery (like Bruce was told) or they’ll just have to leave the province for health care (like 30,000+ patients did in 2017).

 
Colin Craig is the President of SecondStreet.org

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