Direct Billing

Direct billing is a courtesy that we are happy to provide to our patients, whenever possible. Please have an alternative payment method at your appointment as backup (i.e. credit, debit, cash or e-transfer).

At the bottom of this page, you will find a list and images of the insurance companies and federal programs that are supported with our direct billing platforms.

1. Whether or not your policy is set up to accept direct billing. Even though your insurance provider may be listed as accepting direct billing, some of their insurance plans will make payments only to the policy holder, or do not accept electronic submission (i.e. will only allow manual submission from the policy holder). We see this with several Manulife and Sun Life policies. In these situations, when we attempt to process your direct billing, your electronic claim submission will either be denied by the insurance company, or we will be notified that the payment will be sent to the policy holder (you) instead of to the clinic/service provider (us). This means that we need to collect payment from you for your treatment (via cash, e-transfer, debit or credit). You will then need to either manually submit your claim to your insurance company for reimbursement with the insurance receipt we provide you, or wait to be reimbursed from your insurance provider.
2. The terms and amount of your coverage, so that you may be aware of any copay amount you may owe for your session
3. Whether you require a doctor’s referral for your massage benefits. Even though your insurance provider may be listed as accepting direct billing, some insurance policies require the claimant to have a doctor's referral for massage for their benefits coverage. In these cases, if your insurance company does not have your doctor's referral on file, any attempt we make to process your direct billing will be unsuccessful. We are unable to submit a doctor's referral or any other document to your insurance provider on your behalf  through the direct billing portal with most insurance companies, so you will likely need to submit the referral to your insurance provider yourself. Please remember that your insurance company may need 5-6 business days to process and upload your doctor's referral to your file once it has been submitted, and plan your appointment(s) accordingly. For reimbursement of your first treatment, your insurance company may require you to submit your doctor's referral manually with the insurance receipt of your first treatment (which we can provide). Once your insurance company has your doctor's referral on file, we should be able to process direct billing for subsequent treatments, if your insurance policy allows for that. 
4. If your policy has a deductible. If you have a deductible on your insurance policy, your insurance company will likely use the amount of your initial claim(s) towards your deductible before they begin covering your treatments. Therefore, you may need to pay out of pocket in full or in part for your initial treatment(s) until you have reached the amount of the deductible.
5. VAC & RCMP programs require an authorization check via phone call prior to booking any appointments (more details towards end of page). Without this step, we cannot guarantee you have any coverage for your massage treatments. Contact us prior to booking your appointment(s) so we can send you the VAC & RCMP Authorization form and call their authorization department to verify authorization for your massages, or any further steps you need to take to obtain authorization.

Transactions processed through direct billing are final and cannot be adjusted in any way once processed (e.g. if you did not acquire a doctor’s note on time, we can not adjust the date of your treatment to a later date).

For us to provide direct billing for your appointment, we will require the following:

• A completed and signed Direct Billing Patient Consent Form

Please know, that due to insurance companies' privacy and confidentiality policies, we are unable to contact your insurance provider on your behalf to find out the amount and terms of your insurance policy coverage. They will only speak to the policy holder for privacy and fraud prevention reasons. Many insurance companies are also not set up to allow for predetermination of coverage. If you require this information before your appointment, please contact your insurance provider directly.

 If there is a discrepancy regarding your insurance coverage (i.e. you insurance company will not allow us to process your claim for whatever reason), you must pay us directly with an alternative form of payment at your appointment, and you must contact your insurance company to sort out the discrepancy, as this is beyond our control. Please bring an alternative form of payment to your appointment as backup.

 If we are unable to directly bill to your insurance, we will provide you with an insurance receipt, which you can submit to your insurance provider for your claim. This insurance receipt will be emailed to you in PDF format after payment of your service. With our insurance receipt, you will be able to receive reimbursement from your insurance provider without any issues, as per your insurance policy. The insurance receipt will include the treatment duration, price, location, name of provider and the RMT's registration number.

Some more details on direct billing:

There are a few pieces of information, which we must include when processing your claim, whenever applicable:

• If you have Secondary Coverage and with whom (see more info on Secondary Coverage below)
• If you are seeking treatment due to an accident (e.g. car or workplace accident)
• If you require a doctor's referral, some insurance companies (i.e. Sunlife, Green Shield Canada, SSQ, Empire Life, Medavie Blue Cross) may require that the following information is submitted for direct billing to work: name of physician, physician's license number, and/or date of prescription

 

Secondary Coverage:

We can provide coordination of benefits if both the primary and secondary coverage are under the same insurance company AND through an insurer that supports coordination of benefits. 

Currently, coordination of benefits is only supported for different insurers if:

• the patient's primary and secondary coverage is with Canada Life and Claims Secure
• secondary coverage is with Sun Life or Green Shield

In all other cases, coordination of benefits is not supported by the insurance companies (it is a technological limitation on their part as the two different insurance companies are unable to provide instantaneous verification/communication for claims).

Regardless, if you do have secondary coverage which you will be submitting, you must provide us with that information on your Direct Billing Authorization Form for us to include in your claim, so that this information is available to the primary insurer for the purpose of claim adjudication.

Determining  Coverage:

When both spouses have their own coverage, primary and secondary coverage are determined using the following guidelines:

• Patients submit their claims under their own plan (policy) and identify their spouse’s plan (policy) for secondary coverage purposes.

• If the patient is a child and is covered under both policies, the claim should be submitted under the policy of the parent whose birthday occurs earliest in the year.

RCMP & VAC Federal Programs

Insurance Companies & Federal Programs Supported: