The Canadian Medicare system, whatever its flaws, does cover all medically-necessary acts & visits. There is no copay. No one has to
take part, but for providers, you're either in-or-out: I can't say I'll take it for you, but not you
, and I can't take it for you, but charge a little extra also.
There are exceptions. Cosmetic procedures aren't covered (well, d'uh), although some things are a gray area. Anesthesia and medications aren't covered in office visits, so the patient has to pay as "accessory charges." Generally, these are no big sums of money, and if someone truly needs (as opposed to wants) something, and doesn't have the money, then I don't charge them. Initially, I took checks or cash. After awhile, I realized that many people don't carry any cash, even 5$ or 10$ or 20$. Maybe I'm showing my age, but I find that bizarre for a grown adult, but so be it, I started to take charge and debit cards. I had to raise my prices slightly; whether you know it or not, the merchant (me in this case) gets charged every time you use your credit/debit card. A while after that, after a few bounced checks, I stopped taking checks. Didn't happen much, but extremely annoying when it did. For some older patients, whom I've known a long time, and also who are old enough they just don't do 'plastic,' I still take checks, otherwise it's cash, charge, or debit.
Recently the Quebec government (Medicare is organized and run by the provinces, not the feds) and the medical board have been cracking down on these accessory charges if they are "excessive." Part of that is based on complaints; in some cases patients don't understand why they have to pay, and in some cases the fees are indeed excessive. Part is also based on the government wanting to change the Act governing physicians and access to same. Seems that people are having trouble getting to doctors in a timely fashion. Some of that is that when a service is free, it tends to be overused; some is that there aren't enough doctors for the population size. The government feels that the way to improve access, despite not having enough doctors, is to
rearrange the deck chairs on the Titanic
reorganize how that access happens. They have proposed a Bill about that, which died when the provincial parliament recessed for the summer. I think some of this sudden concern about "accessory fees" is a pressure tactic on the part of the government going into negotiations about that Bill. I've already been inspected by the government to make sure I was charging these fees in a legal fashion. It was actually a rather benign exercise, and surprise! I was doing everything correctly.
I admit some of the problem is that a small number of doctors have been demanding excessive amounts, and as in many things, that small number might ruin it for the rest of us. As my accountant likes to say, "You can be a pig, not a hog; pigs get fat, hogs get slaughtered." For now, will keep on doing what I'm doing, getting most of my money from the public system, and a small percentage from private sources generally paid by credit cards. Or debit cards. Or cash. Except of course, time travelers, who are strictly cash.**Points to anyone except ravensron who gets the reference.