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The question: I am looking for a child psychiatrist. One who came recommended told me he charges $60 for a 45-minute visit to cover time not billable to the provincial health plan such as reports, prescription refills and telephone calls. I don't anticipate needing any of these services and $60 a visit strikes me as very high since my child would go every week. This doctor's fee smells like extra billing to me. Do I have any choice? He made it clear that this is how he conducts his practice, but I don't think I can afford it.

The answer: No doctor in Canada who bills the provincial health plan for services can charge such a fee, and what that psychiatrist is proposing is unacceptable. You face a wrenching predicament: You either pay the fee to secure his services or search for another specialist, which could mean a lengthy treatment delay.

There's another option that Dennis Kendel, former registrar of the College of Physicians and Surgeons of Saskatchewan suggests, which is to report this psychiatrist – whose behaviour he labelled unconscionable – to the province's disciplinary body.

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"The doctor simply can't charge that," Dr. Kendel, a family physician, said in a telephone interview from Saskatoon. "To actually apply it this way, when you have a one-time visit, is simply not on."

I think most psychiatrists would be disturbed by this physician's behaviour. Maybe he thinks he's cornered the market on child psychiatry in your community – and maybe he has – but he's breaking the rules.

Typically, patients are offered an option of paying a block fee for a set period of time, or paying à la carte for any additional services not covered by the public health care system. No doctor can make it a requirement that a patient must pay a fee for an uninsured service as a condition for getting access to an insured service, such as psychotherapy for your child.

There are other rules as well. In Ontario, for example, physicians cannot charge a block fee for a period of less than three months, which means the psychiatrist could not bill per visit. Patients must also be provided information about what the block fee covers so they can decide how and whether they want to pay. The fee must also be reasonable.

Given that Ontario psychiatrists are paid about $160 for each therapy session – British Columbia and Nova Scotia are about the same at $161 and $163 respectively – another $60 on top would not likely pass the college's reasonable test.

I think you should make an appointment with your family doctor. Thank the physician for the referral to the psychiatrist but say you cannot afford the $60-a-visit fee. Give your doctor time to respond – don't be afraid of the long, silent pause – as it's a lot to take in.

Request another referral to a similarly qualified specialist, recognizing that it can be difficult. See if there are other health care providers covered by medicare that can help your child while you wait for that new referral. Ideally, you want your family doctor to help you stickhandle your way out of this health care jam; the physician holds the golden key that gets you into that world of medical specialists.

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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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