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Paying to be a patient? Toronto woman calls doctor’s annual $150 fee request ‘galling’

Posted: December 10, 2015

(December 10, 2015)

By: Ashley Csanady, Canadian Politics

A Toronto woman is upset with a letter she received from her doctor asking for an annual fee. Such practices are allowed but she feels the missive wasn’t clear it was for optional services.

A Toronto woman was incensed after receiving a letter from her doctor asking for an annual $150 fee.

The letter from Wellpoint Family Practice cites recent cuts to doctors fees, the clinic’s after-hours service and quality of care in appealing for the fee.

FotoliaSome doctors charge patients for a copy of their immunization records.

“This year, more than ever, I’m asking each and every one of you to pay the annual fee so that I can continue to provide the level of service you come to expect,” the missive from Dr. Nandini Sathi at Wellpoint states. “The fee is good value and avoids the delays that occur when we must request payments from you for individual services.”

These sorts of “block fee” requests are increasingly normal in Ontario and permitted under the law, so long as they cover things such as doctor’s notes and insurance forms not covered by the Ontario Health Insurance Program.

But the tone of this particular letter has the patient and health care advocates scratching their heads.

The patient — who asked that her name be withheld for fear of reprisal from her physician — called the letter “unexpected and slightly galling.”

The 20-something said she only goes to the doctor maybe once a year so she didn’t understand why she was being asked to pay so much.

“I kinda felt like she doesn’t care about being a good doctor… and just wants money,” the woman said. She pointed to a section of the letter that mentions the sorts of things she expects from a family doctor, such as delivering babies, as odd.

National Post/HandoutA view of the explanation of annual fees included alongside a Toronto doctor’s appeal to her patients.

The letter itself makes a strong case for the fee to maintain service but also notes that if patients don’t pay the fee, they can’t expect email communication with their doctors or prescriptions to be renewed over the phone — the types of service for which family practices are allowed to charge.

Wellpoint says the plea is well within the College of Physicians and Surgeons of Ontario’s guidelines on block fee requests. This isn’t the first year they’ve distributed the letter and they say it’s meant to be a convenient way for regular patients to pay for services all at once. The fee remains optional and Wellpoint works with patients who can’t afford services — even those they always charge for — to make sure they get proper access.

“In no way does this affect the patient care in any way,” said Enza Costa, a manager in the clinic. (Dr. Sathi was out of the country at the time of writing). She said they never refuse services or give preferential treatment based on the fee.

Judy Plotkin, a vice-president with the health clinic, said the letter is “pretty clear” it’s just an opt-in request. She said when viewed in conjunction with an accompanying pamphlet, it’s obvious the block fee is a choice. And, in the end, she said it’s always about patient care and ensuring their needs are met.

That newsletter also details the sorts of services for which the clinic charges: a $30 fee for a non-OHIP referral, such as massage therapy; a $25 fee for immunization records; $30 for a telephone consultation with nurses. It also notes what the annual fee doesn’t cover: third-party physicals for immigration; employment or other needs; transfer of records; a physician consultation by telephone instead of in person; and legal or insurance forms.

Some doctors do perform some of those services without charging a fee, but it depends on the office.

“Physicians in Ontario are permitted to charge a block fee — a fee for a predetermined set of uninsured services during a predetermined period of time,” said Dr. Mike Toth, president of the Ontario Medical Association in an email. He also stressed that the fees must be voluntary.

National Post/HandoutA list of what one Toronto clinic doesn’t include in an annual fee it asks patients to pay.

Health Minister Eric Hoskins, also a medical doctor, said physicians are small business owners and must have the freedom to charge for non-OHIP covered services. That said, and without commenting on a specific letter, he said patients need to understand it’s a choice, not a requirement for care. He noted that even after the slight fee decreases that took effect Oct. 1, Ontario doctors are some of the best paid in the country, billing an average of $368,000 a year.

Physician fees were cut twice this year by 2.65 per cent in February and 1.3 per cent in October as part of an effort to hold government spending increases on doctor pay to 1.25 per cent. Hoskins said the cuts were based on a report from former chief justice Warren Winkler, who was trying to broker a conciliation between the Ontario Medical Association, which represents doctors, and the province.

The province spends about $13 billion a year in doctor pay, both through fees and in other areas such as funding for clinics and family health teams. That means, in a province with a budget of just over $130 billion each year, about 10 cents of every dollar spent by Ontario goes to a doctor.

“Its an option that is by law available to them,” Hoskins said. “It needs to be explicit that it is voluntary and that there is no added advantage… if they do subscribe to the block fees it needs to be neutral and it can only be compensate for non-OHIP insured services.”

“No one has to pay a block fee,” said Kathryn Clarke, senior communications coordinator with the College of Physicians and Surgeons of Ontario. She said a policy outlines expectations for doctors to ensure their requests are clear. She said they still receive complaints “periodically” but couldn’t comment on the substance of this precise letter.

National Post/HandoutA list of what is included in the annual fee, or what patients can pay per use.

“The intent of the policy is to establish it’s meant to be an offer. It’s an option that patients are given and they’re not supposed to be mislead or forced into signing it,” she said.

But for Natalie Mehra with the Ontario Health Coalition, which has long lobbied against any sorts of fees in health care as something that undermines OHIP, the Wellpoint letter doesn’t pass that test.

“This letter goes much further than any block fee letter I’ve seen to date,” Mehra said, adding it’s quite vague about it being a request. She said all the language about hours of service and concerns about cuts implies the fee is connected to care.

“I think including the word ‘delay’ in that sentence is very manipulative.

Frank Gunn/ The Canadian PressOntario Health Minister Eric Hoskins speaks at Premier Kathleen Wynne looks on.

“We get complaints fairly often from patients who have received letters from their family doctors asking for block fees and patients are often confused, even when the letters are more clear than this one that the fees are optional. Patients feel that they will get substandard care or they will be forced to wait longer if they don’t pay the fees,” she said. “The fees are really problematic. They really create the perception there’s two tiers of care.”

It’s unclear how many doctors in the province ask for block fees with these sorts of mass letters, but Hoskins said it’s a minority.

NDP health critic France Gélinas said concerned patients should consider talking to the regulatory body, the College of Physicians and Surgeons of Ontario, if they feel pressured into paying such a fee.

“If the letter in any way shape or form implies the care will be different if they don’t pay those blocks fees, they have a reason to complain to the CPSO,” said said. “It’s not the intention of the doctor, it’s how it is interpreted by the people who get the letter, how it was communicated to them, how it was received.”

Some doctors are turning to these fees just to make ends meet, said Tory health critic Jeff Yurek. He said the fee cuts imposed on doctors took hundreds of millions dollars out of the system.

“I honestly think this is playing out from the cuts that took effect October first,” Yurek said of the anecdotal increase in such letters. “I think they’re forced to. They’re small businesses themselves and they need to make ends meet.”

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