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Teleplan Status - Opted in versus Opted Out

The language here can be a bit tricky but there’s a few things to keep in mind when determining if you as a practitioner should be set to Opted In, Soft Opted Out, or Hard Opted Out.

Background

The Medical Services Plan of BC offers limited coverage for those on Premium Assistance. There’s a $23 benefit that can be shared between what MSP calls “Supplementary Benefits”.

Here’s what MSP says on the subject:

And a link to their page on Supplementary Benefits

Definitions

Opted In

This is the status of Medical Doctors and Midwives or any practitioner that bills only through MSP for their fees. You cannot collect any fees above and beyond the MSP fee schedule if you are Opted In.

I have never come across a supplementary benefit provider who is opted in.

Hard Opted Out

I’ve only run into a few providers who have chosen to be Hard Opted Out. This is the status of a practitioner who is collecting absolutely nothing from MSP but want to allow patients to submit for the $23 premium. They can either fill out the forms themselves and mail them in, or you can send the submission in electronically. If you are hard opted out, then you can submit MSP claims for a patient but the patient will be re-imbursed directly. So for allied health practitioners, you can bill MSP for the $23 premium assistance benefit but the payment will be sent DIRECTLY TO THE PATIENT.

Soft Opted Out

The vast majority of allied health practitoiners would fall into this category. You can both bill and collect the $23 from MSP AND charge the patient a user fee on top of the covered amount. The $23 will be paid directly to the clinic/practitioner.

I understand the confusion here - mostly stemming from people believing that “Opted In” is referring to their ability to bill MSP the $23 benefit.

You can find more info on the government site.