Like many Ontarians you may be wondering how to get your physiotherapy treatments covered by OHIP. The good news is that there are a few ways to do this.
In this article, we’ll list the seven things you need to show to get your physiotherapy treatments paid for by OHIP.
How Do I Get My Physiotherapy Covered by OHIP: 7 Things You Need to
If you’re looking to get your physiotherapy treatments covered by OHIP, you need to show seven things.
1. A Referral From a Doctor, Nurse practitioner, or Chiropractor
If you want OHIP to cover physiotherapy costs, you need a referral from a doctor, nurse practitioner, or chiropractor. The referral needs to state that physiotherapy is medically necessary for your condition.
You may also be able to get a referral from your employer or the WSIB.
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2. Name and Contact Information of Physiotherapist
You need to provide the name and contact information of the physiotherapist you see to OHIP. The physiotherapist you see must be licensed to practice in Ontario.
3. Approved Plan of Treatment
The physiotherapist you see will need to create a plan of treatment that has been approved by the referring health care professional. It will need to include the number of treatments you’re expected to receive and how often you’ll be seeing the physiotherapist.
4. Valid Ontario Health Card
You need to have a valid Ontario Health Card to get your physiotherapy treatments covered by OHIP. If you are waiting for a new or replacement card to be sent to you, you may still be eligible for treatment.
5. Proof of Residency in Ontario
You need to be a resident of Ontario to get your physiotherapy treatments covered by OHIP. If you’re not a resident of Ontario, you may still be able to get your treatments covered if you’re a Canadian citizen or have a valid work permit.
Is Any Physiotherapy Covered by OHIP?
No, elective and long-term physiotherapy–such as to maintain function or ability to move or treat chronic conditions–are not covered by OHIP.
6. Documentation That OHIP Has Been Billed
The physiotherapist you see will need to bill OHIP for the services rendered. OHIP will only cover the cost of physiotherapy treatments that have been pre-approved.
7. Receipt for Payment
If OHIP does not cover the full amount of the service, you will need to provide a receipt for payment. The receipt should include the date of service, the name of the physiotherapist, and the amount paid. You may also be able to claim out-of-pocket expenses in your tax return.
Can You Get Reimbursed if You’ve Already Paid for Your Treatment?
If you received physiotherapy treatment outside of Ontario, you might be able to claim the amount back from OHIP. You’ll need to submit the “Out-of-Province/Out-of-Country Claim Submission” to do that. Make sure you do it within 12 months of receiving the service else your claim may be denied.
Whether you can receive reimbursement for treatment you received in Ontario is a little unclear. If you received OHIP-eligible physiotherapy treatment in Ontario, you shouldn’t have had to pay for it in the first place. The best course of action is to contact ServiceOntario to find out if you can get reimbursed for your treatment.
More Ways to Get Your Physiotherapy Covered by OHIP
If you’re not able to get your physiotherapy treatments covered by OHIP, you may be able to get coverage under Ontario’s Community Physiotherapy Clinic Program. The program provides funding for physiotherapy services to Ontarians experiencing worsening of symptoms due to a previous fall, injury accident, or surgery.
You are also eligible if you receive income from Ontario Works or the Ontario Disability Support Program.
OHIP Does Pay for Physiotherapy, But You May Not Want It
It may be tempting to have your physiotherapy treatments covered under the provincial health plan, but you may be in for a surprise. OHIP pays up to $312 per “Episode of Care”–which is far below market rates. Be prepared for long times to get an appointment at OHIP-funded physiotherapy clinics, non-personalized sessions, and limited at-home physiotherapy options.
A better treatment option would be going through your personal or workplace health insurance plan. Direct billing means you won’t have to pay anything out-of-pocket, and you’ll get the right care, not rushed care.
Find out how we can help you achieve your goals without having to pay out-of-pocket for physiotherapy.