What do my insurance benefits cover?

What is covered varies from plan to plan.  Plan coverage tends to be broken into two areas Dental Plans, and Extended Health Benefits.  Extended Health plans may cover a wide range of items, but are generally designed to offer coverage for services not included in universal health care (e.g. Medicare) like prescription drugs, hospital room upgrades, specialized nursing, out of country medical care, artificial limbs/prostheses/medical appliances, wheel chairs/walkers, vision care, Practitioner Services, etc. and funding amounts vary by category.  This means that if you use up all of your vision coverage to get a new pair of glasses this does not impact funding available for a hospital room upgrade or a wheelchair. 

Services such as psychologist/licensed counselling therapist, chiropractors, physiotherapists, massage, podiatrists, osteopaths and optometrists fall under Practitioner Services.  Practitioner Services often draw on one or two pools of money for a group of services.  This means that if you use your benefits to see an osteopath, you may have less money remaining for psychology services, or to see a physiotherapist.  It is also good to note that sometimes therapy can be covered separately from assessments. You need to talk directly to your insurance provider to clarify these details.

Can you direct bill my insurer?

Sometimes…  

We cannot check if your insurance plan covers a particular provider (psychologist, counsellor, social worker, intern). Only the plan member can find out what types of providers they are covered for.

We can direct bill the following when individual plans allow: Blue Cross (Medavie, VAC, RCMP, CAF) for licensed psychologist (Psych), Licensed Counselling Therapist (LCT), and Registered Social Worker (Masters level – MSW); Canada Life, Chamber of Commerce, Johnston, GroupHEALTH for Psych and MSW only; Green Shield, Empire Life, MEDIC, RBC and SSQ for Psych, LCT, and MSW; NexGen and cooperators for Psych and MSW. This does not mean that other providers are not accepted under these plans, it means that we cannot direct bill for them. It also does not mean that your plan covers these designations so it is best to check the details of your plan.

Occasionally a client will have an insurance plan with a company that we can normally direct bill an LCT for, but their specific plan does not allow for it because the employer did not select that feature when setting up the plan.  You can contact your employer and request they add LCTs and direct billing feature.  KV Psychology & Wellness Clinic will not know about restrictions on the plan until we attempt to bill the plan at the end of session.  It is up to the client to check with their insurance provider prior to the session to be sure their particular plan does not have these restrictions.

While some insurance providers have a website that allows for direct billing for physiotherapists, dentists, etc., the insurance company may have chosen to not allow psychologists to direct bill. This is a decision made by the insurance company. Until they receive enough requests to “turn on” direct billing for psychologists, no psychologist or mental health therapist can direct bill these companies. KV Psychology & Wellness Clinic clinicians will direct bill clients of these insurance companies as soon as these insurance companies allow us to do so.  In the meantime, we provide our clients with a receipt at the end of each session that will allow you to seek reimbursement from your insurance provider.

What if my insurance doesn’t cover the entire session cost?

Clients without 100% coverage for their direct billed service will need to pay the balance outstanding at the time of service. 

What if I find out later my insurance doesn’t cover the type of therapist that I saw?

Sessions provided to clients who later find out their insurance does not cover that provider will not be reimbursed. Before attending any therapy session, please check that your insurance covers the provider you are booked with.

If you want to know which type of clinician can direct bill, or are covered by a your individual plan – please call your insurance provider.

It is up to the client to know what providers their insurance covers, how much coverage they have per session, per year, and when the benefits will be renewed.

What kind of therapists can direct bill insurers?

Which type of clinician is allowed to direct bill is entirely at the discretion of the insurance provider.  We do not know why the insurance company reimburses clients for services when the client submit the invoice, but denies clinicians a direct billing option. Our clinicians are happy to direct bill if the insurance company give us the opportunity to do so.  When we cannot direct bill we provide the client with a receipt they can use to claim reimbursement from their insurance provider.  

It is up to the client to know if your insurance plan covers therapists with your clinician’s professional designation.

Not every insurer covers every type of mental health therapist. 

Will insurance pay for a no-show or late cancel fee?