Uninsured Services & Pricing

Alberta (AHCIP)

For treatment by the doctor on duty you must have vaild healthcare coverage and/or make payment for any non-insured services before you see the physician.

Service Description Payment
Office Visit: Canadian resident without a valid health card $60.00
Above status on a weekend or holiday $80.00
Out of country resident $120.00 & up
Above status on a weekend or holiday $150.00 & up
Notes: Sick note for work or school $35.00
Jury Duty Notes $85.00
Chart Copy: Individual patient cost only =
Health Information Act guidelines basic adm charge
$25.00 & up
Plus per page charge $0.25 per page
Medicals: Drivers Medical: including form $150.00
Insurance medicals (attending physician statement) $250.00 & up
Pre-Employment examination and form $100.00 & up
Prescription refills by phone or fax $25.00
Fitness Medicals: Camp, daycare, air travel, etc.
School form completion only
$30.00
Examination and form completion $90.00
Disability Certificate: Examination and form $80.00 & up
Form only $50.00 & up
Forms: Disability parking form $55.00
Seniors residence form $30.00
Maternity certificate form $30.00
Blue Cross Special Authorization Form $35.00
Injections: Per injection $20.00
Flu vaccine (private seasonal stock) $25.00 & up
Ventolin: Treatment and mask $20.00
Treatment only $15.00
Cosmetic: Removal of lesions $30.00 & up
Missed Appointment: Missed appointment (with no 24h cancellation) $50.00 & up
Missed Physical appointment $90.00
Missed  Counselling appointment $85.00
Circumcision: Consult with Physician $180.00 & up
Vasectomy: Consult with Physician TBD
Supplies: Non-insured medical supplies $10.00 & up

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Ontario (OHIP)

Ontario’s health Insurance Plan (OHIP) pays for most medical services but many administrative services and some medical procedures are deemed by OHIP to be not medically necessary and are therefore uninsured. It is MCI policy that these services are billable directly to the patient and payment is due on receipt of the service.

Service Payment
Missed appointment (24 hours notice required) $60
Missed Physical appointment (24 hours notice required) $120
Missed Counselling appointment $100 & up
Office Visit 1. Canadian resident without a valid health card $75
Office Visit 2. Out of country resident
2a. Above status on a weekend or holiday
$110 & up
Prescription refills by phone or fax
(Emergency short term refills at physicians discretion only) *
$30
Driver Medical Examinations and Form Completion $85
Wart treatment by liquid nitrogen (Up to 3) **
NOTE: If procedure is sole reason for visit (Up to 3) **
Cost per wart, in excess of 3
** OHIP will pay for liquid nitrogen wart treatment on genitals and feet only
$25
$55
$11
Immunization & TB testing Form Simple: $45 & up
Complex: $65 & up
Replacement Medical Notes $20 & up
Physical Examinations required by a third-party $135 & up
Medical Supplies (Splints, dressings, etc.) Individual Pricing
Copies of Medical Records First 20 pages:  $30
Per add’l page: $0.25
Storage Retrieval Fee $25
Urine Pregnancy test in office (at patient’s request) $15
Travel Medical Advice Individual: $55 & up

MEDICAL REPORTS / FORMS

(Excluding Examination unless otherwise noted. Cost of physical examination is $135)

Service Payment
Forms required for volunteers at nursing homes/hospitals $40
Back to work / Sick / Daycare Medical Notes $20
Notes for insurance coverage of physiotherapy, massage therapy, acupuncture, compression stockings & orthotics (at the request of patient) $35
Fitness Club Forms $40
Revenue Canada & Related Federal Tax Credits & Forms $50
Attending Physician’s Statements Including Disability Form (may include examination) $140
Replacement of immunization card $25
Photocopying/ Printing of Lab Results Per Page $1
CAS Children’s Aid Application For Prospective Foster Parent $60
Life Insurance Death Certificate $50
Employment Insurance / Sickness Benefits (For insurance coverage at the request of the patient) $35
Day Care Application Form $30
Maternity Certificate / Form $30
Camp Form $30
CPP Disability Form (Charge in excess of Gov’t paid fee) $60
CPP Narrative Medical Form $75
Travel Cancellation Insurance Form (with examination) $115
School / College / University Medical Certificate $30
All other uninsured services not listed Individual Pricing

* Prescription renewals ordinarily require an office visit to re-assess the condition requiring the prescription. If you are unable to schedule an appointment to review your medication, we will charge for this service. Please anticipate your renewals, ask for renewals at each visit and bring your medications for your appointments.

Uninsured Fees follow the recommendations of the College of Physicians and Surgeons of Ontario and the Ontario Medical Association. MCI uninsured services policy rigorously adheres to these guidelines. Above fees are for services of average complexity. Actual fee charged may be increased based on complexity of service provided.

NOTE: For any uninsured services or forms not listed, the doctor’s hourly rate will be applied. All services not necessarily offered at all MCI clinics. ALL PRICES INCLUDE HST, WHERE APPLICABLE. Last updated June 2018

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Block Billing Fee

MCI Medical Clinic Inc. and your Family Doctors are committed to providing you with the best medical care, promptly in a friendly and professional environment. However, there are services that you may request from your Family Doctor that are not considered medically necessary by Ontario Health Insurance Plan (OHIP) and are therefore not paid by OHIP.

These services, such as: insurance forms, legal letters, sick notes, etc., are called “non-insured or uninsured services”. Your Family Doctor at MCI Medical Clinic Inc. will charge for uninsured services in accordance with the fees guidelines set by the Ontario Medical Association (OMA) and the College of Physicians and Surgeons of Ontario (CPSO).

To reduce administrative time and provide a cost saving advantage to patients, block billing fees have been introduced. Patients and families will be able to pay a one-time yearly fee to cover uninsured services. Some of these services include absentee notes and insurance forms. For the majority of patients this will provide a significant financial saving.

It is our office policy to charge for services not covered by OHIP, in accordance with recommended guidelines. While you may choose to pay for individual services not covered by OHIP on a “Pay-Per-Service” basis, we recommend that you consider the Uninsured Services Annual Fee Plan, often referred to as a “Block Billing Fee”. If you sign up, you will be covered for an entire year of use of the most common services not covered by OHIP.

Uninsured Service Fee Guide

The following Uninsured Services ARE covered by the Annual Fee. Prices include HST.

Lost notes/ Prescriptions/ Requisitions $15 & Up Fitness club forms $40
Forms required for commercial weight loss programs $30 Camp Form $30
Forms required for volunteers at nursing homes/hospitals $40 Employment Insurance/ Maternity Certificate $30
Illness/return to work notes (simple) $20 CPP Disability Form ( Charge in excess of Gov’t paid fee) $30
Notes for insurance coverage of physiotherapy, massage therapy, acupuncture, compression stockings & orthotics (at request of patient) $35 Replacement of immunization card $25
Private respite care form (with examination) $85 TB testing form – School/Daycare Simple

Complex

$45 & UP

$65 & Up

Federal Tax Credit and Related Forms $50 School/College/University Medical Certificate $30
Day Care Application Form $30 Private Insurance sickness $40 & Up
Life Insurance Death Certificate $50 & Up

Uninsured Services NOT Covered by the Annual Fee. Prices include HST.

Missed Appointment (24 hour notice required) $60 Transfer of Individual Records First 20 pages

(Other fees my apply) Per add’l page

$30
$0.03
Missed Physical appointment

(24 hour notice required)

$120 Travel Medical Advice $55 & Up
Missed Counselling appointment $85 & Up Legal Reports/ Letters for Third Party $300/hr
Drivers Medical Examination

Driver Medical Form Completion

$85

$50

Physical Examinations required by a third-party

(Will be reduced if $75 if annual fee paid)

$135 & Up
Medical Supplies (splints, dressing, etc.) Individual

Pricing

Life Insurance Death Certificate $50 & Up
Wart treatment by liquid nitrogen (Up to 3)

NOTE: if procedure is sole reason for visit (Up to 3)

Cost per wart, in excess of 3

(Ohip will pay for liquid nitrogen wart treatment on genital and feet only).

$25

$55

$10

Office Visit

1. Canadian resident without a valid health card

2. 1a. Above status on a weekend or holiday

$75

$90

Photocopying of Lab Results Per page: $1 Office Visit

2.Out of Country resident

2a. Above status on a weekend or holiday

$130 & Up

$160 & Up

All other uninsured services not listed Ind. Pricing Travel Cancellation Insurance Form (with examination) $100 & Up

Uninsured Fees follow most of the recommendations of the College of Physicians and Surgeons of Ontario and the Ontario Medical Association. MCI uninsured services policy rigorously adheres to these guidelines.

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