Insurance Coverage & Direct Billing

Insurance Coverage & Direct Billing

Here’s an overview of insurance coverage in relation to our services. The details in your specific plan may vary and you should always check with your insurance provider for the most accurate information.

What is direct billing?

We know insurance paperwork is overwhelming and can get in the way of using the benefits from your insurance company. Direct billing allows us to bill your insurance company directly right after your visit so you don't have to mess with forms, claims, and phone calls.

Are your services covered by my plan?

Most extended benefits plans cover Registered Massage Therapy(RMT) visits and Naturopathic services.

We don’t have access to your insurance plan, so it’s best if you check with your employer or insurance provider to learn what your benefits cover. 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).

Some extended health plans may offer 100% coverage and unlimited visits. Other health plans may work similar to a bank account, where you can “spend” up to a certain dollar amount as you see fit. Only your specific plan provider can give you the details about your coverage.

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?

logos of all direct billing providers

We are happy to be able to offer direct billing with over 20 extended health benefit insurance providers!

The most common plans we see are:

  • Pacific Blue Cross
  • Medavie Blue Cross (RCMP)
  • Green Shield
  • Great West Life
  • Sun Life

In addition we also support direct billing with the following companies

  • CINUP
  • Chamber Of Commerce
  • Claim Secure
  • Cowan
  • Empire Life
  • First Canadian
  • GMS Carrier 49
  • GMS Carrier 50
  • Canada Life (Great West Life)
  • GroupHEALTH
  • GroupSource
  • Industrial Alliance
  • Johnson Inc.
  • Johnston Group Inc
  • Manion
  • Manulife
  • Maximum Benefit

If you don’t see your insurance company on the list - ask us, they may be part of one of the above groups.

RCMP Members:  We’ve got you covered!

We direct bill to Medavie Blue Cross. Note that a physician referral may be required - please check with your plan if you are unsure.

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’ status (meaning that they are unable to complete the adjudication process)
  • You’ve booked with a new practitioner who isn’t set up with your provider yet
  • Your benefit provider doesn’t offer this service to us

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 (except in the case where both you and your spouse are insured with Pacific Blue Cross). 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.

Aesthetic Services – We are not able to submit direct billing for any aesthetic services.

MSP Coverage, ICBC & Worksafe BC

We do not offer direct billing for MSP, ICBC or WorkSafeBC (Workers’ Compensation Board of British Columbia). For ICBC and Worksafe BC, you must pay up front for treatment and then you can submit the receipts to your adjuster.

What we need from you for direct billing

When you come to your visit please bring the following:

  • Your benefits card
  • Physician referral form (if referred)
Membership card icon

Please be prepared to provide the following information so that we can make the direct billing process go smoothly:

  • Your provider ID or policy number (found on your benefits card)
  • Your relationship to the primary policy holder (as applicable)
  • Details about secondary coverage from a spouse, parent, or other relation
  • The date that your symptoms started
  • Whether or not you were referred by a physician

Frequently Asked Questions

When Do You Bill My Provider?

We bill your provider after every visit to our clinic.

What If My Plan Only Covers a Percentage of the Claim?

Don’t worry, you’re still eligible for direct billing. We bill your plan for your treatment and will settle the remainder of your balance in-clinic at the end of each visit.

What happens if my claim gets marked as pending? What does the pending status mean?

If for some unexpected reason your direct billing claim gets denied or is marked as “pending”  we will simply ask that your account balance is paid at the end of your visit. You can then work with your provider to determine why the claim was denied and/or provide additional information as appropriate.

Insurance providers will often mark claims as “pending” for a variety of reasons - it’s nothing to be alarmed about, this just means that they were unable to complete their adjudication process automatically (i.e. they couldn’t auto-approve the claim). This could be for any reason from a systems issue on the insurers side, to a requirement for additional documentation. In most cases no additional work is required from your side - all you have to do is wait for the claim to be approved.

How do I know how much I am covered for?

You will need to contact your extended health carrier, however, due to confidentiality we are unable to obtain access to determine your coverage limits.

Can I use my spouse’s benefits as well?

Unfortunately we cannot bill your spouse’s benefits. We only can bill to one extended health carrier each visit, which needs to be your primary insurance company. However, we will provide you with an invoice to submit to your secondary insurance carrier.

Do I need a doctor’s referral?

You do not need a doctor referral to come to our clinic, however, some insurance carrier plans require you to have a doctors note in order to claim the visit. Please check with your insurance carrier.

I am told I have to pay a deductible?

Some plans include deductibles while others do not - check with your insurance provider if this applies.

A deductible is a fee paid at the start of your plan’s fiscal year and is needed in order to activate your plan. The deductible amount is determined by your insurance company. We are still able to direct bill! The way this works in practice is that you will have to pay a higher percentage for your first visit and then your insurance plan will cover more for each subsequent visit.

Can I pre-bill for future appointments or past appointments?

We can only direct bill your insurance company on the same day as the appointment. We can not bill appointments in the future or past appointments.

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