Cannabis clinics may break health-care rules by charging patients to see doctor

Winnipeg cannabis clinics that require patients to pay a fee to see a doctor may be in breach of provincial and federal rules banning extra billing if that same doctor also bills the province for visits.

The Canada Health Act and Manitoba's Health Services Insurance Act ban extra billing — the practice of charging patients for a publicly insured health service.

Delta 9 Lifestyle and CannaConnect, two Winnipeg cannabis clinics, charge patients a fee before they can see a doctor for a cannabis authorization form, which allows them to use cannabis for medical purposes under federal regulations.

"With any new field you will always have some physicians that will try their luck at bending the rules of the system to see what happens," said Damien Contandriopoulos, a University of Victoria professor of nursing and expert on physician billing.

But Contandriopoulos warns the practice may flout Canada's health care regulations and hurt patients.

"People who need to go often to the doctor or people with low income have a significant restriction in their access to the health-care system. Overall this is unfair and it's also counterproductive."

Delta 9 Lifestyle requires patients to pay $75 on top of a $25 annual membership fee before they can meet with doctors. It costs $30 for any additional visits with doctors where they sign new authorization forms.

Natural Health Services and National Access Cannabis in Winnipeg set up visits with doctors at no charge to the patient.

Fees cover overhead costs: Delta 9

Until October, when marijuana use is legalized, Canadians who want pot from a licensed producer need a health practitioner (such as a family doctor) or nurse practitioner to sign Health Canada's medical cannabis authorization form.

Winnipeg's CannaConnect charges $249 annually to patients. The company offers a $100 discount to repeat customers.

CannaConnect's website states the fees pay for an appointment with a "qualified cannabis educated physician," "unlimited telephone and email support" and "personalized renewal tracking" for authorization forms.

The company asks patients to bring a valid provincial health card to their visit.

CannaConnect declined CBC's request for an interview and CEO Lee Grossman declined to tell CBC whether doctors bill the province for visits or whether they have opted out entirely from the public system.

A spokesperson for Manitoba Health requested CBC file a freedom of information request for billing records at the clinic to find out whether physicians there bill the province for their time.

Delta 9's CEO, John Arbuthnot, confirmed doctors at the company's clinic bill Manitoba's health insurance plan while the clinic charges a patient for the same visit.

Arbuthnot said his company has lost hundreds of thousands of dollars since it opened its clinic last fall and uses the fees to cover overhead costs.

However, Contandriopoulos, who recently led a three-year study for the Quebec government on physician billing, dismissed that reasoning.

"Overheads are a non-starter in terms of explaining why patients should pay," said Contandriopoulos.

Roughly 30 per cent of the fee received by the physician from the province for out-of-hospital visits is expected to cover overhead, such as receptionist salaries, computers and building operations, he said.

Feds could hold back transfer money

Health Canada said in a written statement it's aware of varying approaches to medical cannabis and plans to discuss the fees with the "jurisdictions concerned."

The health agency later said all jurisdictions in Canada will be contacted about fees at cannabis clinics.

In general, patients should not have to pay extra when physicians bill the provincial health plan, Maryse Durette, spokesperson for Health Canada, wrote in an email to CBC News.

"If paying for a medical assessment for access to medical cannabis is a barrier, naturally we would be concerned," wrote Durette.

The federal department urges patients who feel inappropriately charged to complain to their provincial college of physicians and surgeons.

"It doesn't comply with the requirements under the Canada Health Act," said Colleen Flood, a law professor and director of the University of Ottawa's Centre for Health Law, Policy and Ethics.

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