Direct Billing Information
How direct billing works and general information
Many people have private health insurance that covers paramedical services such as massage; while we can never guarantee that we will be able to direct bill these insurance companies we will always do our best (a full list of companies we have the capacity to submit direct billing request to is listed below).
Some of the more common options we see when it comes to insurance coverages are:
– Covering the full amount of a treatment coverage.
– Covering the full amount minus a deductible.
– Covering a certain dollar value per a session, regardless of duration or cost.
– Covering a certain percentage of the cost of a session.
Some plans require a referral from a medical professional such as a medical doctor (MD) or nurse practitioner (NP). This varies by insurance plan and is controlled by the employer/administrator of the plan. If your plan needs a referral you will need to pay for your first massage and submit both the referral and massage invoice directly to your insurance company. Then claims after this should be fine for direct billing. In some cases, plans will allow the clinic to submit the referral with the first visit but this is not something we can guarantee, please check with your insurance company if you have any questions.
In the event that the full amount is not covered then a client will be responsible for the balance remaining. In some cases we will be able to direct bill a second insurance company, though depending on which insurance company is the primary and secondary this will not always be possible (more information on coordination of benefits below).
For direct billing, some individual plans do not allow for electronic submissions. If you are unsure if your plan allows this please contact your insurance company directly.
In some cases when the clinic submits for direct billing, the claim will not show a response right away and be listed as pending. There can be multiple reasons for this that are outside of the clinic’s control. If this happens then we will void that claim and have the client pay. Then they can submit their invoice directly to their insurance company for reimbursement. This is most common for a first time visit; once the first claim has been submitted, the odds of the claim working for direct billing at the clinic increases.
With your first visit to Target Health, our intake form has a section to fill out your insurance information in advance. You can also bring your benefit information to your first appointment.
A note will be added to your file after your first visit of what company you are with and what amount is usually covered for future appointments.
If you have any changes to your insurance due to changes in employment, relationship changes, etc. please let your therapist know at the start of your next visit.
For privacy reasons insurance companies do not allow any clinic or practitioner to see the remaining balance you might have left on your annual benefits. For this information, please contact your insurance company directly. In many cases they now have apps for your phones for ease of accessing this information.
Different insurance policies have different timelines for when they reset. It is up to the client to know when this takes place as clinics do not have access to this information. Plan most commonly follow the calendar year and reset on January 1 annual. Though some plans are tied to other things such as hire dates, benefit eligibility start dates, employers’ financial year ends, school year cycles, etc.
If you ever need a new copy of an invoice from a prior visit, please contact the clinic and we will be happy to provide one for you.
Some insurances plans also have Health Spending Accounts that go beyond any paramedical coverage. If this is the case for you then you will need to pay for any treatments yourself, then submit to your insurance company for reimbursement.
Coordination of Benefits
When a client has extended paramedical benefits from more than one source it can get a little more confusing. Below are some of the most common things that we see and the best way to navigate them.
If the insurance is for a spouse/partner then whoever is receiving the treatment needs to use their own primary insurance first. If there is an amount still owing, then the balance can potentially be submitted to the secondary insurance. If both insurance policies are with the same insurance companies such as Alberta Blue Cross, then sometimes their insurance portal will do this automatically. Unfortunately, even if your spouse/partner has insurance that covers more than your policy does you still need to submit your insurance first.
If the insurance is for a youth, or adult student that is still under their parents’ insurance, then usually the claim needs to go under the policy that the family has had for longer. After this then the remaining balance can be submitted to the secondary coverage.
In some cases, if there is a remaining balance after the primary insurance is put though, it will not be possible to submit to a second insurance company. If this is the case, then a client will be provided with an invoice from the clinic that gives a breakdown of what was covered by insurance and then how the remainder was paid. When this happens, the client can submit the invoice to their secondary insurance for reimbursement on the balance paid.
List of insurance companies we have the potential to direct bill to
Common insurance companies:
Alberta Blue Cross, Canada Life (formerly Great-West Life), Desjardins Insurance, Greenshield, Industrial Alliance, Manulife, Medavie Blue Cross, & Sunlife.
Saskatchewan Blue Cross & Manitoba Blue Cross
Other insurance companies by Alphabetical Order:
BPA – Benefit Plan Administrators, Canadian Construction Workers Union, Chamber of Commerce Group Insurance, CINUP, ClaimSecure, Coughlin & Assictiates LTD., Cowan, D.A. Towny, Empire Life, Equitable Life of Canada, First Canadian, GMS Carrier 49, GMS Carrier 50, Group Health, Group Source, Johnson Inc., Johnson Group Inc., La Capitale / Beneva, LiUNA Local 183, LiUNA Local 506, Manion, Maximum Benefit, MEDIC Construction, NexgenRx, People Corporation, RWAM Insurance Administrators, SSQ Insurance, TELUS AdjudiCare, The Co-operators, Union Benefits, & UV Insurance.
In some cases, employers have insurance though intermediary companies or brokers that are underwritten by some of the above companies. Usually this will be explained in the insurance booklet provided when someone first registers for their policy. Also, some insurance benefit cards will have the name of the parent insurance company listed somewhere on the card.
Some insurance companies that are more geographically focused such as Pacific (BC) Blue Cross do not allow for direct billing for paramedical services outside of their direct province. However, if that is where a client’s employer is located then that might be their benefit provider. All of our invoices still have the information needed for clients to submit on their own, however we will not be able to direct bill these insurance companies at this time.
If your insurance company is not listed above, please still let us know as we are always looking to add the ability to bill more companies directly to make things as simple as possible for our clients.
Who all at Target Health direct bills
The following practitioners have the potential to direct bill all of the above insurance companies:
Andrew Walker, Dino Gradilone, Yolanda Ballingall, Terrence Smith, Samuel Shapiro, Melanie Pajarillo (Not Manitobia Blue Cross), & Patrick Kalinowski .
Both Antonio Montemurro and Tina Farwell are able to direct bill some companies but not all of the ones listed above. If they are your regular therapists please contact them directly to confirm if your insurance is able to direct bill prior to your appointment.
At this time direct billing is not offered for Osteopath, Fascial Stretch Therapy or Counseling services, as such services offered by Chad Van Ellenberg, Barb Earle and Jennifer Nguyen are not available for direct billing at this time.
We have moved!
1724 46 Street NW – Only 2 Blocks from our previous location.
We now have 3 parking stalls in the back parking lot. They are stalls 4,5 and 13.
If your appointment is before 4:00 on weekdays please only park in these stalls or on any of the street parking around the clinic. After 4:00 on weekdays and anytime on weekends you may park in any available stalls.