Direct billing and insurance

Direct billing replaces the older pattern of paying the full fee and waiting for reimbursement.

1. At booking. The patient tells the clinic which insurer covers them. The clinic confirms whether it bills that insurer directly.
2. At the front desk. The patient provides their benefits card or policy details, often the group (plan) number and member (ID) number, and the plan member's details if the patient is covered under a spouse's or parent's plan.
3. After the visit. The clinic submits the claim electronically. Most insurers respond within moments, approving the claim, approving part of it, or declining it.
4. The balance. The insurer pays its share to the clinic. The patient pays anything left: the portion above a per-visit maximum, the coinsurance share, or the full fee if the plan's limit for the year has been used.

When a claim is declined, the reason usually lies in the plan: the discipline isn't covered, the annual maximum has been reached, a referral is required, or the plan member's details don't match. The patient pays at the visit and can follow up with the insurer.

Some patients have two plans, for example their own and a spouse's. Coordination of benefits lets the second plan pay some of what the first plan didn't, under the rules the insurers set. Clinics can often bill the first plan directly; the second may need a separate claim.

Extended health plans, usually provided through an employer, cover services that MSP does not, including physiotherapy, chiropractic, massage therapy and sometimes kinesiology. Plans differ widely, and the details sit in the plan member's benefits booklet or insurer app.

Common plan terms include:

• Per-visit maximum. The most the plan pays for one visit.
• Annual maximum. The most the plan pays for a discipline, or for several disciplines combined, in a plan year.
• Coinsurance. The percentage of each fee the plan pays, with the patient paying the rest.
• Referral requirement. Some plans pay for massage therapy or physiotherapy only with a doctor's referral, even though the professions do not require one to book.
• Practitioner eligibility. Plans pay only for registered practitioners in recognised professions, which is why the "registered" in registered massage therapist matters.

Health spending accounts work differently: the employer funds an account, and the patient spends it on eligible health services, including these disciplines, until the balance runs out. Some can be direct billed; others need a manual claim.

Claims after an injury follow their own rules, separate from extended health plans.

ICBC. Under Enhanced Care, ICBC pre-approves treatment for the first 12 weeks after a motor vehicle crash, regardless of fault: up to 25 physiotherapy sessions, 25 chiropractic sessions, 12 registered massage therapy sessions and 12 kinesiology sessions, among others. No referral or ICBC approval is needed for those sessions. The provider needs the ICBC claim number and the patient's Personal Health Number. Treatment after 12 weeks needs ICBC's approval before it starts. Altus bills ICBC for physiotherapy, chiropractic, massage therapy and kinesiology.

WorkSafeBC. WorkSafeBC funds treatment for accepted workplace injury claims. The patient reports the injury to their employer and to WorkSafeBC, receives a claim number, and brings it to the clinic along with their case manager's contact details. At Altus Integrated Health, WorkSafeBC claims are billed for chiropractic and physiotherapy only, not for massage therapy or kinesiology.

A crash that happens while driving for work can involve both an ICBC claim and a WorkSafeBC claim. The clinic needs to know about both to bill the right one.

The Medical Services Plan (MSP) does not cover physiotherapy, chiropractic or massage therapy for most BC residents. Supplementary benefits are the exception, for eligible people.

• Who qualifies. BC residents enrolled in MSP whose family's adjusted net income is under $42,000, plus some groups regardless of income, such as people receiving income assistance.
• What it pays. $23 per visit toward acupuncture, chiropractic, massage therapy, naturopathy, physical therapy and non-surgical podiatry.
• How many visits. A combined limit of 10 visits per calendar year across all of those services.
• The remainder. Many practitioners have opted out of MSP and can charge more than the MSP amount, with the patient paying the difference. Before treatment, they tell the patient how much MSP pays and how much the patient will pay.
• How to apply. Through the BC government's Application for Health and Drug Coverage, online or by mail.

Altus bills MSP on the patient's behalf for eligible patients.

Bringing the right information makes billing straightforward. Altus Integrated Health asks patients to bring:

• Government-issued photo ID. A driver's licence, passport or provincial services card.
• Insurance information. The extended health benefits card or policy details, for direct billing.
• Claim information, if it applies. The claim number and case manager's contact details for a WorkSafeBC or ICBC claim.
• Medical records that help the assessment. Copies of relevant X-ray, MRI or CT reports, a physician's referral note if the insurer or claim requires one, and a list of current medications or relevant medical conditions.

Fees are confirmed at booking, because costs vary by service; some treatments, such as dry needling and shockwave therapy, cost more than a standard physiotherapy session.

The clinic's cancellation policy, from its intake and consent forms, reads: "Your appointment time is reserved just for you. A late cancellation or missed visit leaves a hole in the therapists' day that could have been filled by another patient. As such, we require 24 hours notice for any cancellations or changes to your appointment. Patients who provide less than 24 hours notice, or miss their appointment, will be charged a cancellation fee." Insurers generally do not pay cancellation fees, so the patient pays them.

Direct Billing Sends Your Claim To The Insurer At The Visit

With direct billing, the clinic submits the claim electronically during the visit and the insurer pays its share to the clinic. The patient pays only the remainder, rather than the full fee followed by a wait for reimbursement.

Coverage Depends On Your Plan, Not On The Clinic

A clinic can bill an insurer directly, but the plan decides which disciplines are covered, how much each visit pays and how many visits a year it allows. The benefits booklet, insurer app or employer's HR department has the details. Asking about per-visit and annual limits, and any referral rule, before the first visit avoids surprises at the front desk.

Some Plans Need A Doctor's Referral Before They Pay

Physiotherapy, chiropractic, massage therapy and kinesiology do not need a referral to book in BC. Some insurance plans still require one before they reimburse, most often for massage therapy. Checking first avoids a declined claim.

MSP Supplementary Benefits Help Eligible BC Residents With Lower Incomes

For eligible residents, MSP pays $23 per visit toward physiotherapy, chiropractic, massage therapy and some other services, up to a combined 10 visits per calendar year. Eligibility depends on adjusted net income or on receiving certain assistance.

WorkSafeBC And ICBC Claims Are Billed With A Claim Number

Both programs link each treatment to a claim. The patient brings the claim number, and the clinic bills the program directly. At Altus, ICBC is billed for all four disciplines and WorkSafeBC for chiropractic and physiotherapy.

Misconception: Direct Billing Means The Visit Is Free

Direct billing changes who submits the claim, not what the plan pays. The patient still pays any amount above the plan's per-visit or annual limits, or the coinsurance share.

Misconception: If A Clinic Direct Bills Your Insurer, Every Type Of Care Is Covered

Each plan sets its own coverage for each discipline. A plan may pay well for physiotherapy and little or nothing for massage therapy or kinesiology. The insurer's list on a clinic's website shows who the clinic can bill, not what any plan covers.

Misconception: MSP Covers Physiotherapy For Everyone In BC

MSP supplementary benefits apply only to eligible residents, mostly those with lower incomes or receiving certain assistance, and pay $23 per visit for up to 10 combined visits a year. Most people rely on extended health plans or pay privately.

Misconception: You Need A Referral To Book Physio, Chiro Or Massage

None of these disciplines needs a referral to book in BC. Some insurance plans require one before they reimburse, which is a plan rule rather than a professional one.

Misconception: Late Cancellations Are Free If You Call

Calling ahead is always better than not showing up, but under Altus's policy, less than 24 hours' notice is still charged a cancellation fee, because the time usually can't be offered to another patient at short notice.

Which insurers to bill directly. Direct billing takes administrative time for each insurer. Some clinics bill every insurer they can; others bill only the largest and ask patients of smaller insurers to claim themselves.

Plan-required referrals. Patient advocates and practitioners argue that requiring a doctor's referral for directly accessible professions adds cost and delay and uses scarce physician time. Insurers defend referrals as a control on claims.

Opting out of MSP. Practitioners who opt out of MSP can charge more than the $23 schedule amount, which supports their fees. Critics argue it reduces the value of supplementary benefits for the lower-income patients they're meant to help.

Cancellation fees. Clinics charge cancellation fees to protect appointment availability for other patients. Some argue that fees deter people with unpredictable schedules or caregiving duties from booking care they need.

Annual maximums. Some argue that typical annual maximums for paramedical care run out partway through recovery from an injury. Insurers point to the cost of premiums for employers and members.

Health care billing for these disciplines assembles from parts that depend on one another. Paramedical coverage forms a component of an extended health plan, alongside prescription drugs and other benefits. The patient portion forms a component of every direct-billed visit where the plan pays less than the fee. The claim number forms a component of every ICBC and WorkSafeBC invoice, connecting treatment to the claim. The 10-visit annual limit forms a component of MSP supplementary benefits. The cancellation policy forms a component of the clinic's intake and consent forms, which patients see before their first visit.

Direct billing lets a clinic send a patient's claim to their insurer at the visit, so the patient pays only what the plan doesn't cover. In British Columbia, physiotherapy, chiropractic, massage therapy and kinesiology can be paid for through extended health plans, ICBC after a crash, WorkSafeBC after an accepted workplace injury, MSP supplementary benefits for eligible residents, health spending accounts or private payment. Coverage depends on the plan, and some plans require a referral even though booking does not. Altus Integrated Health direct bills 21 extended health insurers for eligible plans, bills ICBC for all four disciplines, WorkSafeBC for chiropractic and physiotherapy, and MSP for eligible patients, with fees confirmed at booking and a 24-hour cancellation policy.