Quebecers spent $10M out of pocket for care outside the province

Quebec residents spent over $10 million out of pocket last year to receive health care in other Canadian provinces, highlighting the province’s unique approach to medical billing. Unlike most provinces, Quebec has not adopted reciprocal billing agreements for most medical services.

Under the system, Quebecers traveling outside the province must pay upfront for health care and then submit claims to the Quebec Health Insurance Board (RAMQ) for reimbursement. However, the board may not cover the full cost, leaving residents to shoulder significant expenses.

Data obtained through an access-to-information request show that in 2024, Quebecers submitted $12.6 million in medical expenses incurred in other provinces, but RAMQ reimbursed only $2.3 million. Health Canada explained that reimbursement is based on Quebec rates rather than the host province’s rates, which can result in large gaps.

The Quebec Health Department encourages residents to purchase private travel medical insurance to cover these costs. Charles Shaver, a retired Ottawa physician, noted that clinics in eastern Ontario often bill Quebec patients at Ontario Medical Association rates, which are higher than government-insured rates, creating a financial burden.

Physicians outside Quebec can either bill patients directly or submit fees to RAMQ for reimbursement, but the board typically does not pay the full amount. In 2024, RAMQ was billed $8.9 million by out-of-province professionals but reimbursed only $7 million.

Under the Canada Health Act, provinces must cover emergency hospital and medical services for residents temporarily outside their home province. Quebec has reciprocal agreements for hospital insurance but has no plans to extend them to other medical services.