Extended Health Care Direct Billing

Apr 07, 2017

Many of us have extended health care benefits through work or benefits that we pay for out of our own pocket. Whether you pay out of pocket for your benefits or you get them through another party, why not use them to your full advantage? They’re there for a reason, and in most cases like a lot of other things if you don’t use them you lose them.

Active Physio Works does provide the service of direct billing to many extended health care companies to help you, our patients, make the process of coming to physiotherapy, massage therapy or for acupuncture treatments a little easier and hopefully a little lighter on your wallet. We provide the service to help take one less thing off your plate and create less of a hassle for you, because let’s face it submitting receipts and invoicing can be a confusing task (especially if it’s your first time) and not to mention it takes valuable time out of your day.

Unfortunately, our clinic is not able to direct bill equipment to extended health care companies. In this case you would have to pay and submit the receipts to your benefit plan, however our receptionists would be happy to help with any questions or paperwork that may need to be filled out in order for you to get reimbursed.

This blog post will explain the companies we can direct bill to, how secondary submitting works, the time frame we have as providers and The Health Information Act.

Extended Health Care Companies Active Physio Works direct bills to are:

  • Bluecross/ASEBP/ARTA
  • Sunlife (excluding plans that are # 5555 usually military or government)
  • Great West Life
  • Johnsons
  • Chambers
  • Maximum Benefits
  • Chambers
  • Manulife (as long as your plan is set up for direct billing for providers)
  • Greenshield
  • Industrial Alliance
  • RCMP
  • Veterans Affairs

Secondary Submitting:

Secondary submitting is the act of direct billing to a second extended health care plan, which could include submitting balances from a treatment that a primary or your personal benefit plan did not cover, or if your primary benefit plan exhausts. If you have children and they are coming in for treatment and both parents have extended health care benefits we can also submit through both plans, however whichever parent’s birthday comes first in the calendar year will be considered the primary benefit plan. If you plan on having our clinic submit to two benefit plans please ensure that both plans are “linked”, which means whichever plan we are submitting to second must be aware that there is a primary plan.

As providers we are only able to secondary submit to a few extended health care companies, they are as follows:

  • Bluecross/ASEBP/ARTA
  • Great West Life
  • Greenshield

Unfortunately, if your secondary benefit plan company is not listed above you will have to pay and submit, if this is the case please ensure you ask our receptionist for a copy of your explanation of benefits to assist you in submitting on your own.

Submitting Time Frame

As providers extended health care companies give us time frames for which they allow us to submit. Our clinic does it’s best to ensure that all claims get submitted on time, however sometimes things do slip through the cracks. Please remember that if this does happen that as a patient you will be able to pay and get reimbursed through your extended health care.

The following list shows the amount of time we have to submit for each company we direct bill to.

  • Bluecross/ASEBP/ARTA - 60 Days
  • Sunlife/Johnsons/Chambers/Maximum Benefits/Manulife/Industrail Alliance - 30 Days
  • Great West Life - 30  Days Online/1 Year via paper submission
  • Greenshield - 1 Year
  • Veteran Affairs/RCMP - 1 Year

Health Information Act:

Health Information Act (HIA) The Health Information Act (HIA) establishes rules to protect the privacy of an individual's health information. It also regulates how health information can be collected, used and disclosed. (Alberta, 2017)

So how does this apply to extended health care and our clinic submitting claims for your treatments? Well basically what this means is as providers we are not able to call the extended health care company you are with to get information regarding your personal plan. For example we are not able to call Bluecross to find out how much coverage a patient has for physiotherapy prior or during the appointment. What this means for you as a patient coming into our clinic is that it is always a great idea to call your extended health care company prior to coming in for an appointment. When/if you are calling some information that you should get is:

  • How much coverage do I have?
  • How much/what percentage is covered per visit?
  • Is there a deductible?
  • Do I need a Dr. Referral?

If you find out this information before coming in for treatment direct billing should be a breeze for you and for our clinic. Finding out this information beforehand can also help you in avoiding surprises such as payment for your treatments, and plans exhausting all of a sudden, as you will be prepared for this.

If you would like more information on the Health Information Act please click the link below:

http://www.albertanetcare.ca/learningcentre/Health-Information-Act.htm


References:

Alberta, G.O. (2017) Health Information Act (HIA). Retrieved from Alberta Netcare Learning Centre:

http://www.albertanetcare.ca/learningcentre/Health-Information-Act.htm




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