How We Can Help
Most private health insurance companies offer some kind of coverage for alternative health services such as Physiotherapy or Massage Therapy. However, coverage details can differ greatly from one company to another.
At OPRC, we have extensive experience working with insurance companies and want to help our patients as much as possible in this regard. This is how we can help:
- We can help you get all the information you need about your coverage.
- If your company allows it, we can call on your behalf to gather any pertinent details.
- For insurance companies that allow it, we provide direct billing options.
What You Need To Know
To learn about your coverage, check with your employer for a coverage description or pamphlet, sign into your group claims portal (if one is available through your company), or simply call. Make sure to ask:
- What professional services am I covered for and do I have an annual maximum?
- Is there a maximum amount covered per hour or per session?
- Do I have a deductible for any of these services?
- What is the title or designation needed of my health professional?
- Do I need a doctor's prescription prior to beginning treatment in order to receive reimbursement? If yes, how long is the prescription valid for?
- Do you accept direct billing from my provider?
Your First Visit
On your first appointment, make sure to bring all insurance information (claims, id#, etc.). If you are covered under two insurance companies (your's and your spouse's for example), please bring both sets of information.
We will attempt to verify your coverage details (whether you have coverage, if there is a co-payment and/or deductible, etc.).
- Have no coverage available - In this case, you are responsible for paying out-of-pocket for any services received.
- Have coverage but your insurance company does not accept direct billing. - In this case, you must pay fully at the time of service but your insurance company will reimburse you (partly or fully depending on your coverage). For certain insurance companies, we are able to bill on your behalf. This means that you simply need to give us permission to send the claim for you to your insurance company (so we do all the paperwork), and you receive the reimbursement at home at a later time.
- Have coverage and your insurance accepts direct billing. - In this case, see the next sections.
Direct Billing / Assignment of Benefits
An insurance company that accepts direct billing from a provider of health care services means that you, the patient, gives permission to the provider, OPRC, to bill your insurance company directly. This way, you do not have to pay anything at the time of service (except for applicable copayments and deductibles) because the insurance company will pay us directly. Many companies already accept direct billing from dentists' offices and pharmacies but make you take care of the billing procedure for most other services.
Slowly, more and more companies are expanding the scope of their direct billing policies to include optometry services, physiotherapy, massage, acupuncture, and many more.
- You are responsible for paying up-front at each session any co-payments and/or deductibles that your insurance does not cover.
- Also, if for any reason your insurance company does not pay us within 30 days of us sending the claim (for example, if your insurance expires or they send you the payment instead of us), you are responsible for covering the payment and working with your insurance company.
- Depending on your insurance company, we may send your claims either by mail or online. If it is by mail, you will have to complete a claim form at every visit.
For specific questions, please do not hesitate to contact us or to speak with your insurance company.