Questions to Ask Before Paying for Medical Care

Paying privately for healthcare can give Albertans additional choices, but the decision deserves the same care you would give any important medical decision. Before providing a credit card number or paying a deposit, understand exactly what you are buying, why it is being recommended, whether a publicly funded option exists, who will provide the care, what the total cost may be and what happens if the treatment does not go as planned. The right questions can make a complicated decision much clearer.

First ask: why am I being charged?

Not every healthcare service provided in Alberta is insured by the Alberta Health Care Insurance Plan, or AHCIP.

Physicians and clinics can legitimately charge for uninsured services. Examples can include certain forms and reports, some elective procedures, optional testing and other services outside provincial insurance.

But before paying, identify exactly why the service is not publicly funded.

Ask:

• Is this an uninsured service?
• Is the service medically necessary?
• Is there a publicly funded version or pathway?
• Am I paying for the medical service itself or for an optional additional service?

Ask whether a publicly funded option exists

A private option and a public option can sometimes exist for similar healthcare needs.

For example, Alberta now permits certain patient-paid preventative diagnostic imaging without a physician referral, while medically necessary physician-referred diagnostic testing continues through the publicly funded system.

Likewise, privately operated facilities can sometimes deliver publicly funded healthcare.

Do not assume that entering a private building automatically means you must pay.

Ask specifically whether your circumstances qualify for publicly funded care and what the expected pathway would be.

Ask whether paying changes your medical care

Find out what you actually receive in return for the fee.

Does paying provide a different procedure, additional testing, an optional service, a different facility or simply faster access to a service that is also available publicly?

If the principal difference is timing, ask what the expected public wait is and whether another publicly funded provider or location might be available.

You need enough information to compare the options meaningfully.

Ask who is actually treating you

The clinic name is not enough.

Ask for the name and professional designation of the person who will provide your care.

If it is an Alberta physician, you can independently verify the physician through the College of Physicians & Surgeons of Alberta.

If another regulated professional is involved, check the appropriate Alberta regulatory college.

For a procedure involving several people, ask who is responsible for each part of your care.

Ask whether the facility requires accreditation

Certain medical facilities in Alberta are subject to specific accreditation requirements.

This can include non-hospital surgical facilities and facilities providing specified diagnostic services.

For services within the College of Physicians & Surgeons of Alberta’s accreditation programs, verify the facility independently rather than relying only on an accreditation logo or statement on the clinic website.

Professional registration and facility accreditation are separate issues.

Ask why the treatment is appropriate for you

A private service should still have a clinical rationale.

Ask:

• Why are you recommending this?
• What problem is it intended to address?
• What evidence supports using it in someone like me?
• What are the realistic benefits?
• What are the important risks?
• What happens if I do nothing?
• Are there less invasive or less expensive alternatives?

A good consultation should help you understand both reasons to proceed and reasons not to proceed.

Ask what the test or treatment cannot tell you

This is particularly important with screening and preventative testing.

A medical test may have limitations, false-positive results, false-negative results or incidental findings.

A treatment may improve one problem without addressing another.

Ask what uncertainty will remain even after you pay for the service.

Understanding limitations can be as important as understanding potential benefits.

Ask for the complete price

The advertised price may not be the final price.

Request a written estimate showing what is included and what could cost extra.

Depending on the service, additional charges might include:

• consultations
• laboratory tests
• diagnostic imaging
• physician or surgeon fees
• facility fees
• anesthesia
• medications
• implants or medical devices
• pathology
• follow-up appointments
• revision treatment
• treatment of complications

Ask for dollar amounts wherever possible rather than accepting an undefined statement that extra fees “may apply.”

Physicians must tell you about uninsured fees

The College of Physicians & Surgeons of Alberta has a standard governing charges for uninsured professional services.

Under the current standard, physicians must inform the patient or responsible third party of a fee before providing the uninsured professional service.

A general notice posted in an office is not, by itself, sufficient.

If you do not understand a physician’s charge, ask for an explanation before the service is provided.

Be careful with membership or block fees

Some medical practices offer a block fee or membership-style payment covering a group of uninsured services.

CPSA rules require physicians offering a block fee to allow patients to choose between the block fee and paying individually for uninsured professional services.

The patient must receive enough information to make an informed choice.

A physician cannot refuse an insured professional service because a patient did not pay a block fee for uninsured services.

Nor can an insured service already paid through another mechanism simply be included in the block fee as another patient charge.

Ask whether your deposit is refundable

Before paying a substantial deposit, read the cancellation and refund policy.

Ask what happens if:

• you change your mind
• the physician determines you are medically unsuitable
• your health changes before treatment
• the clinic cancels
• the physician becomes unavailable
• you need to postpone

Get important financial terms in writing.

Ask what happens if you have a complication

The initial procedure price is only part of the financial question.

Ask who manages complications and who pays for that care.

For surgery or another invasive treatment, ask:

• Who do I contact after hours?
• Where do I go if I become unwell?
• Can the clinic treat complications?
• What happens if I need hospital admission?
• Are additional physician or facility fees possible?
• Is revision treatment included?

You should understand the clinical plan and the possible financial consequences.

Ask what follow-up is included

A procedure is rarely just the moment when treatment occurs.

Find out whether the price includes follow-up visits, test-result review, wound checks, medication management or other aftercare relevant to the service.

Ask how long follow-up continues and who provides it.

If you live far from the clinic, determine whether follow-up can be provided locally and who will coordinate it.

Ask what happens to your medical records

Your privately paid care can become important to other healthcare professionals treating you later.

Ask how records are stored, whether results are added to provincial electronic health information systems when applicable and how you can obtain a copy.

If your family physician or specialist needs the information, ask how it can be shared with your consent.

Ask about insurance before assuming you are covered

Employer and private health insurance policies differ significantly.

Do not assume that a service is reimbursable simply because a clinic describes it as medical care.

Ask your insurer:

• Is this specific service covered?
• Is a referral required?
• Does the provider need a particular professional designation?
• Is pre-authorization required?
• What percentage is reimbursed?
• Is there an annual maximum?

If the amount is substantial, written confirmation can be useful.

Ask whether you have time to think

Most non-urgent elective healthcare decisions do not need to be made while sitting in a consultation room.

If you are being asked to spend thousands of dollars, it is reasonable to take time to understand the proposal.

Ask for the treatment plan and quote in writing.

Consider discussing major medical decisions with another qualified healthcare professional if you are uncertain.

High-pressure sales techniques are not a substitute for informed consent.

Consider a second opinion

A second opinion can be particularly useful when a proposed treatment is expensive, invasive, irreversible or based on an uncertain diagnosis.

The second clinician does not necessarily need to disagree with the first.

The value is having another qualified professional independently consider the diagnosis, alternatives and proposed treatment.

Ask what happens if you choose not to pay

This question can reveal an important distinction.

If the service is optional or uninsured, the clinic should be able to explain what happens if you decline it.

For physician block fees, declining the fee cannot be used as a reason to refuse insured professional services.

If you are told that paying an additional fee is required before you can receive an insured service, ask for a clear explanation of exactly what is being charged and why.

A simple checklist before you pay

• What exactly am I paying for?
• Why is it not covered by AHCIP?
• Is there a publicly funded alternative?
• How long might the public pathway take?
• Who will provide the treatment?
• Have I verified the professional?
• Does the facility require accreditation?
• Why is this treatment appropriate for me?
• What are the benefits, risks and alternatives?
• What is the complete price?
• What could cost extra?
• Is my deposit refundable?
• What follow-up is included?
• Who manages complications?
• What happens if I decide not to proceed?

The PureFarmFresh approach

Paying privately for healthcare is not automatically good or bad. It is a financial and medical decision that deserves clear information.

A patient should know what is being purchased, who is providing it, whether another pathway exists, what it costs and what happens afterward.

Good healthcare decisions are easier when price, medical need and patient choice are kept separate enough to understand each one.

We explain the system. You decide what matters to you.