Q&A - Doctor's Fee for DMER

Q&A ImageQ: Why is there such a discrepancy in price for a medical exam for people turning 80 years old? My doctor quoted $80 before he retired and when I went to a walk in clinic to get the test recently it was $200. That seems quite unfair to me.

A: That's a question that you will have to ask the folks at the College of Physicians and Surgeons of BC. Their guidance to doctors concerning charging for uninsured services, which driver exams fall under, is explained in this practice standard.

I was able to find the following advice:

The Road Safety BC Driver’s Medical Examination Report (DMER) “for any driver with a known or possible medical condition” is billable to Medical Services Plan (MSP) as a $75 fee using billing number 96220.

NOTE TO DRIVER AND PHYSICIAN OR NURSE PRACTITIONER: The Superintendent of Motor Vehicles (RoadSafetyBC) has arranged that physicians may bill the Ministry of Health, through the Teleplan billing system, $75 to complete this form. RoadSafetyBC will reimburse Teleplan for such charges. RoadSafetyBC has no authority to set the fee physicians or nurse practitioners charge. Physicians are entitled to set their own fee and to bill patients directly for either their full fee or any portion of the fee that exceeds the $75 the physician may bill through Teleplan. RoadSafetyBC will accept a DMER completed by any qualified medical practitioner in British Columbia.

In the comments below, we find that there are two types of DMER, a blue and a yellow form. The yellow form is used for routine exams at and after age 80. RoadSafetyBC does not reimburse the doctor for this so they bill the patient for the full amount.

Comments

It's worth mentioning

Yes indeed, fees for this can vary tremendously. Having held a professional (Class 1, 2, 3 or 4) license for 47 years, I've had to complete this many times in order to maintain my license.

These days, as a Class 4 Driving Instructor, I have taken many, many applicants through the testing process - and after successful completion of this, when they issue the full medical form (a standard $28 processing fee applies, although I think this would be waived for seniors), the counter clerk or DE will invariably recommend to the driver that they take it to their GP, rather than some walk-in clinic - just because of the cost involved.

It makes no difference to ICBC, but they try always to give the best advice to newly minted professional drivers in this instance.

possible medical condition??

The $28 processing fee was not waived for this senior. Not sure I understand why this is levied only at DL renewal time every 5 years, when in my case (Class 2) I have to have the medical annually.

I understand "known medical condition". But what is a "possible" medical condition? There's a huge list of "possible" medical conditions that applies to everyone without a known medical condition limited only by gender specific medical conditions. Does that mean that all drivers DMERs are billable. If so the rule should just say all drivers, not any driver with a known or possible medical condition.

Maybe the intent is to allow for billability for drivers with a confirmed or suspected medical condition.

The clinic I have used for years asked for $75, now $80, in cash, and I don't know whether or not they are claiming. Makes one wonder.

I'll take a shot at this one!

Keeping in mind that I'm not an employee of ICBC or RSBC, I'd like to take a shot at answering some of these questions! Hopefully if I have anything factually incorrect, our site host will help out.

The $28 processing fee was not waived for this senior. Not sure I understand why this is levied only at DL renewal time every 5 years, when in my case (Class 2) I have to have the medical annually.

I'm starting to wonder if I was correct, regarding how this affects seniors. I'm pretty certain that free license renewals (or replacing the license with a BCID), as well as free re-examination (the Enhanced Road Assessment, these days) are provided by ICBC for those over 65 (it is only 'automatic' after turning 80). But the $28 processing fee (which basically is meant to cover ICBC's costs to administrate the paperwork between the driver, their physician/clinic, and RSBC) may not be. I'll find out when ICBC are open again tomorrow.

Being absolutely candid here, I was going to state that nobody has to complete a medical on a 5-year renewal basis. This is the way it's been for my whole life; National Safety Code rules demanded a successfully completed medical examination every three years for professional (Class 1,2,3, or 4 drivers) while, oddly enough, Driving Instructors were required to undergo this every two years. But sure enough, these days the NSC rules stipulate every 5 years, which can be co-incident with their BC license renewal.

I'm darned certain that completing a regular medical examination as a condition of holding a professional license is not required annually. I'll betcha that neither ICBC or RSBC have ever sent you a cautionary letter demanding another medical be done, only a year after the last one you completed. I'm surprised you would be able to obtain the form from an ICBC office every year, to take to the clinic quite frankly.

I understand "known medical condition". But what is a "possible" medical condition? There's a huge list of "possible" medical conditions that applies to everyone without a known medical condition limited only by gender specific medical conditions.

I'll take a crack at answering this one, perhaps with an analogy. Let's suppose that Driver A suffers the loss of an eye, but Driver B suffers the loss of a limb. (Does Driver A have to re-qualify, after driving for years? The answer is No - monocular drivers are all around us, piloting everything from Motorcycles to B-Trains. But Driver B has suffered a loss that could affect their ability to drive, at least without some modification to the vehicle (which would then become a specific Restriction on their license, often R26 or R28).

Maybe the intent is to allow for billability for drivers with a confirmed or suspected medical condition.

Well, the 'Driving Commercial Vehicles' guide, under 'Medical qualifications', advises that RSBC 'identifies and assesses drivers to determine if they are physically, cognitively, and medically fit to drive'. And let's face it, what will happen to each and every one of us, eventually, is that  one of these will happen in fact - unless we die first. That's it.

Consequently, in the Motor Vehicle Act we have this:

Report of health professional

230 (1) This section applies to every legally qualified and registered psychologist, optometrist, medical practitioner and nurse practitioner who has a patient 16 years of age or older who

(a) in the opinion of the psychologist, optometrist, medical practitioner or nurse practitioner has a medical condition that makes it dangerous to the patient or to the public for the patient to drive a motor vehicle, and

(b) continues to drive a motor vehicle after being warned of the danger by the psychologist, optometrist, medical practitioner or nurse practitioner.

(2) Every psychologist, optometrist, medical practitioner and nurse practitioner referred to in subsection (1) must report to the superintendent the name, address and medical condition of a patient referred to in subsection (1).

So if the medical professional has a concern about their patient's continued ability to drive safely (but the patient continues to drive), they are obligated to notify RSBC, who will then issue (or not) a Medical Form to be completed and returned to them in Victoria.

The clinic I have used for years asked for $75, now $80, in cash, and I don't know whether or not they are claiming. Makes one wonder.

It certainly does. If I'm understanding you correctly, they're soaking you $80 annually, specifically in cash payment, to do their examination and get the form filled out? Frankly, from my point of view, this stinks to high heaven. And just as there are regulatory authorities that govern licensing requirements, there are also regulatory authorities governing the conduct of physicians in BC. Plus, of course, there's CRA aka Revenue Canada. I'll bet they would like to know what's going on, here.

So that's my 2 cents worth. (And thanks to DavidP for his helpful comments below. Sounds like someone who knows what he's talking about.)

RoadSafetyBC Payment Schedules re DMER

Here is detailed information about RoadSafetyBC's payment schedules re: doctors billing MSP for completing DMER.

Doctors only reimbursed $75 for completing blue, not yellow DMER

There are currently two types of DMERs – blue forms which are sent to drivers with known, or suspected, medical conditions, and yellow forms which are sent to drivers when they turn 80 and every two years thereafter and to commercial drivers at specified intervals.

RoadSafetyBC reimburses physicians $75 for completing a blue DMER on a patient’s behalf.  Information regarding how to claim that reimbursement is printed on the form. Patients are responsible for paying any surcharge which medical professionals may levy beyond $75 for completion of the DMER. RoadSafetyBC does not reimburse for completion of a yellow DMER.

Annual medical for professional drivers

CompetentDrivingBC said; ......I'm darned certain that completing a regular medical examination as a condition of holding a professional license is not required annually. I'll betcha that neither ICBC or RSBC have ever sent you a cautionary letter demanding another medical be done, only a year after the last one you completed. I'm surprised you would be able to obtain the form from an ICBC office every year, to take to the clinic quite frankly.

Quite frankly the "darned certain" and the "betcha" comments are misleading. A regular medical examination as a condition of holding a professional license is required annually if you are over 65, even with no known or suspected medical conditions. I never have to get the form from an ICBC office because they automatically mail me one every year, requiring the form be completed by a doctor and returned to them within 45 days. This year we get an extra period of time to return the form, because of lengthy delays in getting an in-person office visit to the doctor - I am on a waiting list but no estimate of how long it is.

I betcha I was darned certain when I wrote that ...

Well I've been doing some research. And, you're right. I owe you an apology.

After decades in the industry, and as a holder of both a Class 1 Driver License and a Class 4, 5, 7 Driving Instructor License (with a 2-year gap from 1997 - 1999 working for ICBC as a Driver Examiner), I have honestly never encountered this requirement. Though I guess I would have pretty soon, being as I turned 65 earlier this year.

I found the relevant information on the RSBC site, under 'Commercial Driver's Fitness Requirements'. Let's see if I can copy/paste the relevant piece, here.

Driver’s Medical Examination Schedule This schedule requires drivers holding a class 1, 2, 3 or 4 licence or class 5 licence with endorsements 18, 19 and 20 to take and submit to RoadSafeyBC a Driver’s Medical Examination form upon application for a licence and at the following intervals:  every fifth year (i.e. when the driver is in their 25th, 30th, 35th, 40th and 45th year of age)  every third year (i.e. when the driver is in their 48th, 51st, 54th, 57th, 60th and 63rd year of age)  every year for drivers age 66 and older. 

Other information on that page confirms that the $28 Medical Processing Fee will be applied at the time of the 5-year renewal, although the frequency of submitting the forms increases at various intervals. I guess this is what they call the 'golden years' eh?

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