By the time private investigator Michael Campbell was hired to approach Telus about getting health care, the company had been responding to the Medical Services Commission’s concerns about extra billing for most of a year.
It started with a Feb. 18 letter to Darren Entwistle, president and CEO of Telus, from MSC chair Robert Halpenny.
“The MSC understands that Telus is offering a service known as ‘LifePlus,’ which appears to enable LifePlus customers to access numerous health related services in exchange for a fee,” Halpenny wrote.
The letter explained the Medicare Protection Act, which makes it generally illegal to charge a fee for services that would normally be provided under the province’s Medical Services Plan.
The commission wanted clarity about the LifePlus charges and what was for care that would normally be paid through medicare and what was for other care, he wrote.
“The MSC requires this information to determine whether Telus may be extra billing contrary to the [Medicare Protection Act],” he said.
With representatives from the government, Doctors of BC and the public, the nine-member commission manages MSP and is responsible to ensure some $2.5 billion is spent in accordance with the province’s laws and regulations.
Under the Medicare Protection Act, doctors who receive MSP payments may not charge a patient directly for any service normally paid for through the public insurance plan. Nor may a provider give preferential access to somebody in exchange for payment, or refuse to give insured care to someone who does not pay.
On Thursday the commission filed a petition in the B.C. Supreme Court seeking an injunction declaring that Telus Health is in breach of Section 17 of the Medicare Protection Act which prohibits extra billing and asking the court “to enjoin Telus Health from continuing this conduct.”
In a news conference Thursday, Telus’s vice-president of consumer health, Juggy Sihota, said the corporation was surprised by the court action and it was unnecessary since Telus had been co-operating fully with the Medical Services Commission review and is committed to comply with regulations.
“We do not charge for primary care services with our LifePlus service,” she said, adding the program is relatively small with about 4,000 customers and 25 doctors. “Our fee is [for] preventative health uninsured services like dietitians, kinesiologists and wellness services.”
Sihota also said the MSC had refused requests to engage with the company or to give it a chance to fix any outstanding issues, saying the court filing felt “rather political” and that the government was “firing bullets indiscriminately.”
But dozens of pages of documents the commission filed in court show that over the course of eight months there was a detailed discussion between it and representatives of Telus about the concerns. In its responses, Telus consistently argued that its LifePlus billing practices complied with the law.
As the Medical Services Commission summarized, “Telus Health has maintained throughout its communications with the Commission that: its fees for LifePlus and other patient-paid programs are solely for access to uninsured services; LifePlus members and non-members receive equal access to MSP insured services from Telus Health LifePlus physicians; and Telus Health is not contravening the Act.”
The last letter from Telus to the MSC is dated Oct. 14.
A few weeks later private investigator Campbell from Encore Claims Services Inc. in Vancouver, hired by the MSC’s legal counsel, contacted Telus Health about getting health care.
Campbell emailed and spoke with clinical enrolment nurse Sarah Huynh, he said in an affidavit filed in court, and explained to her that he had a knee injury and was frustrated that he was unable to find a family physician.
“Huynh explained to me that I was required to enrol in the Telus Health LifePlus program and pay the required amount of $4,882.50 in order to book an appointment with a family physician at a Telus Health Care Centre,” he said.
In Campbell’s affidavit he described the Nov. 9 phone conversation in enough detail that it can be recreated:
Sarah Huynh: “We do have an annual membership program that utilizes a personalized approach for preventative health care, so if you were to join us and are looking for a family doctor, you would have to go privately so you have to pay for the annual membership program.
“But you said you weren’t interested in our LifePlus programs so let me see. So, within our programs, we have the personalized health assessment. This is just a one-time annual service that we offer where we can help you with your health needs, but then you won’t have that ongoing care that you’re looking for. In order to have access to that ongoing care and longer appointment times, you would have to enrol in our LifePlus program.”
Michael Campbell: “Does the Telus Health North Vancouver Care Centre have family physicians?”
Huynh: “Ya, we do have family physicians, but all of our family physicians work under the annual membership program, so under that LifePlus program.”
Campbell: “So looking at your email, so that LifePlus program, that’s more than I can afford, that’s the $4,882 for the first year?”
Campbell: “So I don’t have an option to sign up for a family doctor through you guys?”
Huynh: “No, unfortunately not, we only offer the annual membership program.”
Campbell then expressed frustrations about walk-in medical clinics and the type of care they provide.
Huynh: “So with the LifePlus program you’ll have your own team, so you’d have your physician, you have the nurse, you have the kinesiologist that can help you with your knee and your ankle they can help you set up your mobility strength, you have access to a dietitian, you get access to a doctor on call 24-7, you have a virtual care app, so you have a comprehensive plan here.”
Campbell: “Can I do some sort of initial visit with one of the doctors at the care centre for an assessment and then sign up, or do I have to sign up first?”
Huynh: “I believe we can do like a clinic tour; you wouldn’t be able to speak with a physician.”
Campbell: “So I wouldn’t be able to see a physician?”
Huynh: “No, it would just be like a clinic tour.”
Asked for her comments about MSC using a private investigator in its review of Telus Health, Sihota said the company was waiting for more information and she couldn’t speak to the details.
Three weeks after the exchange between Campbell and Huynh, the MSC informed Telus Health representatives it would be seeking an injunction “to prohibit further actions in contravention of the [Medicare Protection Act].”
The next day the commission filed the petition.
“It is clear on the evidence that there exists more than a mere suspicion that Telus Health’s LifePlus program contravenes the Act,” it said. “A reasonable person would consider the payment of a fee for LifePlus would enable them to obtain preferential or priority access to MSP insured services, including access to a family physician.”
Telus has 21 days to file its response with the court.