What is Direct Billing for Extended Health Insurance?
Employers everywhere are starting to see the benefit of including extended health insurance as part of a benefit package for their employees. They are recognising that our standard medical system does not offer everything you might need to be a healthy, happy and productive employees. Extended Health insurance plans often include alternative and complementary medical services, such as massage therapy, that you would otherwise have to pay for out out of pocket.
Common services that extended health insurance plans might include are:
- Massage Therapy
- Naturopathic Medicine
- Custom Foot Orthotics
- Counselling and Psychotherapy
- Eye care and glasses
- Fitness Spending
- Discretionary funds to use how you like! You need to ask about this!
Typically you will receive a certain dollar amount (i.e. $300 – 500) toward a particular service.
The most common companies providing extended Health plans are:
- Pacific Blue Cross
- Great West Life
- Sun Life Financial
- Chambers of Commerce Group Insurance Plan
- Standard Life
- Industrial Alliance
- Maximum Benefit
- SSQ Financial
- Johnston Group
No two plans are alike!
Each plan is unique to the individual, and depends on the following factors:
- Your Employer
- The Insurance Company
- The specific Plan or Policy that your Employer chooses within this.
For example, your Pacific Blue Cross policy might include $500 toward massage therapy, while your spouse’s Great West Life policy through their employer might only get $300. Amounts are decided on by each company, and are often negotiated by unions.
How is Direct Billing done?
Before direct billing came to BC, it used to be that the only option for getting these services paid for was to pay for them yourself upfront, submit the receipt either by mail or online, and then wait for a cheque in the mail (or a direct bank deposit). The turnaround time to get the money this way can be prohibitive for people who are tight on cash.
Many companies have now created websites that allow clinics like ours to log in themselves and get paid directly, saving you the hassle of both submitting and waiting for your money! We do this for you through sites like Telus E-Health, which has combined access to many companies on one easy website.
This is great news! All you have to do is bring your policy and plan numbers (you should have a wallet card) and we can directly bill for you!
Will I ever have to pay up front?
- If your plan only covers a portion of the visit (i.e. 80%) you will have to pay the difference to the clinic,
- If your company does not do Direct Billing at all or for specific types of services (call ahead if you are unsure)
- If it’s the first time using Direct Billing Services the Insurance Company sometimes blocks the first transaction because they want to make sure a real person can verify that it’s legitimate. This does mean that you will have to pay up front on your first visit, but it usually clears up for follow-ups.
Common Questions to ask your Insurance Provider:
Being prepared for direct billing before you come in for your first visit for is always a good idea. Do to privacy issues, you are the only one who can ask about your plan! Plan to make a quick phone call and ask the following questions:
- What is my coverage period?
- What Categories am I covered for?
- Do I have an annual deductible?
- What are my maximums for each category? (dollar amount)
- Up to what amount is covered per each visit? Is it different for initial visits versus follow-ups?
- Are labs and diagnostics covered under Naturopathic Services or under another category?
- Do I need a referral from an MD to obtain any of these services?
- Does my plan cover Registered Therapeutic Counsellors?
- Does my plan cover orthotics and do I need a referral?
- Do I have separate “health spending account” or “fitness account” that can be used for other health care services not listed above?
Here’s a link to our online questionnaires that you can use when you call your insurance company, and it will submit the answers straight to our front desk to have on file for your visit.
What are my health options if I’m self employed?
If you are a small business owner, or even a family, and would like to invest in a extended health benefit plan for yourself and only a handful of other people, check out the Chambers of Commerce Group Insurance Plan. You can also call any of the above insurance companies and have them give you quotes for what it might cost for a small plan.
You can also contact your financial advisor to help you find funding solutions for health care from your own income, savings and investments. For example, LivingWell Healthcare Funding Solutions provides financial services to those who want to plan for healthcare expenses, providing innovative strategies to restructure your mortgage, debts, and cashflow, and immediately get more life from the money you didn’t know you had!
At Empower Health Clinic, here on Commercial Drive Vancouver BC, we accept direct billing from most of the major extended health insurance providers in BC. Call today for details! 604-336-2844