Why can’t you submit my insurance claim?
There are several reasons why we are unable to submit your claim.
- Your company’s plan does not allow for direct billing
- You do not have a valid doctor’s note for your appointment & your insurance company requires one to use your coverage
- The portal that we use to submit your claim is not working
- The therapist you are seeing is either a new graduate or new to our clinic
(We submit requests to the insurance companies to have the therapist added to our list of providers we can direct bill for. It can take up to a few weeks for therapists to be added to our list)
How do you submit my claim to my insurance company?
We use three primary web based direct billing portals to submit your claim. Telus Health portal, Provider Connect portal & Blue Cross portal. As with all technology, these portals do not always work.
What if my insurance claim can NOT be processed at the time of my appointment?
There are some circumstances when we can’t process your insurance claim directly.
- You will be required to pay in full for your appointment
- We will electronically submit your claim once the portal is back up and running & instruct your insurance company to send the payment directly to you
- OR We can provide you with a receipt for your visit and you can submit it to your insurance company yourself.
How often do you direct bill and how long does it take for you to receive my claim payment?
We bill your insurance company as soon as you arrive for your appointment. Every company pays their claims differently. Some as soon as the next business day and some pay bi-weekly. It is unusual for payment to take longer than 10 business days.
I have 2 benefit plans; do you offer co-ordination of benefits?
In MOST cases, we are only able to submit to your primary insurance coverage.
There are 2 exceptions to this;
- Your secondary insurance coverage is through Green Shield Canada.
- Both your Primary AND Secondary coverage are with Canada Life (formerly GWL)
My primary benefits are maxed out for the year, can you direct bill to my secondary benefit plan?
When your primary benefits are maxed out, you are responsible for notifying your secondary benefits provider in order for us to direct bill to them. We are unable to notify them on your behalf. You may have to request a statement from your primary company stating that your benefits have been maxed out.
Can you find out how much my insurance company will cover for each treatment? When does my plan expire and renew?
Due to confidentiality your insurance company will not provide a third party (us) with any specific information about your plan coverage.
Will I need to pay anything out of pocket?
Depending on your insurance plan, you may need to pay the reminder of your visit fee. If your
insurance company covers 100% of your appointment, then you don’t need to pay anything. If your insurance only covers part of your visit, then you need to pay the remaining balance. Some insurance plans have an annual deductible that is charged the first time you submit a claim each year.
Do I need a doctor’s referral?
Some plans require a doctor’s note. Please check with your insurance company to find out if you are required to have one to use your benefits.
How often do I need a doctor’s referral?
Ever insurance company is different, some plans require a new note annually. Some allow you to use the same note ongoing, if you don’t let more than 6 months lapse between visits. Check with your company for their specifics.
An insurance deductible is the amount of money you will pay in an insurance claim before the insurance coverage kicks in and the company starts paying you. For inquiries regarding your deductible, please contact your insurance company.
Are there any services that you do not direct bill for?
We are currently unable to direct bill for reflexology, osteopathy and reiki. We are happy to provide you a with a receipt for your service for you to submit to your company directly.
Can you send in any charges that are not covered by my insurance to my health spending account?
We do not have access to health spending accounts, but we can provide statements at any time for you to submit directly.
Do you bill directly for work related injuries (WSIB)?
We do NOT bill directly to the Workplace Safety Insurance Board. Prior to booking your appointment with us, you should report your injury to your employer and submit appropriate paperwork to the WSIB.
I’m from out of province, are you able to directly bill my insurance company?
No, unfortunately direct billing is only available for Ontario residents.
What is your return policy?
You have 45 days to return items for a full refund, with or without a receipt. Items must still have their original tags.
The appointment is for my child. Both my spouse and I have coverage, which insurance company is the primary coverage?
The parent who’s birthday comes first in the calendar year is the primary coverage.
