Understanding your insurance coverage for physiotherapy can be confusing. At M.O. Therapy in Markham, we make it easy by offering direct billing to most major insurance providers. This guide explains everything you need to know about insurance coverage and how to maximize your benefits.
What Is Direct Billing?
How It Works
Direct billing means we submit claims directly to your insurance company on your behalf:
Traditional Process:
- You pay for treatment
- Get receipt
- Submit claim yourself
- Wait for reimbursement
- Track your coverage
With Direct Billing:
- Provide insurance information
- Receive treatment
- We submit claim directly
- Insurance pays us
- You pay only your portion (if any)
Benefits of Direct Billing
For You:
- No upfront payment (in most cases)
- No paperwork to submit
- No waiting for reimbursement
- Know what's covered immediately
- Focus on your treatment
Insurance Coverage in Ontario
Extended Health Benefits
Most Ontarians access physiotherapy through extended health benefits:
Sources:
- Employer-provided benefits
- Union benefits
- Association plans
- Individual policies
What's Typically Covered:
- Physiotherapy
- Massage therapy
- Chiropractic care
- Other paramedical services
Common Coverage Details
Annual Maximums:
- Set amount per year
- May be combined or separate by service
- Resets annually (varies by plan)
Per-Visit Limits:
- Some plans cap amount per visit
- May cover a percentage (e.g., 80%)
- Others pay up to specific amount
Frequency Limits:
- Some plans limit visits per year
- May require certain intervals between treatments
Providers We Bill Directly
Major Insurance Companies:
- Sun Life
- Manulife
- Canada Life (Great-West Life)
- Green Shield Canada
- Blue Cross
- Desjardins
- Industrial Alliance
- Equitable Life
- SSQ Insurance
- Many others
Checking Your Coverage
What to Know:
- Your annual maximum
- Per-visit amounts
- Any referral requirements
- Percentage covered
- Combined vs. separate maximums
How to Check:
- Review your benefits booklet
- Call your insurance company
- Check online portal
- Ask your HR department
- We can help verify
Types of Claims We Handle
Extended Health Benefits
For:
- Physiotherapy
- Massage therapy
- Chiropractic care
Process:
- Verify coverage
- Submit claims electronically
- Track remaining benefits
- Update you on balance
WSIB Claims
Workplace Injuries:
- Registered WSIB provider
- Direct billing to WSIB
- All documentation handled
- No cost to you
Auto Insurance (MVA)
Car Accident Injuries:
- Bill auto insurers directly
- Handle all paperwork
- Complete required forms
- Coordinate with adjusters
Other Claims
May Include:
- Veteran Affairs Canada
- Indian Affairs
- Certain other programs
Maximizing Your Benefits
Using Benefits Wisely
Strategies:
- Know your coverage limits
- Plan treatment timing around benefit year
- Use benefits before they expire
- Coordinate with family members if applicable
When Coverage Is Limited
Options:
- Prioritize treatment needs
- Space appointments if needed
- Consider out-of-pocket for additional care
- Ask about package pricing
Combining Services
If You Have Multiple Services Covered:
- Use physio, massage, and chiropractic together
- Different services = different maximums
- Comprehensive treatment approach
- Better outcomes
Understanding Your Coverage
Common Terms
Deductible:
- Amount you pay before coverage kicks in
- May be annual or per service
- Not all plans have deductibles
Co-pay:
- Fixed amount you pay per visit
- Insurance covers the rest
- Common structure
Co-insurance:
- Percentage you pay (e.g., 20%)
- Insurance pays remainder (e.g., 80%)
- Applied after deductible if applicable
Maximum:
- Cap on what insurance will pay
- May be annual or lifetime
- Separate or combined by service
Reading Your Benefits
Key Information:
- Service category (physiotherapy, RMT, etc.)
- Coverage amount or percentage
- Annual maximum
- Any restrictions or requirements
Special Situations
New Job/New Benefits
What to Know:
- When coverage starts
- Any waiting periods
- How to register
- Coverage details
Between Jobs
Options:
- COBRA-like continuation (if available)
- Spouse's plan
- Individual coverage
- Pay out-of-pocket temporarily
Dual Coverage
If You Have Two Plans:
- Primary plan pays first
- Secondary plan may cover remainder
- Coordination of benefits rules apply
- Can maximize total coverage
No Insurance
If You Don't Have Coverage:
- We offer competitive rates
- Ask about package pricing
- Payment plans may be available
- Focus on essential treatment
Frequently Asked Questions
Do I need to pay anything upfront? For most direct-billed claims, you don't pay upfront. You may be responsible for any amount exceeding your coverage (deductible, co-pay, or beyond maximum).
How do I know what's covered? We can verify your coverage when you provide your insurance information. You can also check your benefits booklet, online portal, or call your insurance company.
What if my claim is denied? We'll work with you to understand why and, if appropriate, resubmit with additional information or help you appeal.
Do I need a doctor's referral? Most extended health plans don't require a referral for physiotherapy. However, some plans do, so check your specific coverage.
When do my benefits reset? This varies by plan. Most reset January 1st, but some are based on your hire date or policy anniversary.
What happens if I've used all my benefits? You can continue treatment on a private-pay basis. We'll discuss options and pricing.
How to Use Direct Billing at M.O. Therapy
Getting Started
What We Need:
- Name as it appears on insurance card
- Insurance company name
- Policy/group number
- Member/ID number
- Date of birth
At Your Appointment
Process:
- Provide insurance info at first visit
- We verify coverage
- Treatment provided
- We submit claim
- You pay any remaining portion
Tracking Your Benefits
We Help You:
- Know remaining coverage
- Plan treatment appropriately
- Avoid surprises
- Maximize your benefits
Book With Confidence
Knowing your physiotherapy will be covered makes it easier to get the care you need. At M.O. Therapy in Markham, we handle the insurance details so you can focus on getting better.
Contact Us:
- Call (905) 201-5827
- Book online anytime
- Bring your insurance card
- We handle the rest
Experience hassle-free physiotherapy with direct billing at M.O. Therapy.