Exercising your valuable health benefits for physiotherapy can be a bit of a maze to navigate, especially if you’ve never used them before. How much will your benefits plan cover? Will there be any extra uncovered costs? Do you need to pay upfront? Here’s a list of common terms you should understand about your insurance policy, before beginning physiotherapy, to avoid nasty surprises at the clinic. Select each one to learn more.
A co-payment is the portion of the treatment fee that you will be responsible for paying. It is usually a certain percentage or a set fee. Some plans may not have a co-payment (congratulations, you have a great plan!)
Some policies require you to pay out of pocket for a certain number of visits or amount before you can begin to claim your benefits.
Almost all policies have a cap, or a maximum amount of fees you can claim per visit and/or per year.
The cap per visit is the maximum amount that insurance will cover per treatment. Sometimes, the cap may be dependent on the length of the visit. For example, a 60 minute session may have a cap higher than a 30 minute session; it is therefore important to specify on the invoice the length of the session.
The cap per year is the maximum amount claimable per calendar or policy year; be sure to verify the starting month of your plan!
Although a doctor’s note prescribing physiotherapy is becoming less common as a requirement, it is not unusual. You will need to visit your family doctor or walk-in clinic to obtain a note.
If you have been attending physiotherapy for a while, or you have had a workplace injury resulting in short or long-term disability, your insurance might request a progress note from your physiotherapist.
An invoice detailing the date of service, treatment cost and time, clinic name and address, and the physiotherapist’s name and license number, is needed for reimbursement. You may also need to provide proof of payment.
Your physiotherapist may recommend a brace or walking aid to help with your rehab. Some insurance policies cover at least part of the cost of medical devices, but the requirements for coverage vary greatly. For example, some policies require a medical note and a cost estimate for pre-approval, which can take several days to process.
Some policies may allow for direct billing, which can help you avoid paying upfront. However, sometimes you may still be required to pay first for various reasons.
Therapeutic Relationships
Although fees are an important consideration for most people, one must not underestimate the importance of a strong therapeutic relationship. It is often hard to put a price on your health and quality of life. If you happen to meet a physiotherapist you like and can trust to help reach your goals, it is probably worth staying with him or her, even if there’s a co-payment attached.
