De-listing of PT Services by Insurers
The Canadian Physiotherapy Association and its partners at branches across the country have been informed of, and continue to manage, a pertinent issue related to delisting of physiotherapy services by insurers.
The following is a review of the current situation and insurer rationale, steps physiotherapists can take to protect themselves and their clinic from delisting, as well as an update on the next steps being taken by the CPA issue on a national scale.
Recently, certain extended health benefit (EHB) insurers have delisted physiotherapists and physiotherapy clinics due to their orthotic prescription and dispensing practice. These insurance companies have indicated that providing footwear to the patient at no cost alongside the prescription and dispensing of orthotics violates their internal policies regarding incentives and this practice is what is resulting in delisting. Even if you follow proper billing practices outlined by your provincial regulatory college, the insurer or other payor may have internal policies that could result in delisting.
Delisting decisions do not just apply to orthotics claims. A delisting decision based on the orthotics-specific rationale above can expand to cover all claims submitted by the physiotherapist, and possibly the entire clinic. Currently, there is no clear path to having a physiotherapist or clinic relisted by an insurance company.
To protect themselves, physiotherapists should:
- Understand the rationale provided by the insurers against the physiotherapist or clinic’s dispensing practices.
- Review all policies surrounding orthotics and incentives.
- Before providing a patient with orthotics, it is important to ensure their insurance provider covers orthotics/orthopaedic footwear, allows physiotherapists to prescribe and dispense orthotics, and what the parameters are within the patient’s plan.
At CPA, we are working to educate providers of extended health benefits on the value of physiotherapists in the provision of orthotics. We have made a presentation to the members of the Canadian Life and Health Insurance Association (CLHIA) regarding our concerns related to delisting and extended health benefits.
We are reaching out to providers of extended health benefits to try and better understand the rationale for delisting decisions. We are working to have insurers provide us with a clear pathway for appeal and relisting of physiotherapists and clinics.
CPA is also part of an Extended Healthcare Provider Coalition, meeting with representatives of CLHIA and its members to resolve issues, including delisting and orthotics dispensing.
If you have questions or concerns about the information provided above, please reach out to firstname.lastname@example.org.
The CPA is committed to open communications regarding the profession with its members. We will provide an update regarding this issue as it progresses.