Insurance Covered Physiotherapist Services: What Are Your Funding Options?

Recovery from injury or surgery places extreme demands on both the mind and the physical body. Depending on the extent of injury or complexity of the surgery, recovery can be long and painful, especially without the help of an insurance covered physiotherapist.

Physiotherapy involves the use of physical exercises and counseling to improve health and mobility and to speed up recovery from injury or illness. Seeking physiotherapy early also significantly lessens the chances of developing chronic pain. But primary healthcare is expensive, let alone allied healthcare services such as physiotherapy.

Sadly, many patients fail to access much-needed physical therapy services because they simply can’t afford it. There are also cases where patients don’t have information on alternative funding sources they could take advantage of. Perhaps before we even get to funding options, let’s answer the question you are probably asking already:

Does Health Insurance Cover Physiotherapy?

In Canada, physiotherapy is classified under primary healthcare. This underlines the importance with which this branch of healthcare is treated. By implication, this classification impresses upon different insurance providers the necessity of ensuring coverage for physiotherapy care.

But while the common assumption is that physiotherapist services are covered under your employer’s insurance, the reality is there are parts of the population that aren’t covered. This applies to both the private or the free healthcare plans run by provincial governments. Many patients have to pay for physiotherapy out of pocket or buy personal health insurance plans.

Insurance Coverage Options for Physiotherapist Services

While insurance coverage for physiotherapist services is not guaranteed, people living in the different provinces of Canada do have options they can explore to ensure coverage. Below we will look at the various ways patients in Ontario can access insurance coverage for physiotherapist services:

Physiotherapy Coverage Under the Ontario Health Insurance Plan (OHIP)

The Ontario provincial government, through its Ministry of Health and Long Term Care, runs the Community Physiotherapy Clinic Service program under OHIP (Ontario Health Insurance Plan). Under this plan, patients can access free physiotherapy care at select clinics dotted across Ontario.

Sadly, though, not everyone is covered under OHIP. In fact, a large part of the population is omitted. And even for those that qualify, there are conditions that must be satisfied. To qualify for OHIP coverage, the following applies:

  • You must be aged below 19 years or over 65,
  • You must have been referred by a physician or registered nurse,
  • You must have been recently discharged from hospital where you sought treatment for the condition that physiotherapy would speed up recovery from
  • The physiotherapy must be directly related to the condition you were recently hospitalized for and for which there should be a referral from your doctor.

OHIP, while an excellent public health insurance plan that has also promoted the importance of physiotherapy for faster recovery from injury and illness, omits coverage for the province of Ontario’s most economically active people.

The provincial government likely looks at OHIP as a social security initiative whose aim is to ensure insurance coverage for economically marginalized sections of the population. If you are aged between 19 and 65, you have to consider other funding sources for physiotherapy care. Thankfully, there are quite a few options, which we will look at below.

Physiotherapy Coverage Through Personal Health Plans

Even for those that qualify for OHIP coverage, it goes without saying that if you are looking for comprehensive coverage or more personalized care, you will have to buy a personal/private health insurance plan. Private health plans, though, aren’t free and can be expensive. Not everyone can afford private health insurance.

Personal health insurance coverage is not specified for physiotherapy. It is lumped together under paramedical cost, which also covers chiropractic care, massage therapy, and naturopathy. Coverage is usually medically underwritten or offered under guaranteed issue. There are fundamental differences between the two:

  • Underwritten plans require answering specific medical questions and giving the insurance provider access to your medical records. In other words, coverage is offered upon assessment of your individual health needs.
  • Guaranteed issue plans do not require any medical records nor answers to specific medical questions. However, in comparison, its coverage for both drugs and care is usually lower.

Depending on the private health plan you are under, a doctor’s referral may not be necessary. But the advice here is to not make assumptions. Check with your insurer and ask specifically what coverage entails and the different conditions you must meet to access it.

Also, check for coverage limits as these almost always apply. There are maximum limits to costs per visit and the number of visits per year. Of course, these are computed from your monthly premium. Note also that some plans may include an option for what’s called catastrophic coverage, which increases coverage for people suffering from chronic conditions or those recovering from serious injuries.

Physiotherapy Coverage Under Employee Benefits’ Plans

Like coverage under private health plans, here physical therapy is grouped together under paramedical care, which also includes massage therapy, chiropractic care, and naturopathy (where it applies). The distinction is here it is your employer that foots the bill for the health insurance.

Also known as group health insurance, employee benefits plans also place limits on the number of visits you can make to your physiotherapy clinic. There is usually also a maximum cost per visit. The good news is while coverage is usually capped, it is often enough to cover 80 – 100 % of your physiotherapy costs. A doctor’s referral is also not needed.

Motor Vehicle Accident Coverage

Under this option, insurance coverage for physiotherapist services is offered through automobile insurers. But the coverage only covers physiotherapy for injuries sustained in an automobile accident. The implication here is coverage requires a doctor’s referral.

To qualify for physiotherapy insurance coverage under the MVA option, a patient must have been hospitalized overnight for the same injuries they now require physiotherapy for. The plan also only covers people aged below 19 years and those over 65 years. 

If you are aged between 19 and 65 you can still qualify for coverage if you are already receiving benefits under the Ontario Disability Support Program or Family Works.

Do You Have Insurance Coverage For Physiotherapy Care?

Physiotherapy is absolutely critical for recovery, pain management, and faster recovery from injury or illness. It also enhances muscle function, helps relieve stress, and reduces the risk of re-injury. 

You should now be familiar with the various insurance coverage options you have to ensure funding and access to physiotherapy services. Review your options and decide which one gets you the best coverage and take advantage of physiotherapist services for faster recovery and peak physical health.

St. Clair Physiotherapy Clinic provides full services for physiotherapy care. Our doctors and certified, insurance covered physiotherapists are highly trained and experienced professionals that are trusted by patients in Toronto for high quality, effective individualized care. Contact us to book your first appointment with us.

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