Ottawa plans to crack down on doctors charging for medically necessary health care

A rise in the number of companies offering Canadians faster access to health care at a price is prompting the federal government to launch a crackdown on the practice, CBC News has learned.

Health Minister Jean-Yves Duclos is telling the provinces to put a stop to patients being charged for medically necessary care — and warns that Ottawa will claw back federal health transfer payments if the charges continue.

"I am very concerned with the recent increase in reports of patient charges for medically necessary services," Duclos says in a letter sent Thursday to all provincial and territorial health ministers. Federal officials provided CBC News with a copy.

"No matter where in the country Canadians live or how they receive medically necessary care, they must be able to access these services without having to pay out of pocket."

• Have you paid for a virtual appointment with a doctor? Let us know about your experience in an email to ask@cbc.ca. 

Companies charging patients for virtual visits with a family physician are the chief targets of the federal crackdown, according to a senior government official.

Although the Canada Health Act prohibits charging "insured persons" for medically necessary services, there has been an explosion recently in the number of companies across the country offering online doctors' appointments and charging fees in the range of $50 to $100 per visit.

Companies that charge a fee get around the Canada Health Act prohibition by connecting the patient to a physician in a different province. Under the medicare rules in the province where the doctor practises, the patient technically would not qualify as an "insured person."

Some critics have called this a loophole in the Canada Health Act.

In his letter, Duclos says expanded access to health care using virtual platforms must remain "true to the spirit and intent of the Canada Health Act."

Duclos says he will give provinces and territories a document clarifying that charges for medically necessary services are not allowed, regardless of where the patient lives.

"The complexities of modern family health, virtual and surgical care, including its provision across jurisdictions, and expanding scopes of practice of health workers, should not be used to permit these charges," the letter says.

"As our health care system evolves, it must do so while respecting the Canada Health Act." 

One of the biggest players charging for virtual physician care is Maple, which describes itself as "Canada's top-rated virtual care app" and charges $69 or more for an appointment.

"We charge a fee for our services only when they are not covered by provincial health plans," says the company's website.

"We'd love to be eligible for public coverage consistently across Canada and we're working hard to ensure Maple is included in provincial coverage as soon as legislation allows."

It's not clear from Duclos' letter whether the Trudeau government will also crack down on other examples of doctors charging for medically necessary care, recently revealed by CBC News:

• Some for-profit surgical clinics are charging patients who travel from another province up to $28,000 for a hip or knee replacement.
• Doctor's offices in Ontario are offering virtual and in-person appointments with a nurse practitioner for a subscription of about $30 a month.

Duclos' move comes at a time of growing debate over the role of the private sector in the delivery of publicly funded health care in Canada, particularly as provinces struggle with surgical backlogs and staff shortages stemming from the COVID-19 pandemic.

In Parliament in recent weeks, the New Democrats have repeatedly argued that the Trudeau government is allowing increasing privatization of the health system and that for-profit companies are playing a growing role in providing care. 

The federal government struck a deal with the provinces and territories last month for a 10-year boost to its annual Canada Health Transfer funding arrangement.

Duclos' letter warns that those transfers could be reduced if patients are charged fees for medical care. 

"Canadians pay for their health care services through their tax dollars, and should not be asked to pay again by way of patient charges when they need to access those services," Duclos writes. 

"Where instances of patient charges for these services are present, I will pursue a reduction in federal health transfers by an equivalent amount."

Different provinces have different approaches to coverage of virtual medical appointments, and some of the rules have been shifting as the COVID-19 pandemic has waned.

• How do you feel about doctors charging for virtual health care? We want to hear from you. Send an email to ask@cbc.ca.

For instance, as of last December the Ontario Health Insurance Plan (OHIP) covers the cost of virtual or phone consultations only when the patient has an ongoing relationship with a doctor. "Virtual walk-in clinic" visits — with a doctor the patient has not seen face-to-face — are not covered.

That switch hampered the business model of another company offering virtual appointments — Rocket Doctor, which now charges $55 for a doctor visit.

"Virtual primary care and urgent care services are unfortunately no longer a service that patients can access for free on Rocket Doctor," says the company's website, which urges patients to sign a petition calling for that policy to be reversed.