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My doctor recently sent me a bill for $30 for the telephone renewal of an old prescription. Can she do this?


The short answer is yes, doctors can bill for any uninsured service - prescription renewals, telephone calls and sick notes - items physicians are not paid under the traditional fee-for-service system. What concerns me most is not the $30 bill, but the surprise of it.

Danielle Martin, a family physician at Women's College Hospital in Toronto, agrees the surprise element is problematic, saying most physicians who bill for uninsured services forewarn patients, usually through a poster on their office or, in the case of a block fee, through a yearly letter.

"If it's done poorly or if it's done out of the blue with no warning, it has the potential to change profoundly the dynamic between the patient and the doctor," she said.

Dr. Martin has also paid her physician $30 for a prescription renewal, which she described as being in line with what many doctors charge. The difference, in her case, is that she knew the fee in advance and could decide whether to pay it.

If she didn't want to pay, she could have chosen to get it refilled during the next office visit. Doctors usually offer options: a pay as you go fee for prescription renewals or a block fee, typically $100 per patient per year - more for a family - to have several services not covered by provincial health insurance plans.

The key, said Dr. Martin, is for doctors to make it clear that "in no way will your care be compromised if you choose not to pay for or receive uninsured services."

Dr. Martin, being 35 and healthy, has chosen not to pay the annual block fee to her physician because she does not think she would use it enough.

Benjamin Burko, medical director of Tiny Tots Medical Centre in Montreal, started billing for services 15 years ago, after he resented doing hours of unpaid work each day.

Something as simple as a prescription refill, he points out, takes about 15 minutes of physician and support staff time. The chart is retrieved, taken to the doctor's office, where it must be read. A decision is made to renew and a note made. The prescription must faxed or phoned in, then the chart re-filed.

"These fees are a necessarily evil in an underfunded public health system," said Dr. Burko.

Morally, he agrees you should have been informed beforehand and you can decide now, as a consumer, whether to pay the bill or not. It isn't necessarily wrong to refuse payment - the doctor didn't tell you beforehand - though do you really want her to do work for which she isn't paid?

If it happened to me, I would pay the bill, but I would mention to office staff or the physician that I wish I was given advance notice so I had a choice. Generally speaking, I like to pick my battles; a fight with your primary health provider is not a winnable one.

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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