Insurance Coverage & Direct Billing

To make your experience as smooth as possible, we offer direct billing to simplify the insurance process, so you can focus on your health.

1.What is direct billing?

Direct billing allows us to submit your treatment claims directly to your insurance provider after each visit. This means you won’t need to fill out forms, submit receipts, or follow up with your insurance company. If your plan covers the treatment, you’ll only be responsible for paying any portion not covered by your insurance, making the process simple and hassle-free.

2.Are Our Services Covered?

Many extended health benefit plans cover:

  • Registered Massage Therapy (RMT)
  • Acupuncture & Chiropractic Care
  • Physiotherapy & Osteopathy

Due to privacy regulations, we cannot check your plan’s specific coverage. We strongly recommend reviewing your benefits online or by contacting your insurer before your appointment to avoid unexpected expenses.

3.What You Need

 

To enable direct billing, please complete the following before your appointment:

  1. Intake Form
  2. Direct Billing Consent Form
  3. Accurate insurance information

If you haven’t received these forms, please contact our clinic. We’ll be happy to send them to you.

4.Insurance Companies We Work With

We offer direct billing with over 20 providers. The most commonly used insurers are marked in bold and underlined.

  • AGA Financial Group Inc.
  • Alberta Blue Cross
  • belairdirect (formerly Johnson Inc.)
  • Beneva Inc.
  • Blue Cross
  • BPA-Benefit Plan Administrators
  • Canada Life (formerly Great-West Life)
  • Canada Life – PSHCP
  • Canadian Construction Workers Union
  • Chambers of Commerce Group Insurance
  • CINUP
  • ClaimSecure
  • Coughlin & Associates Ltd.
  • Cowan
  • Desjardins Insurance
  • Equitable Life of Canada
  • First Canadian
  • GMS Carrier 49
  • GMS Carrier 50
  • GroupHEALTH
  • GroupSource
  • Industrial Alliance
  • Johnston Group Inc.
  • LiUNALocal 183
  • LiUNALocal 506
  • Manion
  • Manulife Financial
  • Maximum Benefit
  • MDM Insurance Services Inc.
  • People Corporation
  • RWAM Insurance Administrators
  • Simply Benefits
  • Sun Life
  • TELUS AdjudiCare
  • Union Benefits
  • UV Insurance

Please note: Direct billing is not guaranteed as technical issues or policy restrictions can occur. This is especially common with Industrial Alliance and less frequently used insurers.

5.Limitations of Direct Billing

While convenient, direct billing does come with some limitations:

  • Partial Coverage: If your plan covers only a portion of the cost, you’ll be required to pay the balance at your visit.
  • No Secondary Coordination: We are unable to bill secondary plans (e.g., your spouse’s insurance), with the only exception being Sun Life.
  • Same-Day Billing Only: We can only bill for services rendered on the same day. Pre-billing for future appointments is not permitted.
  • Split Invoices: We cannot divide claims to fit plan maximums or deductibles.
  • Pending or Failed Claims: You may need to pay upfront if your claim is marked as pending, denied, or requires manual processing.

6.Exceptions to Direct Billing

There are situations where direct billing may not be available:

  • Your provider’s online system is temporarily unavailable.
  • A physician referral is required and not yet provided.
  • Your provider responds with a “Payable to Plan Member” notice.
  • The therapist is new or not yet registered with your insurance provider.
  • Your plan does not support direct billing (manual submission required).

In these cases, payment is due at the time of service. We will provide an official receipt for your manual claim submission.

FAQs

We can direct bill for the following services:

  • Massage Therapy
  • Chiropractic
  • Acupuncture
  • Physiotherapy
  • Osteopathy

Note:

  • Direct billing is not available for medical products in Ontario.
  • Osteopathy is not eligible for direct billing through Sun Life. For other insurers, we may attempt submission on a case-by-case basis, but approval is not guaranteed.
  • Some insurers may restrict coverage based on the service type or individual provider.
  • Eligibility may vary even within the same insurance company. For example, your plan may allow direct billing for chiropractic but not for physiotherapy.

Due to privacy laws, we do not have access to your coverage details. To check your benefits:

  • Log into your insurer’s mobile app or website
  • Contact your insurance provider directly
  • Review your benefits booklet (often provided by your employer)

 

We submit claims on the same day as your appointment. Claims must be for services already rendered. We cannot pre-check your coverage or submit claims in advance.

 

If your plan:

  • Covers 100%, no payment is required from you.
  • Covers a portion, you’ll pay the remaining balance.
  • Covers only an eligible amount, you’ll pay the difference between our fee and what your insurer covers.

 

Many insurers define 100% coverage based on their eligible amount, not our full service fee. If the eligible amount is lower than our rate, you’ll need to pay the difference.

For percentage-based plans (e.g., 80% or 90%), insurers apply that percentage to their eligible amount, not our full fee. This can result in a higher-than-expected balance.

Note: Eligible amounts vary by treatment duration. We are unable to submit multiple durations to determine this in advance. Please contact your insurer for details.

 

A pending claim means your insurer couldn’t process it automatically. You may be asked to:

  • Pay upfront
  • Contact your insurer for clarification
  • Provide additional documents (e.g., a doctor’s note)

We will void pending submissions to avoid accidental payment to our clinic.

Exception: If the insurer confirms payment will be issued to you (the member), we will leave the claim in place. This is common with Sun Life, where payments cannot be sent directly to clinics.

Most pending claims are resolved in 5–7 business days.

This status means your insurer does not allow direct payment to clinics. Payment is automatically redirected to you.

In this case, you will be charged the full amount, but you do not need to submit the claim manually—reimbursement will be sent directly to you.

This commonly occurs with Canada Life or Manulife.

Most reimbursements are processed within 5–7 business days.

 

Some insurers appear on our billing portal, but not all policies are eligible for direct billing.

For example:

  • LiUNA Local 183 or 506 is listed, but most plans under it do not allow direct billing.
  • Industrial Alliance appears on the portal, but we have not had success with electronic submissions.

For these insurers, we can attempt submission case by case, but approval is not guaranteed.

Only if the family member is listed as a dependent under your insurance plan.