Health Care

CEO of Canadian virtual health-care company defends charging for services

As It Happens6:32CEO of Canadian virtual health-care company defends charging for services

As the Liberal government pressures provinces to crack down on doctors charging money for medical services, the CEO of a virtual health-care clinic is defending the practice.

Health Minister Jean-Yves Duclos sent a letter last week to his provincial and territorial counterparts raising the alarm about doctors charging for medically necessary services, and warning that his government would claw back federal health-care payments if this continues.

A senior government official told CBC that companies charging patients for virtual visits with a family physician are the chief targets of the federal move.

Dr. Brett Belchitz is the CEO of Maple, a company that lets Canadians book virtual appointments, usually text based, with general practitioners for $69 a pop, or a $30 monthly subscription. It also offers services paid for by provincial health-care plans, as well as some services billable to private insurers.

Maple has been using that business model for years, much to the chagrin of some public health-care advocates.

But Belchetz says it’s all above board because the company only charges fees for services that aren’t covered by a patient’s provincial insurer. Here is part of his conversation with As It Happens host Nil Köksal.

What did you make of the minister’s announcement?

It’s disappointing that this is … where the minister is putting his efforts and attention, given what’s happening in Canada’s health-care system.

Our system came very close to the point of collapse when we were looking at November, December, January, when respiratory illness was peaking across the country. And it’s very clear that Canadians are fed up with the system in terms of how it’s functioning right now.

Let me just interrupt there, because what I’m asking about is this assertion that there are reports that companies such as Maple, your company, are charging people for medically necessary appointments that are available and should continue to be available to them for free.

What is defined as medically necessary in our health-care system is defined by the provinces. And how they define what is medically necessary are the services that they say that they will pay physicians or health-care providers to provide.

A good example of a service that the provincial government says is not medically necessary and they will not pay for is something like laser eye surgery, which everybody agrees to treat a medically important condition. Not being able to see distance is a big deal. But the government has said: This is not what we consider essential, we are not going to pay for it. And therefore, if you want to have laser eye surgery, Canadians have the right to pay out of pocket.

When we look at what the governments across our country have chosen to fund, they do not pay for nurse practitioners to treat patients. If you see a nurse practitioner, there is no billing code for that nurse practitioner’s bill.

The provincial government does not fund a physician to speak to you by secure messaging. So if you want to have an email conversation or a secure messaging conversation with your physician, that is not something the provinces have decided is medically necessary.

It is exactly the same as the laser eye surgery example, which is if you, as a Canadian, want to have access to these services that the government has said are not medically necessary and they are not going to fund, you, as a Canadian , have the right to pay out of your own pocket.

This screenshot from Maple shows the company’s fees for online consultations. In an email to CBC, the company said that it only charges for services not covered by provincial health care, including ‘virtual consultations conducted via secure text messaging or with a nurse practitioner.’ (getmaple.ca)

I’m able to chat with my family physician. Telehealth Ontario and other provinces have telemedicine as well. So… I just want to drill down to this. There are reports that your company is getting around the rules by redirecting patients to out-of-province doctorswhich would essentially be a loophole, and then you can charge them.

That’s entirely inaccurate. We do not do that.

What we do charge for is services that there’s no billing code for. So if you want to see a nurse practitioner on our platform… that is something that there is no billing code [for] … so yes, you will pay out of pocket for that.

If you want to have a conversation by secure messaging with a physician … there is no billing code for that in most of the country.

Ontario’s Liberal health critic, who is also an ER doctor like himself, Adil Shamji, has said [to iPolitics] Maple’s business model may be legal, [but] “it doesn’t feel good.” How do you respond?

I think we should focus on what really matters, which is that 85 per cent of Canadians say that the system needs drastic change. That was a survey from February done by Ipsos. [Fifty-nine] per cent of Canadians actually said Canadians should be allowed to purchase private health care if it will help their access to care.

So my feeling is that people are really, really focused on attacking some of the few solutions that are making a difference for Canadians rather than actually focusing on the big problem that we have the worst performing health-care system in the developed world.

I have many, many patients who sit waiting eight hours to see me in the emergency room for three minutes who would absolutely happily look for another option that our system doesn’t provide. There’s millions of Canadians without family doctors. These are the real problems that we should be focusing on.

Man wearing suit and tie with serious expression on his face at press conference in front of row of Canadian flags.
Minister of Health Jean-Yves Duclos says he is cracking down on companies that charge for medically necessary health-care services. (Adrian Wyld/Canadian Press)

There are those who feel really strongly about public health care in this country. And they’re worried that they might lose that. So what would you like to say to them?

You’re not going to lose that.

If you look across Western Europe, they all have very strong universal health care systems. It doesn’t matter if we’re talking about Sweden, Switzerland, Germany, France, Italy — they all have fantastic universal health-care systems.

But every single one of those countries also allows private health care. And it has not decreed the universal health-care system in any of those countries. And it is completely unreasonable to believe that it’s going to decimate the universal health-care system in our country.

Minister Duclos did … send a letter to the provinces making sure the rules are very clear. How will that change how Maple is operating?

We are providing services, many of which are fully insured by the government. There are many services on our platform where people can see a doctor and pay with their health card. We work in partnership with a number of provincial governments.

Nothing we do is out of the legal framework. Where we charge, it’s for services that are not publicly insured. And the legal framework is very clear that you are allowed to charge out of pocket for services that are not covered by the government.

Unless there is some legal change that the Canadians no longer have the right to pay for things that the government does not provide, which I could not see being something that would pass muster in any court of law, there really isn’t any reason for us to change the way we operate.