Fee Navigator®

    Governing Rule: 3

    EXCLUSIONS

    • 3.1

      The following includes examples of, but is not limited to, services which are not a benefit under the Schedule and may not be claimed:

      1. Advice by telephone or other telecommunication methods except as specified under specific HSCs or for telehealth services;
      2. Ambulance services, except ambulance detention time HSCs 13.99K, 13.99KA, 13.99KB;
      3. Anesthetic materials;
      4. Any service a physician provides to his/her children, grandchildren, siblings, parents, grandparents, spouse or adult interdependent partner or any person who is dependent on the practitioner for support in accordance with the Alberta Health Care Insurance Regulation;
      5. Drugs/agents;
      6. Intravenous sedation for dental procedures administered to a patient who is not an inpatient or registered outpatient of a hospital;
      7. Medical appliances;
      8. Medical testimony in court, except psychiatric opinion at psychiatric review panel under the Mental Health Act;
      9. Secretarial or reporting fees;
      10. Stand-by time;
      11. Travel time of a practitioner to see a patient;
      12. Services requested or required by a third party. Examples include but are not limited to:
        • Examinations or certification related to adoption;
        • Medical examinations to indicate fitness to attend camp;
        • Autopsies;
        • Employment examinations and reports;
        • Examinations and reports requested under the auspices of the Child Welfare Act;
        • Immigration requirements;
        • Insurance/disability reports and forms;
        • Examinations and reports for judicial purposes (e.g., requested by police);
        • Medical-legal reports requested by patients or by lawyers on behalf of patients with the exception of HSC 03.01MT;
        • Motor vehicle license (except after age 74.5 years);
        • Examinations and forms relating to participation in sports;
        • Examinations and forms relating to university or other school requirements;
        • Passport and visa applications;
      13. Pre-travel assessments, counseling or administration of vaccines or drugs for travel purposes to reduce the patient's risk of acquiring an illness, or for prevention of communicable diseases not endemic to Canada;
      14. Administration of vaccines such as Hepatitis A and B is not covered unless specifically otherwise communicated by Alberta Health.
    • 3.2

      Benefits may not be claimed by a surgeon, surgical assistant or anesthetist with respect to:

      1. a procedure performed for cosmetic reasons;
      2. a surgical procedure for the alteration of appearance performed for emotional, psychological or psychiatric reasons unless the Minister gives approval prior to the surgery being performed. Supporting documentation reflecting the need for the change must be retained by the physician.
    • 3.3

      Except for services known to be uninsured, the initial visit(s) to establish a diagnosis of the patient's condition is an insured service, including situations where the patient has been referred to another physician. After establishing a diagnosis during the initial visit(s), if the physician determines the service is not medically required, or is an uninsured service, all subsequent services related to the uninsured service such as preoperative tests, assessments, consultations, surgical procedures, anesthetic or surgical assists may not be claimed.

    • 3.4

      Uninsured services may not be claimed. Examples of uninsured services include but are not limited to:

      • Services, including procedures, which are not medically required;
      • Acupuncture;
      • Artificial insemination;
      • Chelation therapy which is not provided to a hospital inpatient for the purpose of treating lead poisoning;
      • Eye surgery intended for the sole purpose of eliminating the need for eyeglasses or contact lenses;
      • Gamete intrafallopian transfer;
      • In vitro fertilization;
      • Ovarian stimulation and monitoring in association with assisted reproductive technologies;
      • Sperm transfer;
      • Cosmetic liposuction;
      • Breast enlargement for purposes other than specifically listed in the schedule;
      • Oculo-visual examinations for residents aged 19 through 64 years.
    • 3.5

      Deleted

    • 3.6

      Deleted

    • 3.7

      Deleted