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The Question: I'm in my mid-40s, in good health and visit my doctor four times a year for prescription renewals and an annual physical. My doctor charges me $150 annually (along with all his other patients) for services not covered by the Ontario Health Insurance Plan, even though I don't use them. When I asked if I could be on a pay-as- you- go program, I was told it's only for those in financial distress. Can he charge a block fee regardless of services used?

The Answer: Doctors cannot compel you to pay a block fee. Not only that, this doctor could find himself the subject of an investigation, potentially even discipline by the College of Physicians and Surgeons of Ontario, the regulatory bodyin your province. I find his behaviour appalling: This doctor sounds more interested in boosting his income than providing patient care.

This must be very lucrative: If he has 1,500 patients in his medical practice and every one pays this block fee, he's potentially increased his income by $225,000 a year. That's on top of his annual billings from treating patients.

Annual block fees are commonly charged by physicians across Canada to pay for services not covered by provincial health plans, such as prescription renewal by telephone, sick notes, photocopies of medical records and missed appointments. For those with chronic conditions, it makes sense to pay the annual fee – especially for telephone prescription renewals – but patients must be given the option to pay for each service separately when and if they use them.

Rocco Gerace, registrar of the College of Physicians and Surgeons of Ontario, said doctors have to provide in writing the dollar amount of the block fee, plus a list of services and their individual cost.

"They [physicians]cannot require a patient to pay a block fee; it's entirely optional," Dr. Gerace said in a telephone interview. "Should a patient elect not to pay a block fee, they can't refuse service."

That Ontario policy has been around since late 1993. Most other provinces have similar policies, according to Fleur-Ange Lefebvre, executive director and chief executive officer with the Federation of Medical Regulatory Authorities of Canada. Saskatchewan and Prince Edward Island do not have a policy on the issue.

You are right to challenge this practice. The question is what to do now. If you report him to the college, he will know you are the one who complained. That will likely worsen an already strained relationship

I suggest you send that doctor's block policy in an envelope to the college along with his name but nothing that identifies you. Since your physician has sent this fee announcement to all his patients, he won't know you tipped his hand to the college. The college, in turn, can inform him that this is not allowed.

Hopefully, it will save you an uncomfortable confrontation with a doctor who has already demonstrated he has little regard for the rules or his patients' feelings.

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

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