So, you have a bad back you want to take care of, and you have insurance benefits to use. Exercising your valuable benefits can be a bit of a maze to navigate, especially if you’ve never used them before. Here’s a list of common items you should understand about your insurance policy, before beginning physiotherapy, to avoid nasty surprises.

TERM WHY IT MATTERS
Co-payment 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!)
Minimum Amount 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.
Caps 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!
Required Documentation 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.
Medical Devices 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.
Direct Billing 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.

Although fees are an important consideration for most people, one must not underestimate the importance of a strong therapeutic relationship. 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.

Categories: Patient care

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