Health Policy & Positions
|  |
Key Messages
Insurance & Physiotherapy
Physiotherapy services are recognized by many insurers as an essential component of any extended health benefits package.
As a consumer, you have the right to choose the physiotherapist that's right for you and who meets your specific treatment needs. If you need help finding a physiotherapist in your area, click on Find-a-Physiotherapist in the Quick Links at the left.
If you need physiotherapy services and are covered by an insurance plan, it is important that you find out as much as you can about your coverage before seeing the physiotherapist.
Some questions to ask:
- Do you require a physician's referral? Although physiotherapists are primary access practitioners under the Regulated Health Professions Act and do not require a physician referral to treat, some insurers still require it before they will pay for the service.
- Does your insurance have a per-visit maximum? In other words, will they only pay up to a certain amount per visit? If the physiotherapist's rate is higher, you will be responsible for the difference.
- Does your plan have an annual limit?
- Is your physiotherapy coverage combined with any other healthcare? Some plans have a total amount that they will pay for a group of health care providers.
- How does your insurance company handle claims? Can the physiotherapist bill them directly for their services, or do you have to pay up front and submit an invoice?
WSIB & Physiotherapy
Many injured workers go, or are referred, to a physiotherapist to assess and treat their workplace injuries and to help them reintegrate into the workforce. Under the Workplace Safety and Insurance Act, injured workers have the right to choose the practitioner from which they receive care and the right to consult a physiotherapist without a referral from a physician or any other health-care practitioner. In many cases, being assessed by a physiotherapist and beginning treatment as soon as possible after an injury speeds return to work and increases the likelihood of full recovery.
The Workplace Safety and Insurance Board (WSIB) has embarked on a new health-care delivery model. Part of the delivery model involves the development and implementation of Programs of Care for specific diagnostic categories. Programs of Care are based on the latest scientific evidence and are developed in close collaboration with the professions that deliver the care. The Ontario Physiotherapy Association has been intimately engaged in the development of each of the Programs of Care that relate to musculoskeletal conditions. A Program of Care for Acute Low Back Injuries is already operational. Programs of Care for Persistent Low Back Injuries, Lower Extremity Injuries, Upper Extremity Injuries and Mild Traumatic Brain Injuries will be launched soon. Physiotherapists are, or will be, major players in the delivery of care under these Programs of Care. In order to deliver treatment under a Program of Care, however, practitioners must be registered with the WSIB.
Injured workers should understand, however, that their treating practitioner by law must disclose their patients' condition, course and outcome of treatment to the WSIB.
OHIP & Physiotherapy
OHIP funded physiotherapy is delivered in communities by Designated Physiotherapy Clinics (DPCs). By government policy, the number of Designated Physiotherapy licenses (previously Schedule Five Physiotherapy licenses) has been frozen since 1964. Currently there are about 91 licenses authorized to bill OHIP for both clinic based and home based services and 29 licenses authorized to bill OHIP for home based care alone. The policy not to issue additional licenses since 1964 has meant that the system has not grown to meet increased demand or changes in geographic distribution of the population. For instance, there are currently no OHIP-covered physiotherapy clinics in Mississauga.
OHIP covers physiotherapy treatment for a fee of $12.20 per visit in a clinic and $24.40 for an initial home visit. OHIP does not cover the cost of assessment or re-assessment, so in many instances an additional assessment and/or administrative fee is charged to the patient.
In 2004, the government announced it would delist physiotherapy services from OHIP effective March 31st, 2005. In late March 2005, the government announced that the delisting would be limited to those between the ages of 18 and 64 who are not receiving benefits under the Ontario Disability Support Program, Ontario Works and Family Benefits. These changes came into effect April 1st, 2005.
This means that, in order to be covered for physiotherapy services at a Designated Physiotherapy Clinic, you must have a doctor's referral and:
- Be 19 years old or younger, or;
- Be 65 years old or older, or;
- Are receiving benefits under the Ontario Disability Support Program or Family Works, or;
- Have been overnight in hospital for a condition that now requires physiotherapy treatment.
In addition to clinic and home visits, many Long Term Care homes receive services from DPCs. In 2005, in response to the government's commitment to ensure that those over 65 and those who live in Long Term Care homes have access to physiotherapy services, government and stakeholders have been working together to expand services to those homes that had little or no access to physiotherapy under the previous (OHIP Schedule 5) system. In a phased approach, services are now being contracted with individual physiotherapists, private clinics, hospitals and DPCs to achieve this goal.
If you would like further information on whether you qualify for OHIP physiotherapy services, or for help locating a DPC near you, contact us at physiomail@opa.on.ca or call (416) 322-6866.
- April 1st, 2005
Important Announcement regarding the changes to Physiotherapy Services effective April 1, 2005
- March 23rd, 2005
OPA responds to Ministry Announcement on OHIP-Funded Physiotherapy
|
