Last weekend I had the opportunity to attend the BC Doctors of Optometry annual conference hosted at the Hyatt Regency hotel in downtown Vancouver. Each year, optometrists in British Columbia are required to acquire 20 hours of continuing education. I didn’t get all 20 hours but I was able to attain 18 hours at this meeting. One thing I learned, and I’m about to share with readers, is the changes coming to MSP billing for optometrists. Although this topic might sound dull to some readers, I would like to highlight the benefits of MSP to residents of BC and how the agreement between MSP and optometrists in BC is different than all other provinces and territories in Canada.
Medical Services Plan (from now on referred to as MSP) is public health insurance for Canadian citizens and permanent residents that live in BC. It covers the cost of medically-necessary insured doctor services (www2.gov.bc.ca). The BC government has negotiated a fee schedule for insured services provided by optometrists; this includes eye exams for children, seniors, or individuals with a sight threatening eye condition. Anyone in the age group 19-64 with healthy eyes might feel left out, because in 2001 the BC government de-insured coverage for those individuals.
Understanding Balance Billing.
In British Columbia, optometrists’ reimbursement for government insured services is less than most other provinces in Canada. As part of negotiations many years ago, the BC government granted the ability for optometrists in BC to perform balance billing. Balance billing is the ability of the optometrist to charge the balance owing when a service is under-insured. This is the reason why in British Columbia, a child’s eye exam may include a fee. This might come as a surprise to some parents that were expecting a “free” eye exam. Hopefully I can clarify some assumptions about optometry fees, including and not limited to children’s eye exams. First, nothing is “free” – the government pays the optometrist according to the MSP fee schedule for the service provided, and new to BC as of January 1, 2020 businesses pay a tax to cover health benefits for all British Columbians. Secondly, the purpose of the exam fee is to collect on the remaining balance owed for the exam – the existing insurance coverage provided by MSP is not sufficient to provide the services that we do. Our clinic specifically is proud to offer the highest level of care that goes beyond the minimum standard. Each year we re-invest in new equipment, computer hardware and security, and training for our doctors and staff.
Does balance billing create barriers to access?
While we hope that every individual has access to affordable eye care, perhaps not everyone does. Fortunately our clinic offers free eye exams and eyewear to individuals in need. On May 9, 2020 we have offered to perform eye exams for children of single parents at an event held at the Fort St. John Alliance church. Last December we approached School District 60 to nominate children and families that were in need of help, and with parental consent we helped 9 children. The year before, we helped 10 people nominated by their friends or family on social media.
What changes have the BC government approved for 2020?
Beginning April 1, 2020 the BC ministry of Health has approved coverage for extended diagnostic testing for individuals with a disease of their retina. This will allow our doctors to perform additional testing, that isn’t included in a routine eye exam, to diagnose and manage a patients eye disease. Previously, many patients had to pay the full cost of this testing out of pocket. Also, new coverage is provided for patients with diabetes and bleeding in the eye, that allows us to photograph, analyze, and review the information with the patient. These are two services that patients previously had to completely pay for out of pocket or that the optometrist gave the extra time without billing the patient. Overall I am very pleased with these new fee items as they will advance our level of care, where it is much needed in our rural setting.
Amidst the conference and travel I recognize it is important to make time for myself. I took the opportunity to go fishing for Steelhead in the Cheekamus River, close to Squamish. It was a nice break from the 18 hours of sitting that I did in seminars. While I didn’t catch any fish, it was good to be reminded of our great country’s beauty and natural resources. I enjoyed being challenged and improving my craft, similar to how I feel about practicing optometry and being a business owner. I hope that you’ve enjoyed this post and please feel free to leave your comments.