Billing for uninsured services could add as much as $20,000 extra to your income every year, but the vast majority of Canadian physicians still aren't doing it.

Now, with doctors busier than ever and patients more demanding than ever, we may have reached a tipping point. The budding industry of private firms offering to help you get paid for the time you spend on annoying uninsured tasks is rapidly becoming a booming one. Professional medical organizations like the OMA and the CMA are broadcasting their support. Consultants are crisscrossing the country giving seminars and workshops. The future is here, experts say — it's time you stopped working for free.

HOW IT WORKS
As you well know, plenty of things you do aren't covered by your province's public health insurance plan: filling out sick notes and employers' or fitness club physical exam forms, renewing a prescription by phone or by fax, giving advice to a patient by phone, and more. But many physicians are reluctant to ask patients to pay them for those kinds of things. "Some physicians find this extremely uncomfortable," says Dr Benjamin Burko, a Montreal pediatrician and practice management consultant. But if the government isn't prepared to pay you for your work, it's only reasonable to ask patients to do so, he says. "The first thing I teach, and the first realization you have to come to, is that your time is worth something."

After you've wrestled with your altruistic, philanthropic impulse and realized that Dr Burko is right, it's time to get to work on your billing system.

DOCTOR DIY
Some doctors choose to design their own uninsured services billing programs. But how much, exactly, is your time worth? Answers vary — there are no rules on how much you can charge for providing uninsured services, but there are guidelines available to help you figure out some baseline prices. The OMA published a comprehensive and thorough list of suggested prices and guidelines in January.

You must allow patients to pay for each service individually, but you may also give them the option to pay a 'block fee.' A block fee is, in essence, an insurance plan for uninsured services. If they join your block fee plan — for a price from, say, $115, like Dr Burko charges, up to $300, as one of his colleagues does — then any uninsured services patients need are covered for a year. Again, as with the per-use method of billing, the price of your block fee plan is up to you.

Some patients may balk but work is work, says Dr Alan Brookstone, a Vancouver FP who started his own uninsured services billing program in 1996. Did he get a lot of complaints? "No," he says. "Many expected to pay and stated they were surprised that I had not been charging for uninsured services prior to the introduction of the plan and policies." A small minority was less forgiving. "Less than 1% of patients were unhappy with the program. Some of those left the practice." Dr Brookstone's policy was successful. Thirty percent of his patients chose the block fee option and his annual billing for uninsured services amounted to around $30,000, for what he estimates to be about 300 hours per year.

Dr Burko offers consulting for physicians or groups of physicians who want to implement their own billing programs, as does the CMA's private arm called Practice Solutions. It's worth getting some outside help if you're at all unsure about how to work out the legalities and the technicalities of your billing program. Last November, Dr Thomas J Barnard of Leamington, ON, had his licence suspended two months and was fined $2,500 by the College of Physicians and Surgeons of Ontario for block fee plan violations (among other things, his office assistant threatened patients they'd be kicked out of the practice if they didn't pay).

OUTSOURCING
Most physicians choose not to try to create their own uninsured services billing programs, opting instead to outsource the task to an established private billing firm.

"If you're a procrastinator or can't manage office projects, don't try doing it on your own," advises Dr Burko. "It's easier to have a meeting or two with the agencies, and then they just need your patient list and the money will start flowing in."

For a run-down of the four largest billing companies in the country, see this pdf "How do the uninsured services billing firms stack up?".

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