Direct Billing Program
Reaching out to as many people as possible is our passion. Therefore, we are pleased to offer a Direct Billing Program to most extended health plans. Please keep in mind that every Extended Healthcare Benefit Plan is unique. Certain policies may not allow for direct billing and require the patient to submit each appointment receipt themselves. We encourage all our patients to call and check with their Extended Healthcare Provider to ensure that they are eligible for direct billing.
The companies that we direct bill include Pacific Blue Cross, Green Shield, Great-West Life, SunLife, Manulife Financial, Chamber of Commerce, Industrial Alliance, Desjardins, First Canadian, Johnston Group and Maximum Benefits and others. We direct bill for chiropractic, massage therapy, physiotherapy and acupuncture. We direct bill for a limited number of companies for Osteopathy (most companies require a receipt to be submitted by the member for osteopathy benefits.) We offer this service free of charge in order to make your experience more enjoyable. If you have a company that has the capability of allowing us to direct bill, but you don’t see it on our list, please inquire and we’ll do our best to add it to our list.
We also continue to direct bill Medavie Blue Cross for our Veterans, and our RCMP members. Thank you for your service to our community.
In order to serve you best and ensure that we have all information needed to submit to your insurance and track it on your behalf, we ask that you give us your insurance policy information by filling out our Direct Billing checklist. The Direct Billing checklist is included on the online Intake form that is sent to you via email when you book your first appointment with us. We require a day prior to your appointment to create your profile. This will make the process seamless and will minimize waiting at the desk during set up. If you are a current client who would like us to start direct billing for you, please ask for a link to be sent to you for our online direct billing checklist.
How does the Direct Billing program work?
Once we have your profile set up with your insurance information, we will be able to Direct Bill to your insurance company. Please keep in mind that every insurance plan is different so there may or may not be a co-payment or a deductible. Most plans have a deductible amount that will need to be paid before the insurance company starts to cover the costs of the treatment, similar to your dentist. This deductible requirement will reset each January. The Payment portal will give us the exact amount that the insurance company will pay and you are responsible for whatever amounts are not paid by the insurance company at the time of treatment. Unfortunately, we are not able to check your coverage, only you can call your insurance company to get information about your plan.
If, for some reason, the insurance portal is down on the day that you have your appointment, we will bill you the full amount and ask that you submit to the company when their payment portal is back on line. Please ask if you are unsure how to submit on your own; its usually very easy so no need to worry.
Please be aware that we cannot guarantee direct billing at every appointment. This could be due to issues with individual insurance plans, problems with the submission portal, or clinic administration considerations. There are certain days of the week and/or times of the day that some insurance companies have their portal closed. Please check with your insurance company.
Facts about Direct Billing:
How does Direct Billing work?
You will fill out the direct billing checklist with all the information that is needed and tick the box to give consent for us to bill and we submit it through the web portal. The portal will give us the exact amount that your benefits plan pay; you will need to pay the remaining portion of the visit that isn’t covered, if anything.
Will I need to pay anything?
You will pay the portion of the treatment cost that the insurance company doesn’t pay, according to the portal reply. For example, if you have coverage for 80% of your $110 visit fee, you will pay $22 (the portal will “pay” the remaining $88 to the clinic). Payment amounts depend on your individual coverage and portal response. There may also be a deductible that you have to pay before coverage begins. Check with your insurance company. Some insurance policies do not allow direct billing. Please check with your insurance company if you are unsure.
What treatment modalities can you bill for?
We can direct bill for Physiotherapy, Chiropractic, Massage Therapy and Acupuncture treatments. Each individual plan may have different coverage for each treatment type, please check with your insurance company for your particular coverage. There are a couple of insurance companies that allow direct billing for Osteopathy services. Please check to see if yours is one of them. The ability to direct bill doesn’t mean that you don’t have coverage. Osteopathy services are covered by several insurance companies, but for some reason, direct billing isn’t enabled.
Can you check what my exact coverage is or how many visits are covered?
The submission portal is designed for clinics to create submissions in real time; it is not designed to check statements/limits/policies etc. It works very similar to a Point of Sale terminal – it can collect payments but it can not check credit card or debit balances.
If you want to check deductibles, coverage, or remaining visit limits , please contact your insurance provider directly.
Can I use direct billing to pay for an appointment that I have to cancel with no notice?
No, direct billing to your insurance company can only be done for treatments that you attend. We are not able to bill for missed appointments. Missed appointment fees are the responsibility of the person that misses the appointment.
Why do Insurance companies provide different coverage for their members?
Each plan is individual to the member and is negotiated between your employer and the insurance company. Insurance companies can have many different plans. For example, we have seen Pacific Blue Cross cover as little as 10% of the treatment cost, up to 100% coverage.
What if my plan covers 100%?
You are very fortunate! You won’t have to pay anything!
What if I have several insurance plans? Can you help coordinate them?
Unfortunately, at this time, we do not offer any coordination of benefits. We can only direct bill one plan. You will have to submit your receipt for the balance of the treatment cost to the other plan provider on your own.
Do I get a receipt if you direct bill for me?
You will get a receipt only for the portion that you pay. For example, if you have 100% coverage, you will not get a receipt. If you have 80% coverage, you will get a receipt for the 20% remaining balance that you pay.
Are all of Equilibrium Therapists registered for Direct Billing?
Generally yes. It is possible, however, that when the therapist is a locum (filling in) or new to the clinic that the registration is pending and it may not be available yet. We make every effort to ensure that our newest team members get registered ASAP. If your Therapist is not yet registered at the time of treatment, we will ask that you pay for your treatment cost up front and submit to your company personally. We will assist in any way possible.