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Can a psychiatrist charge for missed visits with weeks of notice? Add to ...

The question

While it is standard for doctors to bill for visits not cancelled more than 24 or 48 hours in advance, I have a more complicated scenario. Can a psychiatrist charge for visits during a patient's summer vacation even if weeks or months of advance notice is given?

The answer

It sounds as if you are new to psychotherapy and your psychiatrist has informed you of how he runs his practice. Given that he bills the Ontario government about $150 for a 46-minute therapy session - similar to the rest of Canada; British Columbia and Nova Scotia are slightly higher at $161 and $163 respectively for slightly longer sessions - you will be faced with a hefty bill if you have to cover twice weekly sessions while on holidays. And that seems unfair.

Giving months of advance notice is very different from a patient cancelling at the last minute; a psychiatrist can't bill the health system if the patient is a no-show. But in this case, it sounds as if you have to eat the cost no matter what notice you provide, which will do little for your mental health, let alone your pocketbook.

This issue has come up with the doctor's regulatory body, which in Ontario is the College of Physicians and Surgeons. While it doesn't spell out a specific time frame in which a patient must cancel a psychotherapy session, spokeswoman Jill Hefley said in their experience the practice among psychiatrists is that patients are expected to provide one to two weeks notice, some even longer.

"One would think several months is more than reasonable and in the face of a complaint, a psychiatrist would have to justify billing for a missed appointment with that much advance warning," said Ms. Hefley.

Indeed, Tina Chadda, chair of the Ontario Psychiatric Association's psychotherapy section, said billing patients for missed therapy sessions when given months of advance notice is "not terribly commonplace, but it's not totally unusual either."

With enough notice, psychiatrists can usually fill an empty slot, said Dr. Chadda, noting that "if you are a psychiatrist in a big city, you should be able to fill your time slot within a week because the demand is there."

Whatever the case, billing for missed appointments shouldn't come as a surprise. A psychiatrist will outline their policy on the matter during those first few appointments. Others give handouts to patients; some post a notice in their waiting rooms.

Dr. Chadda encourages you to talk to your psychiatrist. The issue has to do with trust and the setting of basic ground rules. Start by saying you have mixed feelings about having to pay for a missed appointment during your holidays; you are not sure you understand it and that it makes you feel anxious discussing it because you feel a power imbalance.

"I can't imagine something like this would be unresolved," said Dr. Chadda, a practising psychiatrist in Toronto.

During this discussion, you may agree to disagree. Or you may decide the ground rules are unacceptable and you want to change psychiatrists. Finally, you could lodge a complaint to the college - though I doubt that would do much for the therapeutic relationship.

The Patient Navigator is a column that answers reader questions on how to navigate our health-care system. Send your questions to patient@globeandmail.com.

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