Insurance information

CLINIC: DIRECT BILLING POLICY | FIRST APPOINTMENT QUALIFICATION | PATIENT RESPONSIBILTY | GET CONSENT FORM | INSURANCE PROVIDERS

It is patient’s responsibility to know about their own coverage prior to booking.

Direct Billing & Insurance Policy

For your convenience, this clinic offers direct billing to participating insurance companies. By booking an appointment, you accept all Terms & Conditions and

Clinic Policies regarding insurance and payments.

The 5 Conditions for Direct Billing
To qualify for direct billing at this clinic, the following conditions must be met:

Policy Knowledge: The patient understands their specific coverage and limits.
Eligibility: Only persons explicitly listed under the policy qualify.
No Restrictions: The appointment must not violate insurer "restrictions" (see below).
Consent: Written consent must be provided for each insurer.
Documentation: All benefit cards (Primary and Secondary) must be presented at the first appointment.

Note for Non-Cardholders: If you are not the primary member, you must provide the cardholder’s name, date of birth, and your relationship to them (required for all insurers except Pacific Blue Cross).

First Appointments: Payment & Qualification

Standard Policy: All new patients must be prepared to pay in full on the day of the appointment via Cash, Cheque, or E-transfer.

How to Qualify for Direct Billing on Day One:
You may qualify for immediate direct billing if you provide your insurance details and consent in advance:

Option 1 (Advance): Email or text an image of your card(s) to [email protected] with the phrase "Consent given in good faith" for a pre-determination inquiry.

Option 2 (At Clinic): Bring your card(s) and fill out the forms in person. You must sign a physical consent form at the clinic to qualify.

Insurance & Billing: Policies & Patient Responsibility

It is the patient’s responsibility to confirm all insurance coverage and benefits before booking. By booking an appointment, you acknowledge that all fees are ultimately your responsibility.

1. Direct Billing Eligibility

Direct billing is a convenience we offer for participating insurers, provided the claim is processed immediately through the provider portal.

You should ensure your account is setup to "pay provider".

Direct billing is NOT available if:

Third-Party Involvement: The treatment is related to a motor vehicle accident (ICBC), a workplace incident (WorkSafeBC), or any incident involving a liable third party.
Travel-Related: The service is for a medical emergency occurring while travelling outside of Canada.
Documentation Gaps: Your insurer (such as Manulife) requires a doctor’s referral that has not yet been submitted to their member portal.
Portal Restrictions: The Insurer does not allow "provider-pay" or the portal is experiencing technical system issues.

2. Payment Terms & Methods

We accept Cash, Cheque, or E-transfer only. We do not offer debit or credit card services.

Reconciliation: All outstanding balances must be cleared within 24 hours via E-transfer.
Unsuccessful Claims: If a direct billing attempt is denied or fails for any reason, the full balance becomes the patient's responsibility to pay out-of-pocket immediately.
Receipts: Official receipts are typically issued the following in 1-2 business days once the full payment has been received and the account is at a zero balance.

Reconciliation of Balances:

If an insurance claim is unsuccessful, you will be notified via email, text, or phone. The Submission Summary may be included.

Payment Method: Outstanding balances must be paid via E-transfer.
Timeline: All accounts must be reconciled within 24 hours to keep your account in good standing.

3. Attendance & Coverage Limits

Attendance Only: Insurance companies only pay for appointments you physically attend.
No Coverage for Fees: Fees for missed appointments or late cancellations (within the 48-hour window) cannot be billed to insurance and must be paid by the patient as a condition of service. Injuries at work or work-related excluded as well.
Daily Limits: Most insurance policies restrict coverage to a single massage treatment per day.

4. Keeping Your Account Current

Coverage Changes: You must provide updated insurance information during your appointment if your provider or policy details change.
Communication: If a claim is unsuccessful, you will be notified via email, text, or phone to reconcile the balance within the 24-hour window to keep your account in good standing.

5. Key Insurance & Billing Rules:

Attendance Requirement: Insurance providers only cover appointments you physically attend. Missed sessions or late cancellation fees cannot be billed to insurance and are the patient's responsibility.
Daily Limits: Most policies limit coverage to a single treatment per day.
Direct Billing Qualification: "Provider Pay" Only claims that are immediately processed through the provider portal qualify for direct billing (where the insurer pays the RMT directly).
Account Reconciliation: All outstanding balances must be settled within 24 hours of your appointment.
Receipts: Official receipts are typically issued the following business day once full payment has been received and the balance is reconciled.

A Term and Condition of Service:

All accounts must be reconciled within 24 hours to keep your account in good standing.
Account Standing: All fees must be paid in a timely manner to keep your account in good standing. * This is a requirement to continue treatment(s), in accordance with Clinic Policy on New Patients page.

Get An Insurance Consent Form

Insurance Providers and their by portals:

Pacific Blue Cross portal - Pacific Blue Cross;

Lumino Health portal - SunLife. *

* Polices set as Member pay do not qualify.

Telus Health portal - Alberta Blue Cross, Belairdirect (formerly Johnson Inc.), Beneva, BPA, Canada Life (inc Great-West Life), Canada Life - PSHCP, Canadian Construction Workers Union, Chambers of Commerce Group Insurance Plan, CINUP, ClaimSecure, Coughlin & Associates and People Corporation (Coughlin), Cowan Insurance Group, DA Townley, Desjardins Insurance, Equitable Life, First Canadian, GMS, GroupHEALTH, GroupSource, Industrial Alliance, Johnston Group, LiUNA local 182, LiUNA local 506, Manulife Financial *, Maximum Benefit, NDN Insurance, Peoples Corp, RWAN, Simply Benefits, Telus AdjudiCare, Union Benefits, and UV Insurance;

* Delays in adjudication requiring member to provide doctor's note. Typically, the insurers require the member to provide the doctor's note.

Provider Connect portal - Green Shield Canada *, SSQ Insurance, Medic Construction (GSC) & Empire Life;

* Delays in adjudication for more than 5 days are common, may not qualify.

LifeMark portal - Medavie Blue Cross; Partners in Canadian Veterans Services Rehabilitation (PCVRS)*.

* The onus is on the patient to communicate with their "Insurance provider", prior to making appointments or patient-pay. And to ensure that the information is provided to the RMT, when making arrangements for treatment.

* All Insurers agreements must be followed.

Your clinical record is protected by BC PIPA. And a special consent release form is required to release your information.
Please note many private Insurance benefits typically do not cover injuries/accidents due to MVA and or work, nor missed appointments.

Insurance information: