Doctors offering 'extended coverage' for uninsured services
An increasing number of Ontario family physicians are offering “Extended Coverage” plans to patients to pay for a wide range of uninsured services.
The practice is referred to as a “block or annual fee” by the College of Physicians and Surgeons of Ontario with the fee schedule being set by the Ontario Medical Association. Physicians, if they are charging for uninsured services, can offer block fees only if they also offer “pay-per-service”.
For example, in one letter to patients a physician wrote “you can choose to pay for individual uninsured services on a “pay-per-service” basis, I recommend that you consider Extended Coverage…. you would be covered for an entire year of use of the most common uninsured services… prescription renewals over the telephone ($11.02), telephone advice ($22.06) and sick notes ($13.59).”
Not all physicians charge patients for uninsured services though indications are that the practice is growing.
Provincial governments deciding to delist medical services has been a subject of intense debate in the past. Many argue that some of the uninsured services should be covered by provincial health insurance as they are important to the ongoing health of the individual.
And the amounts being asked for are not insignificant. Some physicians, it has been reported, have standard and premium plans charging individuals in the range $60 and $80 (respectively) and families $90 and $120.
“For many patients this is a fair bit of money to spend” said James Clancy, president of the 340,000 – member National Union of Public and General Employees.
“People may worry about getting timely access to these services if they do not pay for the ‘extended coverage’. With a growing crisis in the availability of family physicians many general practitioners may be feeling like they have a captive market before them.”
One individual, who wishes to be anonymous, shares Clancy’s concerns. “I trust and respect my doctor but it did occur to me when I received the letter that not choosing to take out coverage for uninsured services would end up with me being treated as a ‘second class’ patient when I try to book appointments or request an uninsured service.”
Other critics worry that this practice is yet another example of privatization creeping into the public health care system. As governments increase the number of delisted services the block fee figures will increase and the distinction between a public and a private system blurs even further.
These block fee schemes introduce the same language with regards to health care services as for purchasing any other item in the market place. For example, in a letter to patients a physician makes a pitch to the patient’s consumer judgment.
“In an effort to be fair to my patients… rates for Extended Coverage below the average rates charged by other family doctors…. save you the inconvenience of dealing with bills for individual services…. reduce your costs and afford the convenience of one time billing.”
Or in other words – our plan will save you time and money!
While many of the uninsured services are those that few patients will ever access in a year the block fee grab by some physicians could be a big source of revenue. Patient-physician trust can be high and many may sign up for these fees simply because their doctor suggested it.
Still, as Clancy points out, “The basic issue is that these services should be insured.”
“The reality is that all services requiring a physician should be covered by our publicly funded and accountable health care system. There really is no room for pay-per-service or block fees” said Clancy.
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