Direct Billing

Some providers allow us to perform a pre-determination to see if your plan will likely cover the session, however we are not able to determine limitations or policies attributed to your extended health benefit plan. Once we direct bill for a completed session, your plan will indicate the coverage and/or limitations in place at the time of service.

Please contact your provider directly to determine these details of your coverage.

A doctors note is not required to receive massage therapy. However, some extended health plans might require a referral from a medical doctor before it begins reimbursing your massage therapy sessions. We often discover this aspect when submitting to your plan for the first time.

We recommend you consult with your extended health care provider before your session to determine if it requires a recommendation from a medical doctor

The Co-Pay or User-Fee is the portion of your treatment that is not covered by your extended health benefit plan. This portion may be a result of any of the following reasons:

• Percentage Limit – Not every plan covers 100%. Commonly we see 80% coverage, which means 20% of our session rate would be your out of pocket expense. In some plans, this limit may change upon reaching a threshold.
• Per Visit Dollar Limits – Your plan may cover 100%, however that may be restricted to a maximum dollar amount attributed to the treatment length.
• Annual Dollar Limit – These plans limit to an individual or shared maximum amount per calendar year or other annual period.

Your co-pay will be collected at the time of your visit. If we cannot process the direct billing for any reason (i.e. submission portal issues; reception absence; logistical issues), we will re-attempt the following business day and process your payment manually with the credit card number you provided on your Direct Billing Authorization form.

Printed and/or emailed receipts are provided after each completed session.

Please ensure you keep track of your receipts, as we typically charge a nominal fee for producing a statement of account.

The deductible is the amount you pay out pocket before the extended health benefit provider will pay for your sessions.

The majority of plans charge a deductible at the start of an annual period, typically by calendar year. Once we direct bill for your first session of the year, your plan will indicate the portion of your visit that went toward satisfying the deductible. We then bill you for the amount owed as part of your first session’s co-pay / user fee.

Please refer to your extended health benefit manual or contact your provider to find out what your plan deductible is.

Some patients have coverage under multiple extended health benefit plans. If both plans are administered by the same provider, we can potentially submit to both plans for you.

Unfortunately, there are situations where we cannot direct bill to both plans simultaneously. These situations include the following:

1. Most providers on our submission portal are not set up for coordination of benefits through direct billing.
2. Some plans do not permit coordination of benefits, regardless if the plans are administered by the same insurance provider or another.

In the event we are unable to direct bill to both plans, we will attempt to submit to your primary insurer and provide you the receipt for you to submit to your secondary plan.

If you have maximized your coverage on your primary plan, we can potentially submit to your secondary plan ONLY AFTER the secondary provider has been made aware that your primary plan has reached its annual limit. Contact your secondary provider to update them accordingly.