The question: I was eight minutes late for an appointment and my doctor refused to see me. When I rebooked, I was told I owed money for a missed appointment. I explained I hadn't missed the appointment but was late; the office staff said that counted and I owed $30. Just now, I tried to book a visit for my little boy and was told I owed $60 for two missed appointments. I can't honestly recall if I missed another. If I don't show up with the money, I was told the doctor will refuse to see my sick son. As a single parent, pulling $60 out of a drum-tight budget is no easy task. Do I really have to pay this fee?
The answer: No, you don't have to pay that fee to obtain medical care, and it was wrong to suggest otherwise. You may feel trapped, however, because proving your point with this physician could lead to a showdown.
Charging for a missed appointment is the only thing in medicine a doctor can be paid for without providing a service. It is allowed so long as patients are made aware of the policy beforehand, typically through a brochure when joining the practice or a notice posted on a doctor's office wall.
With this policy, physicians should make it convenient for patients to cancel 24 hours in advance – the usual time frame – by having an answering system such as voice mail or an answering machine that functions all hours. Many physician offices don't allow messages after hours and even getting through during normal work hours can be difficult.
"When you are charging for something you didn't do, you have to follow the rules fairly carefully," said Ed Schollenberg, registrar of the College of Physicians and Surgeons of New Brunswick. "An outstanding invoice is not a reason to deny appointments, period."
If your case occurred in his province, Dr. Schollenberg would intervene on your behalf, without mentioning your name, by sending the doctor a letter reminding him of the policy and how care can't be refused because of an outstanding bill. "The physician," he said in a telephone interview from Rothesay, N.B., "could be reminded this wasn't exactly acceptable."
Regulatory bodies in other provinces may only choose to intervene with a formal complaint. Either way, the physician would soon figure out why he is receiving a missive in the mail.
Since many doctors run late, it is usually not a problem when patients occasionally do as well. Being billed for eight minutes tardiness, in my view, is extremely uptight. But you may want to keep in mind that repeated failure to keep appointments – usually three – could be grounds for a physician to terminate the doctor-patient relationship.
So, no, you do not have to pay this fee. A doctor cannot refuse care based on an outstanding bill. If he does, you can report him to his provincial regulatory body, the College of Physicians and Surgeons.
The Patient Navigator is a column that answers reader questions on how to navigate our health-care system. Send your questions to firstname.lastname@example.org.