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The Question

I recently went to my physician to have the Twinrix vaccine – used to help prevent hepatitis A and B – administered. He told me it would cost $25 for each time [three shots] I have a friend whose doctor charged her $10 per shot and my husband's doctor did not charge him at all. My son's pediatrician administered shots to both my boys at no charge. What is the answer?

The Answer

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If this were a multiple choice question, I would say the answer is all of the above. It is solely up to your doctor as to whether to charge you for the injection – most do – but sometimes as you've found out with your husband's doctor and your son's pediatrician, some opt not to; they do it for free.

"We are within our legal rights to charge what is not covered [by the provincial health plan]" said Mark Wise, a family doctor for three decades who runs the Travel Clinic in Toronto.

"Some are very sticky about charging for every unlisted service, others are not."

Doctors are able to charge for Twinrix, a combination vaccine for hepatitis A and B, when it is used for foreign travel.

The fee covers the service of loading the vaccine, injecting it, then having the patient stay for 15 minutes to see if there is an adverse reaction. There's an additional cost for the vaccine, which patients pay for out of pocket if they are not covered under private insurance plans. Some physicians charge two fees: one for the serum, another for the injection. Others bundle them into one.

As with all things private, prices vary. Bundled fees for the vaccine and injection range from $60 each three times to $75. For children it's lower, typically around $45. The injections are usually given over a six-month period.

The decision to immunize is made after a patient consults a physician about their risk of contracting those two serious liver diseases. Dr. Wise has seen Canadians use it when travelling to Mexico, the Dominican Republic and Cuba, where there is risk of coming into contact with contaminated food and water. The hepatitis B component covers those who come into contact with blood or blood products, unprotected sex, unsafe needles, acupuncture and tattoos.

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"We assess your risk," said Dr. Wise. "It depends on where you are going, why you are going, how long you are going for and what your medical problems are."

If this were an insured service, the Ontario Health Insurance Plan would have reimbursed the physician $9.60 to administer each shot. So that $10 fee your friend paid to her physician was spot on.

I did a little shopping around for you. McMaster Family Practice based in Hamilton lists $20 as the fee for each travel injection; Dalhousie University in Halifax lists $15 as its injection fee on its menu of uninsured services.

The price proposed – $25 – is on the high end of normal for the injection alone. You could shop around at travel clinics for a lower fee or decide it's not worth your time trying to score a price break.



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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