- Do I need a referral from a doctor?
- Motor Vehicle Accident Insurance
- MVA Clients Information Outline
- EXTENDED or EMPLOYER HEALTH BENEFITS (EHB)
- COMMUNITY REHABILITATION PROGRAM (CRP)
- Workers Compensation Board (WCB)
- APA Fee Schedule
Do I need a referral from a doctor?
No. Physical Therapists are primary health care providers, just like doctors and dentists. You can come in to see us without having a doctor's note. Some insurance companies may require a doctor's referral before they will reimburse you for your treatment costs, though.
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Forms
Motor Vehicle Accident Insurance Diagnostic and Treatment Protocol Regulations (since October 1, 2004)
10 or 21 treatments are available and may be billed directly to the insurance company, based on our diagnosis, without need for pre-approval by the insurance company, for "minor injuries" (a legal definition of sprains, strains, and Whiplash Associated Disorders grades 1 and 2 - i.e. without neurological injury or fracture, therefore most injuries).
We do the assessment and complete the necessary forms for this.
You must agree to be treated under the terms of the Diagnostic and Treatment Protocol, and meet the time-line of presenting within 10 days of the collision to access this program. The MVA insurance is "first payor" in this situation.
Otherwise the "old" rules apply and (MVA) Section B benefits will REIMBURSE up to $50,000 over 2 years for "medically necessary expenses". Proof of medical referral is usually necessary and the insurer determines necessity.
The appropriate forms MUST be completed and returned by you, by us and by your doctor for PRE-APPROVAL by the insurance company, to establish your claim.
Your motor vehicle insurance company MAY accept "direct billing" after your paperwork is complete, and AFTER any Extended / Employer Health Benefits are exhausted.
Usually, the MVA insurance pays ONLY AFTER any other insurance coverage you may have.
10 or 21 treatments are available and may be billed directly to the insurance company, based on our diagnosis, without need for pre-approval by the insurance company, for "minor injuries" (a legal definition of sprains, strains, and Whiplash Associated Disorders grades 1 and 2 - i.e. without neurological injury or fracture, therefore most injuries).
We do the assessment and complete the necessary forms for this.
You must agree to be treated under the terms of the Diagnostic and Treatment Protocol, and meet the time-line of presenting within 10 days of the collision to access this program. The MVA insurance is "first payor" in this situation.
Otherwise the "old" rules apply and (MVA) Section B benefits will REIMBURSE up to $50,000 over 2 years for "medically necessary expenses". Proof of medical referral is usually necessary and the insurer determines necessity.
The appropriate forms MUST be completed and returned by you, by us and by your doctor for PRE-APPROVAL by the insurance company, to establish your claim.
Your motor vehicle insurance company MAY accept "direct billing" after your paperwork is complete, and AFTER any Extended / Employer Health Benefits are exhausted.
Usually, the MVA insurance pays ONLY AFTER any other insurance coverage you may have.
EXTENDED or EMPLOYER HEALTH BENEFITS
As noted above, under the regular Section B rules, you will usually need to pay for your treatments and submit your receipts for reimbursement. Usually you will need evidence of medical referral to get reimbursed. Any balance remaining after reimbursement by any EHB plan can then be submitted to your MVA insurer for reimbursement.
Fees are payable at time of service. Accepted methods of payment are cash, Interac, VISA and MasterCard.
MVA Clients Information Outline
Please complete the insurance information form we give you at intake. If you do not have all the information with you, return the completed form at your next appointment or drop it off sooner.
Since October 1, 2004 new Diagnostic and Treatment Protocol Regulations (DTP) for "minor injuries" (most injuries are "minor" by this legal definition) are pre-approved for treatments (10 or 21 depending on diagnosis) if you "opt in" to the DTP program.
We have the necessary forms for this program; you no longer have to wait for your insurance company to send them to you.
Under this program your car insurance company is first payor for your first 10 or 21 treatments and our billing goes directly to them. Payment by the car insurance for any further treatment requires approval by your insurance adjuster and / or re-assessment by an independent Injury Management Consultant (IMC).
Previously, if you and / or your spouse had an Extended or Employer Health Benefit (EHB) plan through work, those benefits needed to be used up before your car insurance company would pay anything.
Your EHB is still first payor if you "opt out" of the DTP, or don't fit into the DTP because of the nature / diagnosis of your injuries, delay in presenting for treatment, or require / want further treatment after DTP and this has not been approved by your adjuster.
Almost all EHB plans require the client to pay for service and then submit receipts for reimbursement. If you believe that your plan is an exception to this rule, i.e. will accept direct billing from us, please be aware that we will require confirmation of this from the plan.
Extended Health Benefit plans usually require:
* the invoice for services,
* a written receipt showing payment,
* a completed Determination of Need form, which we will supply with the receipt,
* a completed claim form for their company
You are reminded that you are personally responsible for payment for all services until we receive confirmation from your insurance company that they will accept billing from our clinic, and they have paid your account in full.
If you need more information or help with any of this please ask our front desk staff. We do try to make it as simple as possible.
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Please complete the insurance information form we give you at intake. If you do not have all the information with you, return the completed form at your next appointment or drop it off sooner.
Since October 1, 2004 new Diagnostic and Treatment Protocol Regulations (DTP) for "minor injuries" (most injuries are "minor" by this legal definition) are pre-approved for treatments (10 or 21 depending on diagnosis) if you "opt in" to the DTP program.
We have the necessary forms for this program; you no longer have to wait for your insurance company to send them to you.
Under this program your car insurance company is first payor for your first 10 or 21 treatments and our billing goes directly to them. Payment by the car insurance for any further treatment requires approval by your insurance adjuster and / or re-assessment by an independent Injury Management Consultant (IMC).
Previously, if you and / or your spouse had an Extended or Employer Health Benefit (EHB) plan through work, those benefits needed to be used up before your car insurance company would pay anything.
Your EHB is still first payor if you "opt out" of the DTP, or don't fit into the DTP because of the nature / diagnosis of your injuries, delay in presenting for treatment, or require / want further treatment after DTP and this has not been approved by your adjuster.
Almost all EHB plans require the client to pay for service and then submit receipts for reimbursement. If you believe that your plan is an exception to this rule, i.e. will accept direct billing from us, please be aware that we will require confirmation of this from the plan.
Extended Health Benefit plans usually require:
* the invoice for services,
* a written receipt showing payment,
* a completed Determination of Need form, which we will supply with the receipt,
* a completed claim form for their company
You are reminded that you are personally responsible for payment for all services until we receive confirmation from your insurance company that they will accept billing from our clinic, and they have paid your account in full.
If you need more information or help with any of this please ask our front desk staff. We do try to make it as simple as possible.
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EXTENDED or EMPLOYER HEALTH BENEFITS (EHB)
To access your EHB insurance you will usually need to be disqualified from CRP by the CRP assessment, ineligible for CRP, or have exhausted your CRP coverage.
Usually you will need evidence of medical referral to get reimbursed, and a copy of a CRP "Determination of Need" form, which we provide when you pay us.
You will probably also need to access any EHB coverage you may have if you have exhausted DTP coverage, or otherwise "don't fit" into the DTP (e.g. present more than 10 days after the collision) under MVA rules.
You will need to pay for your treatments and then submit your receipts for reimbursement.
Fees are payable at time of service. Accepted methods of payment are: cash, Interac, VISA, MasterCard.
COMMUNITY REHABILITATION PROGRAM (CRP)
CRP is the system that, since 1995, has replaced Alberta Health Care for physical therapy benefits.
CRP will pay for a "Determination of Need" assessment for most people (you must have valid AHC coverage, and CAN NOT have WCB claim for the presenting problem). Injuries from automobile accidents within the past two years are excluded from CRP eligibility.
GENERAL CRP CLIENTS
If qualified by the CRP assessment, you are ELIGIBLE for UP TO 2 more treatments for a total of up to 3 visits. Most conditions will need more than 3 treatments and therefore you will need to move to self-pay to continue treatment after exhausting your CRP coverage.
Treatment at another clinic, for the same problem, in the same benefit year (April 1 to March 31), IS included in this total. You must tell us if you have had treatment elsewhere.
ORTHOPEDIC CRP CLIENTS
You MAY be ELIGIBLE for additional treatments (up to 4 more - therefore up to 6 after the assessment) if you have had a fracture or an orthopedic surgery procedure, and come to us within the time limits for seeking treatment (8 weeks post surgery or fracture, or 2 weeks after removal of cast).
GOVERNMENT SUBSIDY / LOW INCOME
You MAY be ELIGIBLE for additional treatments (up to 4 more - therefore up to 6 after the assessment) if you are a recipient of an Alberta Government subsidy or assistance programs, OR had "low income" last year, OR are experiencing "temporary financial hardship".
You must present your subsidy card for verification, or declare your financial status on the forms available, BEFORE your basic 3 visits are used, to activate this part of the program.
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Workers Compensation Board (WCB)
WCB is the agency responsible for paying for treatments, lost wages, pensions, etc. for workers injured on the job, or in the course of their employment duties.
Acadia Physical Therapy has opted not to have a contract with WCB.
Therefore, we are not able to accept for treatment anyone with a current or pending WCB claim (for the area or condition for which they are seeking treatment).
Occasionally this means we cannot treat someone we have a pre-existing good relationship with, and that make us sad.
Most of the time it just means we don't have to deal with excessive and random bureaucracy, and yet another source of inappropriate arbitrary fee restriction.
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APA Fee Schedule
Over the years the Alberta Physiotherapy Association has made some efforts to produce Cost of Business analyses to help determine rational Fee Schedules.
Many of these analyses did not consider e.g. whether the owner made a profit on his or her investment, or even had a decent or appropriate wage.
Most recently the Canadian Physiotherapy Association did a Cost of Business survey of Western provinces wherein reasonable owner incomes, and a small return on investment, were presupposed.
An average cost of providing a treatment in each province was thereby determined and from this a reasonable fee was calculated.
Each clinic also got a review of their own expenses / revenues compared to the Provincial average. It was very sobering for some of us!
The recommended fees for treatment, as of December 2006, are available at this link.
Acadia's private fees are currently about 80% of the recommended rate.