Quebecers are paying millions of dollars each year out of pocket for medical treatment received in other provinces because their government continues to refuse to join the national system of reciprocal billing agreements.
According to data obtained by The Canadian Press through an access-to-information request, Quebec residents submitted $12.6 million in claims last year to the province’s public health insurance board for medical services received elsewhere in Canada. Only $2.3 million of those expenses were reimbursed, leaving patients to personally cover more than $10 million in costs.
Unlike other provinces, Quebec does not have reciprocal billing agreements for most physician services, meaning Quebecers travelling or temporarily living outside the province must pay upfront for doctor visits, diagnostic tests, or other non-hospital treatments. They can later apply for partial reimbursement at Quebec’s own lower rates, which are often well below those charged in the province where the care was provided.
Health Canada confirmed that the discrepancy stems from the absence of interprovincial agreements covering medical services. “Since Quebec does not have reciprocal billing agreements for medical services with other provinces, Quebec residents generally pay for these services out of pocket and are then reimbursed according to Quebec’s own rates, rather than the host province’s rates,” the department said in an email.
The difference in rates can be substantial. Quebec’s Health Department has advised residents to purchase private medical insurance before travelling outside the province to avoid unexpected expenses.
Doctors say the issue creates headaches for both patients and clinics. Dr. Charles Shaver, a retired internal medicine physician in Ottawa, said his former clinic required out-of-province patients to pay upfront. “It’s not a good situation,” he said, noting that many physicians in eastern Ontario charge Quebec patients rates based on the Ontario Medical Association’s fee schedule, which is higher than Ontario’s government rates.
In 2024, professionals outside Quebec billed the province’s health insurance board $8.9 million for services provided to Quebecers. Only $7 million of those claims were reimbursed.
Under the Canada Health Act, provinces and territories are required to cover emergency hospital care for their residents when they are temporarily outside their home province. Quebec does participate in reciprocal hospital agreements, which allow its residents to receive emergency or inpatient care anywhere in Canada without paying upfront. However, there are no such protections for physician or clinic-based services, and the Health Department says it has no plans to sign reciprocal billing agreements for them.
As a result, Quebec remains the only province in Canada where residents regularly face steep medical bills for basic care while travelling domestically — a costly exception to the country’s universal health-care model.