Uninsured Services in Alberta
— What You Can (and Can't) Charge Patients (2026)
Many Alberta family physicians leave thousands of dollars on the table each year by not properly billing for uninsured services. While a busy GP can generate approximately $8,000 annually from these services, confusion about what can be charged, how much to charge, and how to collect payment means most physicians significantly underutilize this revenue stream. From $30–$150 sick notes to $300–$600 driver's medical examinations, understanding uninsured services billing is essential for practice sustainability.
Understanding Uninsured Services in Alberta Primary Care
Uninsured services are medical services that fall outside the scope of insured physician services covered by the Alberta Health Care Insurance Plan (AHCIP). These services are not medically necessary for diagnosis or treatment but are often requested by patients for employment, legal, insurance, or personal reasons. The Alberta Medical Association and College of Physicians & Surgeons of Alberta recognize that physicians may charge patients directly for these services, provided patients are informed of fees in advance and the service is truly uninsured.
Common uninsured services in family practice include completion of employment medical forms, disability insurance questionnaires, workers' compensation progress reports beyond the initial claim, sick notes for non-medical absences (such as work or school absency notes when no medical assessment occurred), driver's medical examinations, travel letters, prescription renewals without a visit, transfer of medical records beyond what's legally required, and completion of cremation certificates. The key principle is that if the service is requested for the patient's convenience or a third party's requirements rather than for direct medical care, it typically qualifies as uninsured.
Establishing a clear uninsured services fee schedule and communicating it to patients before providing the service is essential. Most successful practices post their fee schedule at reception, include it on their website, and have administrative staff confirm fees when patients book these appointments. This transparency prevents billing disputes and ensures patients can make informed decisions. For a typical family practice seeing 25-30 patients daily, uninsured services can represent 5-8% of total practice revenue when properly identified and billed.
Common Uninsured Services and Recommended Fee Ranges
Applies when a patient requests written documentation of illness for employer or educational institution without requiring a full medical assessment or when the note is requested retrospectively after the illness has resolved.
No specific regulatory limits, but the service must be clearly uninsured and not part of an insured visit for medical care.
Record the date of service, that the patient requested the documentation, that the fee was disclosed and agreed upon, and note whether a medical assessment was performed or if this was solely administrative.
Applies when patient requests physician completion of detailed medical questionnaires for insurance applications, disability claims after the initial assessment, or employment-related medical assessments that are not for immediate medical care.
Time spent should be documented as complex forms requiring chart review and detailed responses justify higher fees within the range.
Chart must include the type of form completed, time spent on completion, chart review performed, and confirmation that patient consented to the fee prior to service.
Required for commercial drivers (Class 1, 2, or 4 licenses) or standard drivers when requested by licensing authorities, employers, or for drivers over certain ages requiring periodic assessment per provincial or federal transportation regulations.
The examination must follow the specific requirements outlined by transportation authorities; incomplete examinations may result in forms being rejected by licensing bodies.
Complete the standardized driver's medical examination form fully, document all required elements including vision testing, cardiovascular assessment, neurological screening, and any conditions that may affect safe driving.
Applies when patients request copies of their medical records beyond what is required by law for continuity of care, such as personal copies, records for legal purposes, or duplicate copies for multiple recipients.
Alberta privacy legislation requires provision of records for continuity of care to the new physician at no charge or minimal copying costs; fees apply only to additional copies or non-continuity purposes.
Document the patient's request for records, the purpose of the request, the date records were provided, and number of pages if charging per-page fees.
Applies when patients request prescription renewals for stable chronic conditions without a medical visit, when the physician determines no assessment is currently required but pharmacy requires a new prescription, and when the renewal is for patient convenience rather than medical necessity.
Physicians must ensure patient safety and that renewing without assessment meets the standard of care; this cannot be used to avoid providing necessary medical care.
Chart the medication renewed, dosage, quantity, date of last assessment, rationale that renewal without visit is medically appropriate, and that patient was informed of and consented to the fee.
Common Documentation Mistakes That Trigger Payment Disputes
Many physicians complete a sick note or simple form during a regular insured visit and then charge separately without clearly documenting that this was an additional uninsured service. To bill correctly, your chart must clearly indicate what portion of the visit addressed the insured medical concern and what was the separate uninsured administrative request. Best practice is to schedule uninsured services separately or clearly document patient consent to the additional charge during the visit.
The most common cause of payment disputes is patients being surprised by charges they didn't expect. The College of Physicians & Surgeons of Alberta requires that patients be informed of uninsured service fees before the service is provided. Document in your chart that you or your staff informed the patient of the specific fee and that the patient consented. Consider using a standard form that patients sign acknowledging the fee.
Some physicians incorrectly charge for services that are actually insured, such as initial Workers' Compensation Board reports, medical certificates required for patients receiving insured medical care, or prescription renewals that occur as part of a medically necessary assessment. Review the AHCIP Schedule of Medical Benefits regularly and consult AMA resources to ensure you're not charging for insured services, which could result in College complaints.
Uninsured service revenue must be tracked separately from AHCIP billings for accounting, tax, and audit purposes. Implement a system where uninsured charges are recorded with the patient name, date, service provided, fee charged, and payment received. This documentation is essential if payment disputes arise or if you need to demonstrate compliance with College standards.
Real Example: Commercial Driver's Medical Examination
A 52-year-old patient working as a commercial truck driver requires a Class 1 driver's medical examination for license renewal, including completion of the federal commercial driver's medical examination form
Frequently Asked Questions
Can I charge for a sick note if I also billed an insured visit code for assessing the patient's illness?
This depends on whether the sick note was an integral part of the insured medical service or a separate administrative request. If you assessed the patient for a medical condition and the sick note simply documented your medical findings as part of that insured care, you cannot charge separately. However, if the patient requests a detailed employment letter, multiple copies, or specific formatting required by their employer beyond a simple medical note, that additional administrative work can be billed as uninsured. Document clearly what was insured medical care versus uninsured administrative service.
What should I charge for completing complex disability insurance forms that take 30-45 minutes?
For complex insurance forms requiring extensive chart review and detailed responses, fees in the $100–$150 range are appropriate and commonly charged by Alberta physicians. Consider implementing a time-based fee structure: $75 for forms taking under 15 minutes, $100 for 15-30 minutes, and $125–$150 for forms requiring 30+ minutes. Always inform patients of your fee structure in advance and document the time spent to justify your charge if questioned.
Are there any uninsured services I'm legally required to provide for free?
Yes. You cannot charge for: initial WCB reports (Form 8813) as these are insured services billable to WCB; medical information required for a patient's own continuing medical care; completion of Assured Income for the Severely Handicapped (AISH) initial applications; or public health reporting. Additionally, while you can charge for medical record transfers for non-continuity purposes, transfers to a new physician for ongoing care must be provided at no charge or minimal copying costs per Alberta privacy legislation.
How do I handle patients who refuse to pay for uninsured services after I've provided them?
Prevention is key: always inform patients of fees before providing the service and consider collecting payment at the time of service for uninsured work. If a patient refuses to pay after service, document all communications regarding the fee dispute. You can send a payment reminder letter, but aggressive collection tactics for medical services can lead to College complaints. Many practices require pre-payment for uninsured services or have patients sign a fee acknowledgment form before completing the work. Consider writing off small disputed amounts rather than damaging the physician-patient relationship over $30–$50.
Can I charge my own fee schedule or do I have to follow AMA recommended rates?
You can set your own fees for uninsured services as there is no regulatory requirement to follow AMA suggested rates, but your fees should be reasonable and consistent with what other physicians in your community charge for similar services. The College of Physicians & Surgeons of Alberta expects fees to be fair and not exploitative. Survey what other local practices charge and stay within market norms. Posting your fee schedule publicly demonstrates transparency and helps avoid disputes. Typical Alberta ranges are $30–$50 for sick notes, $75–$150 for insurance forms, and $300–$600 for driver's medicals depending on complexity.
Related Billing Guides
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