Physiotherapy Insurance Coverage 101
Welcome to your 1-stop shop for understanding your insurance benefits! We’ve answered the most commonly asked questions in this month’s blog.
What does health insurance cover?
Physiotherapy is commonly covered under health insurance as one of many extended health benefits. Some plans will list it as a stand-alone provider listed as Physiotherapy, while others will include it as one of several eligible providers under Paramedical Services. The difference between these two, for example, is having $300 for Physiotherapy vs $300 for Physiotherapy + Massage + Chiropractic + Acupuncture.
How do I check my health insurance benefits?
3 main ways to check your benefits
Check your policy brochure or benefit booklet which you can find in your online account, or in your welcome package.
Contact the Customer Service for your insurance company to ask them about your policy.
Ask your HR contact for more information, if your benefits are provided by your workplace.
Our admin team can run pre-authorization checks for some insurance companies, but it will only tell you what is covered for one service type (like an assessment or a single treatment).
What do I look for?
If you’re taking the time to check your benefits, make sure to look for these key pieces of information:
Is it limited per visit?
Your plan may cover $500 a year but each session may have a limitation, either in percent covered or maximum dollar value. Look for phrases like “up to 80%” or “$35 per session”.
Prescription requirements.
While more common with Massage Therapy, some Physiotherapy benefit plans require a doctor’s prescription. If you require a prescription or referral, it should be noted under the Physiotherapy section of your policy brochure.
What preventive services are covered by insurance?
All of them! Physiotherapy is covered by your health insurance plan whether it’s for treating an injury or preventing one. Registered Physiotherapists address weaknesses and muscle imbalances to prevent injuries. They can also help build strength and improve balance to prevent falls.
How to maximize health insurance benefits?
Flex Benefits
This might be called a Health Spending Account (HSA) or a Wellness Account and can be used to bolster your most utilized benefits or supplement missing benefits. They can often also be used for health-related purchases like bicycles and exercise equipment.
Understand Physiotherapy Potential
Physiotherapy is often thought of solely for injury rehab, but it has the potential to reach much further! Our clinic in particular offers appointments in Birth Preparation, Running Gait Analysis, and Climbing Performance Assessment. All of these are offered by Physiotherapists who have advanced their education to support body changes and adaptations in pregnancy and sports.
Physiotherapists can also help you start your fitness journey by assessing your muscular strength and providing home exercise plans and education.
Health insurance plans offering coverage for Physiotherapy services offer you the potential for a lot more benefit than you may have thought!
What is co-ordination of benefits?
Co-ordination of benefits refers to the hierarchy of which plan pays first and acknowledging how much the primary plan paid when submitting claims to the secondary plan. Your primary plan must always be billed first, even if the coverage is less advantageous than your secondary plan.
What determines who becomes the Primary plan?
Any plan that lists you as the “insured member” will be considered the primary plan.
When you have a plan that lists you as a “dependent”, it will be secondary to any plan that lists you as the “insured member”.
If you have two plans that both list you as “insured member”, the primary plan will be the one that you’ve had the longest.
If you have two plans that both list you as “dependent”, the primary plan will be the policy belonging to the older insured member. This is usually seen where someone is covered under two parents, and the parent who was born takes the lead for primary policy.
For situations not listed above, your insurance company will usually advise you on whether or not they are your primary coverage.