Alberta Bill 11 and Dual Practice: What Clinics Should Know

Alberta’s new dual-practice framework has opened a national debate about how far public and private care can overlap.

Created by Bill 11, the Health Statutes Amendment Act, 2025 (No. 2), the framework took effect on September 1, 2026. It lets eligible physicians provide publicly funded surgeries in the public system and privately paid surgeries in approved private settings. The province says the model will expand patient choice while protecting publicly funded care through physician eligibility rules, minimum public-service requirements, and monitoring.

The Canadian Medical Association has taken the opposite view, warning that allowing eligible physicians to work in both publicly funded and privately paid settings could draw scarce physician time away from the public system and undermine access based on medical need. On the day the rules took effect, the CMA said they “clearly violate the Canada Health Act” and urged the federal government to oppose them. The Canadian Health Coalition marked the same day as a national day of action against the bill.

That policy disagreement is bigger than any single clinic. But the operational consequence is immediate: when funding models multiply, billing gets harder.

For clinics, the central question is not only who pays? It is also:

Is this service insured in this setting?
Is this provider eligible to bill for it?
Which rules apply to the encounter?
What must the patient understand before care begins?
What evidence will the clinic need if the payment is questioned later?

Those questions become harder to answer when policy changes faster than day-to-day workflows.

Key takeaways

Dual practice is now legal in Alberta. Bill 11’s dual-practice rules took effect September 1, 2026. Approved physicians can offer privately paid surgeries alongside their public work, provided they keep up their public service levels. Family physicians, cancer care and emergency surgery are excluded.
The dispute is over the Canada Health Act. The CMA says the rules violate it; Alberta says they comply. Federal Health Minister Marjorie Michel has raised concerns with the province, but as of late August Ottawa described its approach as collaboration.
Bill 11 also changes who pays first. From October 1, 2026, Alberta’s Coverage for Seniors and Non-Group Coverage programs become the payer of last resort, including for Non-Group prosthetic and orthotic benefits. Claims submitted in the wrong order will be deemed ineligible.
Ottawa has moved too. The federal Canada Health Act Services Policy, in effect since April 1, 2026, says patients should not be charged for medically necessary services from nurse practitioners, pharmacists or midwives when the same service would be covered if a physician provided it.
The practical answer is the same everywhere: map each service to its funding rule, confirm the payment pathway before billing, and keep a record that can explain every decision later.

Two policy shifts, one growing administrative burden

Alberta’s physician dual-practice framework is one part of the story.

Under the new rules, approved physicians can perform privately paid surgeries in accredited chartered surgical facilities and hospitals, as long as they maintain their public service levels from the previous fiscal year. Family physicians are not eligible, except those with a subspecialty in anesthesia or surgical assistance. Cancer care and emergency or urgent procedures remain entirely publicly funded, and records of private services must be uploaded to provincial health information systems. Applications are reviewed on a rolling basis, and the province expects approved physicians to begin later this fall.

The eligible list includes orthopedic surgery, such as hip and knee replacements, alongside cataract, gynecological, select ear, nose and throat, dermatology, plastic and minimally invasive general surgery. That matters downstream. Patients leaving orthopedic surgery often need a brace, a walker or other equipment, and more of them may now arrive from a private pathway.

A separate federal policy is changing the treatment of some services delivered by non-physician health professionals.

The Canada Health Act Services Policy took effect on April 1, 2026. It reflects the federal government’s position that patients should not be charged for medically necessary services delivered by regulated professionals—such as nurse practitioners, pharmacists, or midwives—when the same service would be publicly covered if delivered by a physician.

The policy does not instantly create one uniform billing model across Canada. Provinces and territories still determine the scope of their insurance plans and must decide how affected providers will be funded. Health Canada has indicated that jurisdictions will first report relevant patient charges beginning in December 2028. Legal analyses from Osler, BLG, and Torys have highlighted the resulting uncertainty around provincial implementation, payment models, and compliance timelines. Osler reports that Ontario Health Minister Sylvia Jones has said Ontario will comply by April 1, 2027; BLG notes that in April she said there were no plans to let nurse practitioners bill OHIP fee-for-service.

These are distinct policy developments, but they create a common operational problem: clinics may need to navigate public payment, private payment, and changing eligibility rules at the same time.

Bill 11 also changes who pays first

Dual practice is the part of Bill 11 that made national news. For clinics that work with benefit plans, a second change arrives sooner.

From October 1, 2026, Alberta’s government-sponsored drug and supplemental benefit programs—Coverage for Seniors and Non-Group Coverage—become the payer of last resort. When a patient also has private, employer-sponsored, retiree or federal coverage, those plans pay first. The government plan then covers what remains of the patient’s co-payment, up to what it would have paid as the first payer. Alberta Blue Cross, which administers both programs, says in its implementation guide that claims submitted in the wrong payer order will be deemed ineligible.

That reaches device clinics directly. Non-Group Coverage pays up to 25% of the maximum allowable amount for listed prosthetic and orthotic benefits, including prosthetic devices (other than myoelectric) and braces needed for six months or longer, with a physician’s written order. Foot orthotics are not a benefit. Every benefit in both programs falls under the new payer order.

The same bill stops employers from ending or reducing drug and supplemental health benefits for active employees solely because of their age. More older patients may therefore keep a private plan that now has to be billed first.

At intake, “Do you have coverage?” is no longer enough. The question is which plans a patient holds, and in what order they pay.

Complexity appears before clarity

Policy debates happen in legislation, press conferences, and courtrooms. Billing complexity appears at the front desk.

It shows up when a patient is unsure whether a service is covered. It appears when staff must choose between similar payment pathways. It grows when provider type, location, referral source, or service setting changes the answer. And it becomes a compliance risk when the reason for a billing decision cannot be reconstructed months later.

Three areas deserve particular attention.

1. Payment pathways must remain separate and explicit

A clinic may handle publicly funded services, privately paid services, and services with both a funder and patient portion. Each encounter needs a clearly identified payment route before an invoice or claim is created.

That does not mean maintaining disconnected records. It means sharing one source of truth while preventing duplicate, inconsistent, or misdirected billing.

2. Patient communication is part of the billing workflow

Patients should understand what is covered, what is not, and why they are being asked to pay before the service is delivered whenever possible. A receipt after the fact cannot repair a confusing financial conversation.

Clear estimates, consistent explanations, and documented consent protect both the patient relationship and the clinic.

3. An audit trail matters when rules change

When guidance evolves, clinics need more than a final invoice. They need to know which provider delivered the service, which policy or fee rule was applied, who approved the claim, what the patient was told, and how the payment was reconciled.

Without that history, even a reasonable decision can be difficult to defend.

What clinics can do now

Clinics do not need to predict the final shape of Canadian health policy. They do need workflows that can adapt without losing control.

A practical starting point is to:

Map each service to its current funding rule. Record the provider, setting, payer, eligibility requirements, and any patient portion.
Record every plan, in order. Capture each public and private plan a patient holds and which one pays first. In Alberta, that order changes on October 1.
Create a pre-billing checkpoint. Confirm the payment pathway before a claim or invoice is submitted.
Use one connected patient record. Keep appointments, supporting documents, funding decisions, claims, invoices, and payments linked.
Document exceptions. If a service does not follow the usual route, capture the reason and approval instead of relying on memory.
Review rules on a schedule. Assign ownership for monitoring ministry guidance, insurer requirements, and fee changes.
Prepare patient-facing language. Give staff a consistent way to explain coverage and out-of-pocket costs without offering legal interpretations.

Clinics should confirm specific obligations with current provincial guidance and qualified legal or billing advisors. Software can support a compliant process, but it cannot decide whether a service is insured.

The system should carry the complexity—not the patient

Medfair was built for orthotics, prosthetics, mobility, and hearing clinics in Ontario, where public funding, patient responsibility, clinical documentation, and payment already meet in the same workflow. (Our Ontario assistive device funding guide explains how those costs are split.)

Our approach is simple: connect the patient, appointment, claim, invoice, and payment; keep the funder and patient portions visible; and preserve a record of what happened. When a team can follow the full path from intake to reconciliation, fewer decisions disappear into spreadsheets, inboxes, or institutional memory.

The direction of Canadian health policy will continue to be debated. Clinics should not have to rebuild their operations every time the rules move.

Good systems make change manageable. They give staff a clear next step, give leaders a reliable audit trail, and give patients a financial experience they can understand.

That is not only better administration. It is part of better care.

Frequently asked questions

What is Alberta’s Bill 11?

Bill 11 is Alberta’s Health Statutes Amendment Act, 2025 (No. 2), passed in the fall 2025 sitting. It allows dual practice, so eligible physicians can work in both the public and private systems, starting September 1, 2026. From October 1, 2026, it also makes Alberta’s government-sponsored drug and supplemental benefit programs the payer of last resort, and bars employers from cutting drug and supplemental health benefits for active employees solely because of their age.

What is dual practice in Alberta?

Dual practice lets an approved physician provide publicly funded surgeries in the public system and privately paid surgeries in accredited chartered surgical facilities and hospitals. To qualify, physicians must maintain their public service levels from the previous fiscal year. Family physicians are not eligible, except those with a subspecialty in anesthesia or surgical assistance, and cancer care and emergency or urgent surgery remain entirely publicly funded.

Does dual practice violate the Canada Health Act?

That is the dispute. The Canadian Medical Association says the new rules violate the Act and has urged the federal government to oppose them. Alberta says the model complies, because the Act lets provinces set conditions for private care from physicians who have opted out of the public plan. Federal Health Minister Marjorie Michel wrote to Alberta on July 24, 2026, asking it to protect its public health system; as of late August, Ottawa described its approach as collaboration with the province.

What is the Canada Health Act Services Policy?

A federal policy, announced in January 2025 and in effect since April 1, 2026. It treats patient charges for medically necessary services from regulated health professionals, such as nurse practitioners, pharmacists and midwives, as extra-billing and user charges when the same service would be covered if a physician provided it. Provinces and territories decide how to fund those services, and will first report any such charges in December 2028.

What does payer of last resort mean under Bill 11?

From October 1, 2026, Alberta’s Coverage for Seniors and Non-Group Coverage programs pay only after all other coverage, such as private, employer-sponsored or retiree plans, has been applied. The government plan then covers the remaining co-payment, up to what it would have paid as the first payer. According to Alberta Blue Cross, claims submitted in the wrong payer order will be deemed ineligible.

Alberta’s dual-practice shift is a billing wake-up call for Canadian clinics