Insurance Coverage and Direct Billing
What is direct billing?
We aim to make using your insurance benefits as simple as possible. After your visit, we submit claims electronically, and depending on your insurance provider’s policies, this may result in direct billing or a claim being submitted on your behalf for reimbursement.
Because insurance plans vary, the final processing method is determined by the insurer after submission. This helps reduce paperwork and follow-up whenever possible.
Are your services covered by my plan?
Most extended health benefits plans cover Registered Massage Therapy (RMT) visits and Acupuncture (R. Ac) services.
We don’t have access to your insurance plan, so it’s best if you check with your employer or insurance provider to confirm what your benefits include. Even though we’d like to help, we’re not allowed to access your account to see what is left, or inquire about the details of your coverage (that information is private to you).
Coverage varies by plan. Some benefits plans may reimburse a percentage of each visit, while others provide coverage up to a set dollar amount per year. Your insurance provider can give you the most accurate information about how your plan works.
Some benefits plans will only reimburse the expense if it has been referred by a physician, please check with your provider if this is the case before coming to the clinic.
Which Companies Can You Direct Bill With?
Are there any limitations?
There are a few limitations to direct billing:
Partial Coverage – If your plan doesn’t cover the cost of a full visit, you will be billed and issued a receipt for what was not covered at the end of the visit.
Secondary Coverage – We are not able to coordinate any secondary coverage that you may have through your spouse. Unfortunately this is a limitation from the insurance providers themselves.
Future Payments – We can only bill your insurance plan when services are rendered – we cannot bill for future appointments.
Split Invoices – We are not able to split invoices in order to coordinate with your plan’s maximums.
What we need from you for direct billing
Before you come for your appointment, please fill out the Massage Therapy Health History and Direct Billing Form or Acupuncture Health History and Direct Billing Form accurately. Without your insurance information or authorization for direct billing, we are unable to provide direct billing for you. In case you have not received the form, you can contact our clinic to send it to you.
We are happy to be able to offer direct billing with over 20 extended health benefit insurance providers!
Some of the common plans we see are:
- Canada Life (formerly Great West Life)
- Manulife
- Sun Life
- ClaimSecure
- Desjardins
- Equitable Life of Canada
- Industrial Alliance (IA Financial Group)
- People Corporation
- Green Shield Canada
- Beneva (formerly SSQ Insurance and La Capitale)
- Empire Life
- Blue Cross
Exceptions
Unfortunately there are always exceptions to every rule. In some cases we will ask you to pay in full at the end of your visit and submit your receipts to your insurance company for reimbursement.
This might happen if:
- Your insurance company’s online portal is down.
- Your insurance company responds to our direct billing request with a ‘pending’ or 'on hold' status (meaning that they are unable to complete the adjudication process).
- We submit your claim on your behalf and your insurance company will reimburse you instead, indicated as "Payable to Client" or "Payable to Plan Member".
- A prescription from your physician is required by your insurance company.
- Your insurance plan requires you to submit your claims manually instead of direct billing.
- You’ve booked with a new registered massage therapist or acupuncturist who isn’t set up with your provider yet.
- Your benefit provider is not on our list of insurance companies for direct billing.
- The direct billing application for a new RMT is under review and no direct billing is available for the new RMT temporarily.
While we do our best to assist with insurance submissions, final processing is determined by your insurer. We do not participate in insurance fraud or misrepresentation of any kind, including submitting claims under a different individual’s name. We kindly ask that all communication with our staff remain respectful, as they do not control insurance policies or outcomes.