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Physiotherapy Coverage

Physiotherapy coverage varies from clinic to clinic and navigating the funding system can be complicating.  As a general rule, most community based physiotherapy clinics are private and charge a Fee per Visit (Not Fee Per Time, Not Fee Per Service). Services provided at each visit fall into 4 types:
-Basic Care
-Regular Visit
-Comprehensive Visit
-Complex Visit
Typically, most patients complete the Regular Visit which covers 1 body part.

Payment Options for Physiotherapy

If you need physiotherapy, let our team help you navigate the funding systems. Most patients are unaware of the benefit from their insurance plans and other funding sources. Contact our team and we can help. ask@albertaPT.com .  Below are the 4 most common ways of accessing physiotherapy care. 

1. Private Insurance

Most patients who are employed are covered by a Group Insurance Account or a Health Spending Account through their employer. For patients who have Group Insurance, the benefits for physiotherapy range from 100% coverage, to partial coverage with deductibles. When looking into your plan, you will need to know:

- Per visit amount covered
- Percentage of visit covered
- Total Coverage per Year

If you have a health spending account, you will need to ask your employer your yearly maximum amount and who to submit your receipts to. Many employers will offer both the Group Insurance and the Health Spending Account so that access to physiotherapy is fully covered.

For patients who are married and both partners have insurance, the process can be somewhat more complicating and does vary from case to case. To maximize your benefits, you should talk to the clinic administrator prior to your visit.

 All AlbertaPT clinics provide direct billing to insurance if available.  

2. Motor Vehicle Insurance

If you were injured in a car accident, physiotherapy is completely covered by the Automobile legislation. Accessing funding does require paperwork to be completed by both the patient and the physiotherapist. If you are assessed within 10 days of the car accident, you can qualify for either the WAD 1 or WAD 2 in-protocol programs. For out-of-protocol programs of care, legislation requires private insurance be accessed first, with the remaining unpaid balance covered by the Automobile Insurance.

The rate charged per visit will vary depending on the level of care and the amount of data collection required. When in-protocol, you are covered for the Regular Visit Rate. When out-of-protocol, you are covered by either the Comprehensive Visit or Complex Visit Rate.

Navigating the Automobile Accident Insurance Benefits and dealing with adjusters can be a complicating process. Let our Care Coordinator assist you with the process.  

3. Worker’s Compensation Board

If you are injured at work, the Worker’s Compensation Board covers physiotherapy services for 6 weeks with a maximum of 21 Visits. If all the required paperwork is completed, most acute injury claims are approved. For chronic conditions, pre-approval of services are required prior to treatment.

The mandate of WCB is return to work and exercise. As such, the WCB fee is for a Basic Visit only. In certain cases where more than 2 areas are injured, WCB may recognize a modified Comprehensive Visit. During a WCB visit, the physiotherapist is only to treat the areas recognized in the WCB claim.

4. Public Funding (Alberta Health Services, Primary Care Network)

Public funding is limited and restricted to Basic Visit coverage only. Qualifying for Public Funding will depend on condition or income level.

Patients qualify for 7 AHS Basic Visits (limited to AHS Accepting Clinics) if:

- Orthopedic Surgery (must be seen within 3 months of surgical date)
- Fracture (must be seen within 3 months of injury date)

Patients qualify for 5 AHS Basic Visits (limited to AHS Accepting Clinics) if:

- Verified low income

Patients qualify for 3 PCN Basic Visits (limited to PCN Accepting Clinics) if:

- The referring physician is part of the Mosaic PCN and provides the Yellow Physiotherapy Card

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