Billing for out-of-country patients

Patients from out of country need to be billed directly, and they may be charged 2-5 times the Schedule of Medical Benefits fee. Before services are provided, the patient needs to be aware that there will be a charge for medical services, and that they are expected to pay this rate. The patient’s ability to pay must be taken into account. It is acceptable to collect either a part of the fee or the full fee in advance of the appointment. The following can be billed for out-of-country patients (from the AMA’s Guidelines to Billing Uninsured Services):

  • Non-resident of Canada patient - charge 2- 5 times* or appropriate multiple of Schedule of Medical Benefits fee schedule. *Physician fee only; does not include hospital or facility fee

Patients from out of country on a work visa must apply for healthcare coverage. They would then be billed to Alberta Health as usual. If a patient is in-between visas, they can be charged as an out-of-country patient, and they may be charged 2-5 times the SOMB fee.

Once the patient receives a visa, if they were charged as an out-of-country patient, they are eligible for a refund only if the visa is backdated to the time the service was provided. The physician would then bill Alberta Health as appropriate.

The following is from Alberta Health regarding billing for an out-of-country patient whose health coverage/visa has expired:

The patient is responsible for paying for health services if they do not have the appropriate documentation to confirm their status in Canada and meet Alberta Health’s eligibility requirements.

Eligibility for coverage under the Alberta Health Care Insurance Plan (AHCIP) is based on being legally entitled to be and remain in Canada, making their home and being ordinarily present in Alberta. Individuals who are in Alberta from outside Canada are eligible for coverage under the AHCIP if they have a valid Work, Study or Temporary Resident Permit and or, in some cases, a Visitor Record.

Once the immigration document expires, so does their AHCIP coverage. However, if they have applied for an extension of their Citizenship & Immigration Canada (CIC) document and are waiting for a reply from CIC, we will provide a one-time 90 day extension. If they don’t have their CIC document by the time the 90 days is up, they are responsible for paying for health services received.

If they receive their new immigration document and it is an extension of their old one, they may be eligible for coverage during the lapse and can obtain reimbursement for services paid. This is confirmed by the ‘Remarks’ on the immigration document that states that their temporary resident status was ‘restored, maintained or had no break in continuity’ which implies that their legal status continued. These individuals will have their AHCIP reinstated from the date they were cancelled so coverage is continuous. Then the individual can contact the doctors or facilities they were at to inquire about having the bill reversed or refunded.

It is important to note, individuals who are waiting for their spousal sponsorship or confirmation regarding their application for Permanent Resident Status to arrive, do NOT have legal status to be or remain in Canada unless they have a Work, Study or Temporary Resident Permit or a Visitor Record. Unfortunately, many believe that they do have legal status during this waiting period.

The AMA’s Guidelines to Billing Uninsured Services is available on the AMA’s website to AMA members only, it is not a public document. Physician or clinic manager log in is required for the complete guide.

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