Medical billing
Canada — the Canada Health Act prohibition on extra-billing and user charges
NationalCADerived or secondary source
Canada
- Rule id
- medical.ca
- Version
- 1.0.0
- In force from
- April 17, 1984
- Last read against its sources
- August 5, 2026
- Countries bound
- Canada
In plain language
What this regime says.
The Canada Health Act makes federal funding conditional on provinces not permitting extra-billing or user charges for insured health services. The enforceable prohibition lives in provincial legislation, and the effective complaint route is the provincial ministry or plan.
Who is covered
Insured persons in a province receiving insured health services.
What you get
Cancellation or refund of a charge for an insured service, through the provincial plan.
Where claims go wrong
- Paying at the desk for something that is an insured service, because the clinic said the plan would not cover it.
- Assuming coverage transfers immediately on moving province. Waiting periods apply and are a common source of bills.
Authority
Every citation,
with its pinpoint.
A claim that cites “EU law” gets filed. A claim that cites Article 7(1)(c) gets answered. These are the exact coordinates this entry rests on.
- Canada Health Act, R.S.C. 1985, c. C-6, ss. 18-19Canada Health Act (Canada)URL verified 2026-08-05s. 18 — extra-billing condition; s. 19 — user charges condition; s. 2 — definitions of "extra-billing", "user charge" and "insured health services"; ss. 20-21 — deductions from the federal cash contribution where a province permits either
Sources
Where a figure is indexed, converted or published by a regulator rather than fixed in the instrument, the provenance is recorded separately. Anything marked as a modelled estimate is exactly that — a model, not a statutory number.
- Canada Health Act annual report and the provincial ministries responsible for administering insured servicesHealth Canadaretrieved 2026-08-05
What it imposes
Clocks, defences and the ladder.
A rule module builds these while it evaluates, because a limitation period depends on which forum is open to you. What follows is the structure this regime produces — deliberately with no dates and no figures, because those belong to your facts rather than to the law.
What it entitles you to, beyond money
- No charge to an insured person for an insured health serviceWhere the province prohibits extra-billing and user charges, as all must to receive the full federal contribution, a charge for an insured service is not payable and any payment made is usually recoverable through the provincial plan.
- A complaint to the provincial ministry or health insurance planProvincial plans investigate improper charging by physicians and can order reimbursement. Name the clinic, the date and the amount, and attach the receipt.
Where to take it next
- Ask the clinic to identify the service and why it is not insuredAsk in writing which service was billed, and on what basis it falls outside the provincial insured basket. Clinics frequently withdraw the charge at this point.Claim directtypically 21 days
- Provincial ministry of health or health insurance planEach province runs a route for reporting improper charging for insured services, and can order a refund. This is the effective remedy; the federal Act operates on the province, not on the clinic.Regulatortypically 90 days
- The provincial college of physicians and surgeonsColleges regulate physician conduct including billing practices, and a pattern of improper charging is a professional matter as well as a financial one.Regulatortypically 120 days
Documents
What this regime can produce.
Every one of these is a document you send yourself, in your own name. Duesday never writes to anybody on your behalf and is never anyone’s agent.
The same claim type elsewhere
EU cross-border healthcare — Directive 2011/24/EU reimbursement, the EHIC and the S2EUSupranational — 27 countriesDirective 2011/24/EU, Arts. 6, 7 and 8Confidence: highFrance — dépassements d'honoraires, secteur 1 and 2, and the OPTAMFRNational — FranceCode de la santé publique, art. R. 4127-53Confidence: mediumGermany — the GOÄ and GOZ private billing schedules and their multiplier limitsDENational — GermanyGebührenordnung für Ärzte (GOÄ), §§ 2, 5 and 12Confidence: mediumIreland — public hospital charges, medical cards and the HSE complaints routeIENational — IrelandHealth Act 1970 (as amended)Confidence: lowItaly — Servizio Sanitario Nazionale, the ticket and the URP routeITNational — ItalyLegge 23 dicembre 1978, n. 833Confidence: lowNetherlands — NZa tariffs, the eigen risico and the SKGZ dispute routeNLNational — NetherlandsWet marktordening gezondheidszorg (Wmg), art. 35Confidence: mediumSpain — Sistema Nacional de Salud coverage and the right to economic informationESNational — SpainLey 41/2002, de autonomía del pacienteConfidence: lowUnited Kingdom — NHS charging, overseas visitor invoices and private healthcareGBNational — United KingdomNational Health Service Act 2006, s. 1(4)Confidence: medium
Other rights in the same countries
Alberta — unclaimed property (Unclaimed Personal Property and Vested Property Act)CA-ABSub-national — CanadaUnclaimed Personal Property and Vested Property Act, SA 2007, c. U-1.5Confidence: mediumAlberta — residential security deposit (Residential Tenancies Act, SA 2004, c R-17.1)CA-ABSub-national — CanadaResidential Tenancies Act, SA 2004, c R-17.1Confidence: lowBritish Columbia — unclaimed property (Unclaimed Property Act, SBC 1999, c. 48)CA-BCSub-national — CanadaUnclaimed Property Act, SBC 1999, c. 48Confidence: mediumBritish Columbia — residential security deposit (Residential Tenancy Act, SBC 2002, c 78)CA-BCSub-national — CanadaResidential Tenancy Act, SBC 2002, c 78Confidence: lowCanada — Canada Post delivery guarantee and claimsCANational — CanadaCanada Post Corporation Act and the Canada Post Terms and ConditionsConfidence: lowCanada — drip pricing under the Competition ActCANational — CanadaCompetition Act (R.S.C. 1985, c. C-34), ss. 52, 74.01 and 36Confidence: mediumCanada — payment card codes of conduct, provincial consumer protection and OBSICANational — CanadaCode of Conduct for the Payment Card Industry in CanadaConfidence: mediumCanada — provincial class proceedings and the Quebec authorisation regimeCANational — CanadaClass Proceedings Act, 1992, S.O. 1992, c. 6 (Ontario)Confidence: medium
Does this one reach your facts?
The engine runs every regime that could apply at once and reconciles them, rather than making you guess which page to read.
Not a law firm. Not legal advice. You send it yourself. This page describes a law; it is not advice about your situation and no outcome is promised.