Uninsured Services
Medical Clinic Policy
Uninsured Services
The Alberta Health Care Insurance Plan does not cover certain uninsured services. Some are billed to lawyers, government agencies or you directly.
Your doctor and our support staff can discuss any fee with you before providing an uninsured service. Payment will be expected when you receive the service. We accept cash, debit or credit cards.
The following is a list of uninsured services for which Pinnacle Medical Centres may bill:
SERVICES NOT COVERED BY ALBERTA HEALTH CARE
| Note of Illness | $55.00 |
| Massage Note | $30.00 |
| Seniors Residence Medical Report | $55.00 – $105.00 |
| Disabled parking Form | $60.00 – $105.00 |
| Blue Cross Special Authorization Forms | $55.00 |
| Long/Short Term Disability Form | |
| • Form completion only | $65.00 – $135.00 |
| • Examination and form completion | $155.00 – $245.00 |
| Insurance Attending physician Statement | $185.00 – $375.00 |
| General insurance Eligibility | |
| • Examination and form completion | $275.00 – $480.00 |
| Driver’s Medical Exam under 74.5 | $160.00 – $295.00 |
| Driver’s Medical Form Completion Only | $80.00 – $160.00 |
| Veteran’s Affairs Examination and/or Form Completion | $65.00 – $135.00 |
| Independent Medical Examinations (IME) and Report | $960.00 – $2,340.00 |
| Third Party Requested Letters on Patient Attended | $240.00 – $480.00 |
| Proof Of Death Physician’s Statement other than Vital Statistics | $85.00 – $150.00 |
| Other Simple Forms (El, Pregnancy, tax credit) | $60.00 – $100.00 |
| Certification of fitness for school | |
| • Form completion only | $55.00 |
| • Examination and form completion | $95.00 – $145.00 |
| Certification of fitness for summer camp, daycare air travel etc. | |
| • Form Completion only | $55.00 |
| • Examination and form completion | $95.00 – $145.00 |
| Pre-Employment Medical Examination and Report | $160.00 – $350.00 |
| Injection (per) | $20.00 |
| Travel Medical Consult | $60.00+ |
| Other | |
| No Show Appointment – General | $60.00 |
| No Show Appointment – Physical | $150.00 – $180.00 |
| No Alberta Health Care Office Visit | $60.00 |
| No Alberta Health Care Physical Female | $150.00 – $180.00 |
| No Alberta Health Care Physical Male | $150.00 |
| Out of Country | $100.00+ |
| Uninsured Wart/Mole Treatment – Non Surgical | $55.00 – $100.00 |
| Uninsured Wart/Mole Treatment – Surgical | $95.00 – $210.00 |
| Photocopying or printing | $0.50/pg. |
| Faxing Charges | $1.00/pg. |
| Transfer of records to Physician | $25.00 |
| First 20 pages plus 0.25 per page thereafter + Postage | |
| Third Party Transfer of records | $80.00 +$0.50/pg. + Postage. |
| Lawyer Request for Chart Copies – Chart Review by Physician | $50.00-$75.00 |