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The question: My new doctor has sent me a letter stating I could pay a "block fee" to cover certain services that I may need. I am unclear on what this means as my previous doctor did not charge me sick notes or prescription renewals. Is this allowed and if so, is it necessary for me to pay this block fee?

The answer: Getting charged for a service at your doctor's office can feel uncomfortable if it's not clear why there's a fee. Given that you were previously not charged for these services, it's understandable why this letter may have lead to some confusion.

Provincial health plans do not cover all services that your doctor can provide to you. For this reason, services that are not covered can have an associated fee that can be directly charged to each patient. The decision to ask patients to pay for these services is allowed and is up to the discretion of each physician. If your physician does charge for uninsured services, it should be clearly stated either through a published sign in their office or a letter detailing the cost of each service prior to it being rendered.

To understand what's covered under your provincial health plan, let's review what constitutes an insured versus an uninsured service. Insured services are those that the provincial health plan deems to be medically necessary. This includes your regular doctor's visits for acute illnesses such as infections, emergency room visits or hospital admissions. You are also covered for the management of chronic diseases and preventative screening tests such as cancer screening, blood work or investigations that your doctor orders. For these services, your doctor will bill the government directly for compensation.

Uninsured services include those that are not deemed to be medically necessary such as the completion of an insurance form, a driver's licence physical or sick notes. Other common uninsured services include the transfer of medical records, prescription renewals over the phone, or any cosmetic service such as wart treatment, Botox or removal of benign skin tags. Your doctor can also charge for travel advice and missed appointments.

Block fees are an option that some physicians have implemented that is a one-time yearly fee that covers most uninsured services. In general, your doctor sends a list of what services are included and a set fee is charged to each patient. It is absolutely your choice to decline the block fee and you should not feel any pressure to pay it if you do not want to do so. Declining block fees should not cause any interruption in your service from your doctor.

For some however, participating in block fees are convenient, especially for those who use uninsured services often. Some examples of people who may opt into the block fee option may be those who would like to avoid a doctor's visit for a prescription renewal or parents of young children may enjoy the option to call for phone advice prior to making a visit to the office.

The fees are set by your doctor but most will take guidance from the provincial medical associations' recommended fee schedule. If you struggle with covering the cost of either the block fee or the individual service fees, have a discussion with your doctor to see what can be done. Most physicians will take these concerns seriously and will try to find a way to accommodate your needs.

Dr. Sheila Wijayasinghe is the medical director at the Immigrant Womens' Health Centre, works as a staff physician at St. Michael's Hospital in their Family Practice Unit and at Hassle Free Clinic, and established and runs an on-site clinic at Women's Habitat Shelter in Etobicoke.

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