Chiropractic Coverage in Ontario –
Extended Health Care Benefits
Chiropractic Physiotherapy RMT Toronto
Chiropractic Coverage and Direct Billing in Ontario
Patients may have coverage for chiropractic care, physiotherapy, registered massage therapy and related services through an extended health benefits plan, an approved WSIB claim or eligible automobile accident benefits.
Coverage varies between plans and claims. Your insurer or program determines eligibility, limits, required documents and reimbursement.
Core Wellness Centre may be able to submit eligible claims directly to participating insurers. Direct billing does not guarantee that an insurer will approve or pay a claim.
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Does OHIP Cover Chiropractic Care?
OHIP does not cover chiropractic services in Ontario.
Patients usually pay for chiropractic care themselves or use available coverage through:
- An employer or personal extended health benefits plan
- An approved WSIB claim
- Eligible automobile accident benefits
- Another applicable third-party program
Review your plan or contact your insurer before your appointment if coverage will affect your decision to proceed.
Is Physiotherapy Covered by OHIP?
Ontario provides publicly funded physiotherapy to certain eligible patients through participating community physiotherapy clinics.
Eligibility does not mean physiotherapy at every private clinic is covered by OHIP. Confirm that the clinic participates in the government-funded program before arranging care.
Private physiotherapy may also be covered under an extended health plan, WSIB claim or automobile accident benefits.
Extended Health Benefits
Many employer and personal health plans include some coverage for services such as:
- Chiropractic care
- Physiotherapy
- Registered massage therapy
- Custom orthotics
- Compression socks or stockings
The amount and conditions of coverage depend on your plan.
Your plan may include:
- An annual maximum
- A maximum amount per appointment
- A deductible
- A co-payment
- A required physician’s referral
- A prescription requirement
- Limits on particular services or products
- Requirements concerning the practitioner’s credentials
- A benefit-year renewal date
Core Wellness Centre cannot change your plan’s requirements or guarantee reimbursement.
Questions to Ask Your Insurance Provider
Before booking, consider asking your insurer:
- Is the service covered under my plan?
- How much coverage do I have remaining?
- Is there a maximum amount per appointment?
- Do I have a deductible or co-payment?
- Do I need a referral or prescription?
- Does the plan require a particular type of practitioner?
- Are assessments, reports or treatment products covered?
- Are custom orthotics or compression garments covered?
- Can the clinic submit the claim directly?
- When does my benefit year renew?
Record the representative’s name, the date of the conversation and any confirmation number provided.
How Direct Billing Works
When direct billing is available, Core Wellness Centre submits the eligible portion of your claim to the insurer.
You may need to provide:
- Your insurance company’s name
- Your policy or plan number
- Your member or certificate number
- The policyholder’s information
- A referral or prescription, when required
- Consent to submit the claim information
The insurer may:
- Pay the approved amount directly to the clinic
- Pay the patient instead of the clinic
- Cover only part of the fee
- Request more information
- Decline the claim
You remain responsible for deductibles, co-payments, amounts above your plan limits and claims the insurer does not pay.
Can the Clinic Confirm My Coverage?
Our team may be able to check basic claim information through an insurer’s billing system. The information available to the clinic may be limited.
Only your insurance provider can confirm the terms of your policy and make the final decision about coverage.
An estimate, pre-authorization or successful previous claim does not guarantee payment for a future appointment.
WSIB Coverage for Workplace Injuries
WSIB may cover approved healthcare costs related to an eligible workplace injury or illness.
Having a WSIB claim number does not mean that the claim or every proposed service has been approved. WSIB determines entitlement based on the circumstances and information connected with the claim.
Core Wellness Centre can help with eligible forms and billing related to chiropractic or physiotherapy care following a workplace injury.
Please bring:
- Your WSIB claim number
- Your date of injury
- Your employer’s information
- Your WSIB case manager’s contact information, if available
- Relevant reports or referral information
Some services or extended care may require WSIB authorization.
Automobile Accident Benefits
Ontario automobile insurance policies include medical and rehabilitation benefits that may apply to eligible care following a motor vehicle accident.
Depending on the claim, eligible services may include chiropractic care, physiotherapy or registered massage therapy.
The insurer determines:
- Whether the claim is eligible
- Which services require approval
- Applicable limits
- Required forms and treatment plans
- The amount the insurer will pay
Core Wellness Centre may assist with forms and direct billing for eligible motor vehicle accident claims. Approval and payment cannot be guaranteed.
Please bring your claim number, insurer information and adjuster’s contact details.
Paying for Care Yourself
You may book an appointment without using insurance coverage.
Before care begins, the practitioner or clinic team will explain the applicable fees. You can request a receipt to submit to your insurer or keep for your records.
Using insurance coverage is not a condition of receiving care.
Chiropractic Care at Core Wellness Centre
Dr. Kris Dorken, DC, provides chiropractic assessment and care based on each patient’s health history, clinical findings, needs and goals.
Dr. Kris is registered as a chiropractor in Ontario and is a member of the College of Chiropractors of Ontario.
Care recommendations and insurance coverage are separate decisions. A clinical recommendation does not mean an insurer will approve or pay for the service.
Frequently Asked Questions
Does OHIP cover chiropractic appointments?
No. OHIP does not cover chiropractic services in Ontario. Some patients have coverage through extended health benefits, WSIB or automobile accident benefits.
Does direct billing mean I will not have to pay?
No. You may need to pay a deductible, co-payment, amount above your plan limit or any portion the insurer declines.
Do I need a referral?
A referral may not be required to book an appointment, but your insurance plan may require one for reimbursement. Ask your insurer before your appointment.
Can Core Wellness Centre tell me how much coverage I have left?
The clinic may be able to view limited claim information. Contact your insurer for a complete and current explanation of your remaining benefits.
Can you guarantee that my claim will be approved?
No. The insurance company, WSIB or automobile insurer makes the final decision about eligibility and payment.
What happens if direct billing is unavailable?
You can pay the clinic and receive a receipt. You may then submit the claim to your insurer, subject to your plan’s requirements.
Questions About Coverage?
Contact Core Wellness Centre before your appointment if you need help understanding the clinic’s billing process.
For questions about eligibility, limits or reimbursement, contact your insurance provider or claims representative directly.
Core Wellness Centre
726 St Clair Ave W
York, ON M6C 1B3
Phone: (416) 479-8311