Other Reports & Forms
Physicians will encounter requests for services and completion of forms for a variety of patients with different insurers. In some situations, patients have health benefits through federal programming, and in others third party insurers are responsible. In these situations, physicians may be told in advance of the service that the insurer intends to pay the physician a prescribed amount for the service, and in others, physicians can set their own fee. When the fee is not prescribed, physicians should use the Setting Your Fee article [linked] to assist in determining a reasonable fee.
Where the completion of a report/form requires a medical assessment of the patient, the physician is entitled to bill the appropriate visit fee in addition to the report/form fee. In situations where the insurer prescribed a fee for the completion of a form but a visit is required, the physician should communicate this to the insurer and seek prior approval for the service.
Canada Pension Plan (CPP) Disability Medical Reports
Physicians should be aware that the test for CPP disability benefits is rigorous. Claimants must:
- Have a mental or physical disability that regularly stops them from doing any type of substantially gainful work; and
- Prove the disability is long-term and of indefinite duration or is likely to result in death.
There are two distinctly different types of CPP Disability Medical Reports that the federal government pays for:
|The Disability Medical Form||$85|
|Narrative Medical Reports||up to $150|
Narrative medical reports are not the same as the Disability Medical Report Forms, and are usually initiated by correspondence from staff of the Income Security Programs Branch of Human Resources Development Canada
Narrative reports generally require a medical history, the date of onset of each medical condition, an examination of findings, various excerpts of consultation reports, diagnosis, copies of tests, a prognosis and course of future action.
To expedite payment, physicians should the time required to provide the service requested note on the invoice.
Physicians may charge a fee higher than the amounts set out above for the CPP Disability Medical Report Form and CPP narrative medical reports and may bill patients for the difference between their fee and the above fees. The physician should inform the patient of this fee before completing the service.
|Occupational Fitness Assessment Form||$150|
|Veterans’ Affairs Canada Prescription Drug Program|
|Telephone conversation with physician||$46.70|
|$10.00 per call|
|Original report by general practitioner (one page); completion of a form, subsequent report by sepcialist||$25.00|
|Original report by specialist (one page)||$50|
|Copies of physician’s notes or reports||$15 per page|
|Previously prepared for a third party||$2.00 each additional page|
|Renewal of prescription by telephone||$5.00|
|Physician call to request authorization for special authorization benefits||$5.00|
|Non Insured health Benefits (NIHB) Forms|
|(e.g) Limited Use/Drug Exception Request Form)||$31.83|
|Human Resource Development Canada (HRDC)|
|Compassionate Care Benefits Medical Certificate||$20 — $25|
|Medical Services to RCMP/Canadian Forces personnel|
|Services provided to members of the RCMP and Canadian Forces are uninsured services. Physicians may bill for these services at Manitoba Health rates through Blue Cross. Physicians who elect to charge for these services at rates in excess of Manitoba Health rates may do so by direct billing their patients, who will in turn seek reimbursement through Blue Cross.|
|Manitoba Employment and Income Assistance Report||$45|
|If a physician conducts an examination in conjunction with the completion of this form, Employment and Income Assistance will pay an examination fee at the same rate paid by Manitoba Health.|
|Manitoba Department of Justice Medical Report||$50|
|Manitoba Criminal Injuries Compensation Medical Reports||$34.77|
|Certificate of fitness form for school, daycare, summer camp, travel, etc.||$25 — $30|
|Pregnancy leave and Employment Insurance forms||$30 — $50|
|Disabled Parking Authorization||$30 — $50|