Physician Enrollment Status

Physicians (and their patients) should be aware of the implications of not enrolling with, or de-enrolling from the Medical Services Plan (MSP).

1. Patient Visits With a Not Enrolled/De-enrolled Physician

Services provided by not enrolled/de-enrolled physicians are not benefits under MSP. If a patient visits a not enrolled/de-enrolled physician in a private or community setting, they will be required to pay out of pocket for those services and will not be reimbursed by MSP.

2. Notice Requirement

Under the Medicare Protection Act (MPA), if a not enrolled/de-enrolled physician intends to require their patients to pay all or a portion of the costs of a service, they must inform the patient, prior to providing the service:

• that the patient will be required to pay part or all of the cost directly;
• the amount the patient will be required to pay; and
• the amount the patient can expect to be reimbursed by MSP (if any).

If a physician does not meet the notice requirement, the patient is not liable for payment to the physician and the patient may be entitled to a refund.

3. Limits on Charges and Reimbursement

Not enrolled or de-enrolled physicians in B.C. may not charge beneficiaries more than the MSP amount for an insured benefit if the service is provided at a facility defined in the MPA (e.g., hospital or community care facility). When a service is provided outside of these facilities, the amount that may be charged to a beneficiary is not limited by the MPA.

Services provided by a not enrolled/de-enrolled physician are not reimbursable by MSP since the services of these physicians are not benefits.

Services provided by opted-out physicians are eligible for reimbursement by MSP. By law, an opted-out physician may not charge a patient more for an insured benefit than the prescribed MSP amount.

4. Laboratory Services

In accordance with the MPA and the Laboratory Services Act, not enrolled/de-enrolled physicians can order laboratory tests. However, laboratory tests ordered by a not enrolled/de-enrolled physician are not payable by MSP.

Patients are responsible for those costs and are not eligible for reimbursement.

5. Diagnostic Imaging

Not enrolled/de-enrolled physicians can order diagnostic imaging. However, diagnostic imaging ordered by a not enrolled/de-enrolled physician is not payable by MSP.

Patients are responsible for those costs and are not eligible for reimbursement.

6. Referrals by Not Enrolled/De-enrolled Physicians

Not enrolled/de-enrolled physicians can refer patients to enrolled physicians (specialists).

Based on the Preamble to the Medical Services Commission (MSC) Payment Schedule, if a specialist provides services to a patient without referral from another practitioner authorized by the MSC to make such referral, the specialist may submit a claim to MSP for the appropriate family physician visit fee and may also charge the patient a differential fee. This is not considered “extra billing”. The maximum amount the patient may be charged is the difference between the amount payable under the Family Medicine Payment Schedule for the service rendered, and the amount payable under the Payment Schedule to the specialist had the patient been referred.

Any subsequent services received by a patient from the enrolled specialist are benefits under MSP.

7. Prescriptions

A not enrolled/de-enrolled physician can prescribe medications/devices in the same way as an enrolled physician. The requirements for prescribing are set by the College of Physicians and Surgeons of BC (CPSBC). In order to write prescriptions a physician requires a valid CPSBC registration ID.

The enrollment status of the physician does not affect the patient’s ability to receive coverage under PharmaCare plans.

8. Hospital Privileges

There is no prohibition against a not enrolled/de-enrolled physician applying for “permits to practice in a hospital” (i.e. hospital privileges).

Hospital services under the Hospital Insurance Act include everything a patient receives while in a hospital, except the physician’s services – which are governed by the Act.

The MPA provides that services rendered by a de-enrolled physician in a hospital are subject to billing limits; see “Limits on Charges and Reimbursement” above. 

9. Negotiated Physician Benefits

A not enrolled/de-enrolled physician is not eligible for benefits negotiated in the Physician Master Agreement, including but not limited to:

• Continuing Medical Education Fund
• Physician Disability Insurance Program
• Canadian Medical Protective Association Rebate
• Contributory Professional Retirement Saving Plan
• Physician Health Program
• Parental Leave Program

If you require additional clarification, please contact MSC@gov.bc.ca.