All things I was curious how they were legal under the Canada Health Act.

Yeah, the CHA's requirements are surprisingly straightforward and readable. There's a lot of stuff that's just customary and not required by it.

So docs in the other provinces make QC residents pay directly since they can charge their local rate at point of service, and QC insurance will reimburse the QC resident. But if the doc tries to charge QC directly, they get fucked by RAMQ reimbursement prices? Yeah, that tracks.

IIRC (but it's been a long time since I looked into it) RAMQ doesn't even let them bill.

I think it’s the Quebec exception that doesn’t necessarily exist on paper but definitely exists in practice for a lot of stuff. Weird differences in coverage aside, my NS health card got me care in Ontario for a couple years before I finally bothered to switch to OHIP (i should have within 6 months)