Direct Billing Information

Do you have extended health benefits? We offer direct billing to many insurance companies for Acupuncture services, including:

Preparing for Your Appointment

• Extended health benefit plans vary in coverage and in their ability to accept direct-billing.  Prior to booking your first appointment, we highly recommend contacting your insurance benefit provider to confirm the type and amount of coverage your plan offers, and whether they accept direct-billing and assignment of benefits.

• Our practitioners are Registered Acupuncturists, and are members in good standing of the College of Acupuncturists of Alberta.  A small number of benefit plans only cover Acupuncture if it is performed by a chiropractor, physiotherapist, or physician, so please be sure to check these qualifications when you contact your benefit provider.

• Some plans require a prescription to claim Acupuncture benefits; if you are required to send the prescription/doctor’s note in yourself, we may not be able to direct-bill your treatments until the prescription has been received and reviewed by the benefit provider.

• At this time, we cannot direct-bill for Manual Osteopathic Therapy treatments, although many benefit providers will reimburse you directly when you submit your receipt. Please contact your benefit provider to find out if they will cover osteopathy provided by a Manual Osteopathic Therapist registered with the Canadian Massage and Manual Osteopathic Therapists Association (CMMOTA). Please note: at this time, Canada Life does not reimburse claims for Manual Osteopathic Therapy provided by any practitioner registered with CMMOTA. To make an inquiry about their policy regarding this service and qualifications, please speak to your plan administrator or Canada Life directly.

• Herbal consultations, Chinese herbal medicine, and other supplements are generally not eligible for reimbursement; however, if you have a wellness or health spending account you may be able to submit your receipts for reimbursement. Please check with your benefit provider regarding your coverage if you are interested in using your benefits for any of these other services.

Policies

• You are responsible for any amounts owing that are not paid by your benefit plan. Payment for any amount owing after direct-billing is due at the time of treatment.

• The direct-billing portals are generally very reliable, but technology sometimes fails. If there is a problem with the submission portal and we cannot direct-bill your claim, you will be required to pay for your visit and submit your receipt for reimbursement. Please be sure to bring an alternate method of payment just in case.

• We can only direct-bill for completed treatments. We cannot bill for missed or cancelled appointments (unless your plan covers these), and we cannot bill treatments in advance. If your plan does not allow for assignment of benefits, we cannot submit a claim for reimbursement to you prior to the treatment being paid for in full.

• Direct-billing is a privilege granted to our office and a convenience provided by the benefit providers. To maintain our good standing with the various benefit providers, we must comply with their terms and conditions, including verification requests, which may include sharing information about your services as per their requirements. We appreciate your understanding that we can’t circumvent plan limitations by submitting claims inappropriately, as this may jeopardize our ability to direct-bill for our other clients.

Important Information and Commonly Asked Questions

• We are not able to determine your coverage eligibility or amount until the time of the treatment. We are only notified once you reach your yearly maximum and cannot check to see how much you have left for the year. Please contact your benefit provider to find out your plan limits; there may be limits per visit, per year, or both.

• Many benefit plans follow their own “Usual & Customary Fee” guide; the cost of your treatment may be higher than this amount, resulting in an out of pocket expense.

• Many benefit plans have a coinsurance amount; for example, they will pay 80% of the treatment cost, and you would be responsible for the remaining 20% as an out of pocket expense. This varies widely between plans, so please check with your benefit provider to verify your coinsurance amount.

• Some plans have a deductible that must be paid out of pocket before claims will be reimbursed.

• Some plans do not allow assignment of benefits; that is, they will not pay the clinic directly and will send any payment to you instead. If this is the case, we must collect payment from you at the time of treatment.

• If you have multiple benefit plans, please check with your benefit provider(s) if you do not know the order in which the plans pay (primary, secondary, etc.) Most benefit providers do not allow direct-billing as the secondary payer with a few exceptions: Alberta Blue Cross, Sunlife, and Green Shield Canada. If your secondary benefit plan does not allow direct-billing of any balances, you will be required to pay the balance at the time of your treatment and submit a claim for reimbursement to your secondary plan.

• We do not have a contract with Workers’ Compensation Board and cannot direct-bill for treatments of workplace injuries.

• The Coverage for Seniors program administered by the Government of Alberta unfortunately does not provide coverage for Acupuncture.