Ten or 15 years ago, the notion of opting out of (or not opting into) the plan would have been seen as lunacy. I remember stories from my father (a well-respected cardiologist) about patients who would sometimes pay for services with gifts (like chickens or vegetables) when they had no money. And many patients simply couldn’t afford to pay at all. The advent of the plan created a program where physicians were well paid for services provided with no risk of non-payment so long as their bills were submitted to Alberta Health in a timely manner. There were no accounts receivable and there was even a suggestion that many patients, relieved of the burden of paying directly for the services, took advantage of that by seeking more and more frequent medical attention (thus increasing demand).
Today, it may be a different story.
From the patient’s perspective, waitlists for procedures are in many cases intolerable. Although there are “concierge” medical clinics that give enhanced access to non-insured services, Alberta Health and the College of Physicians & Surgeons of Alberta are taking a very close look at these to ensure that membership in such a clinic does not entitle the patient to enhanced access to insured services. In light of this, patients with sufficient money to pay directly for medical services may welcome the publication of a notice of opting out.
From the physicians’ perspective, once opted out, what does this mean? Well, simply put, it means that the physician can continue to provide medical services to patients in Alberta – he/she just can’t bill the public system for those services. The bill goes directly to the patient. And, of course, if the patient receives those services from an opted-out physician, that patient is not entitled to reimbursement from the plan. It also means, however, that the physician likely cannot participate in alternative relationship plans such as ARPs or AARPs (as these are, by definition, funded with money coming from the Physician Services Budget as an alternative to fee-for-service billings).
Unlike Ontario, where an opted-out physician is obliged to bill the patient the same fee as he/she would if operating under a publicly funded plan, Alberta physicians face no such constraints. However, although the CPSA does not publish a Standard of Practice focusing on an opted-out physician’s billing rates, it does address charging for uninsured professional services and that Standard of Practice might form the basis of a CPSA review of billings if faced with a complaint. The Standard of Practice requires that amounts charged for uninsured services must reasonably reflect physician professional costs, administrative costs and the patient’s ability to pay. In addition, patients must be informed in advance of any fee to be charged, and the doctor may not charge a fee in advance for “being available.”