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Patient Guide

Statement of Practitioner Services (Canada)

How to Obtain Your Medicare Billing Statement

Medicare: The Payment Loop

In the United States where health care is steered by insurance plans, a medical billing invoice is sent automatically to patients, usually monthly. This invoice is called an Explanation of Benefits.

Canada differs: Medicare is universal. The cost of health services is spread evenly over the population, paid via taxation. The tax dollars are held in government coffers, and this determines the payment loop: A Canadian doctor submits his bill directly to the government, specifically to the Ministry of Health in the province where he/she works. After minimal processing, the government mails the fee cheque directly to the doctor's office.

Thus in Canada, the payment loop involves two parties, going from doctor to government, then back to the doctor. Patients are excluded from the loop. Few Canadians ever see an invoice for their own doctor visits, or for their diagnostic and treatment procedures. Citizens who want to see their medical billing data must take the initiative and apply for it.

You are entitled to know the amounts that physicians and hospitals bill for your medical care. Long ago, each province enacted Freedom of Information legislation which, among other things, allows you to access the billing records pertaining to your own name and Health Number.

In Canada, the invoice is called a Statement of Practitioner Services. What does it look like? Check the sample below which shows several lines of a typical 2016 Statement.

Statement of Practitioner Services, Sample 2016

How to Apply for you Billing Statement

The Saskatchewan Ministry of Health has a payment arm, the Medical Care Insurance Branch. MCIB maintains a database of all Medicare bills submitted by each physician in the province. The billing procedures are set down in legislation titled the Payment Schedule for Insured Services Provided by a Physician.

The Payment Schedule describes which medical tests and treatments are insured, and for each assigns a dollar amount. The billing codes are finely-tuned: a different fee is assigned to each level of patient visit, procedure, or communiqué. There are many subdivisions that depend on timeframe.

In the MCIB database, then, each small unit of work has a separate entry which lists the specialty, MD name, location, date, type of service, fee, and patient identification. Each patient is entitled to see the subset of the database that is filtered through their own ID (patient name and health-number).

Every province has their own version of this financial record. In Saskatchewan it is called the Medical Services Report – Statement of Practitioner Services. Shorthand names: Billing Statement or Medical Statement.

The Statement is a chronological list of medical services rendered to an individual patient. It also names the doctors who treated you. This makes it always interesting; sometimes crucial. Were you under anesthesia during surgery that went awry? Your Statement will list all MDs present in the Operating Room (provided they billed for their work).

The application process in Saskatchewan is now standardized, patient-friendly, easy. Visit Saskatchewan Ministry of Health Forms and find the link titled Medical Statement Request Application. Click to get a direct download in PDF format. On this Application, fill in all the blanks with your personal data, sign it, and mail it to:

Saskatchewan Ministry of Health
Medical Services Branch
3475 Albert Street - 2nd Floor
Regina, Saskatchewan  S4S 6X6

In 2016 I, the Tuum Est webmaster Georgena Sil, completed the application. Sask Health replied with Billing Statements covering the previous ten years (from 2016 back to 2006). The process was prompt and smooth. Indeed, both FOI and HIPA guarantee your right to access information the government holds on you. You should never be asked to prove, or even state, a reason for requesting the information.

Statement Format

On the Statement, each medical service is summarized on one line. The basic financial data is always present, but other details vary over the years because MCIB periodically redesigns the document. Observations about the 2016 format:

  • For many years, Statements had a Provider Correspondence column which furnished the doctor's full billing address. It is gone. In its place is a column titled Location of Practitioner which gives only the city where the MD practices. If you need the billing address, go to the College website and search for the MD's individual profile.
  • The new column Location of Service provides a keyword such as Office or Home indicating where the doctor met the patient. This information, though not detailed, is still useful. It helps patients identify whether an MD purports he made a House Call, and (indirectly) invites feedback if no such visit took place.

How to Read Your Statement

The Statement is meant to encompass a full spectrum: office visits with a family doctor, consultations with specialists, laboratory work, diagnostic tests, and other clinic services. If it contains an MD name unfamiliar to you, check first to see if the doctor works in the background. Examples are a radiologist who read your X-Ray; the head of the lab where you had blood tests; or an anesthetist present during your surgery.

If such MDs actually took part in your care, then it will be easy to verify – you only need to call the X-Ray center or the laboratory, for example, or obtain the Operative Report from your chart at the hospital where your surgery was performed.

If that doesn’t resolve your concerns – if you detect or suspect Medicare Fraud, or are just puzzled – then contact the Ministry of Health branch which sent you the statement. That branch holds the financial database necessary to conduct an investigation. You should also notify the College of Physicians and Surgeons in your province. For instructions visit:

Report Medicare Fraud (Canada)

Georgena S. Sil
Saskatoon, Canada
Physicist & Technical Writer
Alumnus: University of British Columbia
TuumEstContact@protonmail.com

Copyright © 2008-2018 Georgena Sil. All Rights Reserved.