Pacific Blue Cross Physiotherapy Frequently Asked Questions

1. What is “scope of coverage” vs. “scope of practice”?

   Scope of coverage describes the expenses eligible for reimbursement under a Pacific Blue Cross insured or administered plan, up to the maximum amounts outlined in a member’s benefits plan. Scope of practice defines the set of activities a practitioner can perform, as determined by applicable health laws, regulations and the provincial/territorial body that regulates that profession. Pacific Blue Cross’ scope of coverage may differ from a practitioner’s scope of practice.

2. What is Pacific Blue Cross’ scope of coverage for the in-person physiotherapist benefit?

   Pacific Blue Cross’ scope of coverage for the “physiotherapy treatment rendered by a physiotherapist” benefit only includes dedicated time spent by an actively registered physiotherapist with one client i.e. a member or dependent to provide physiotherapy services to reduce or eliminate the signs and symptoms of an injury or disease. The scope of coverage is limited to dedicated one-on-one time between a physiotherapist and one client i.e. a member or dependent; any time spent by a physiotherapist with two or more clients at the same time is not within Pacific Blue Cross’ scope of coverage for the physiotherapist benefit and therefore is not an eligible expense for reimbursement under your extended health benefits plan. 

3. What is Pacific Blue Cross’ scope of coverage for the online physiotherapist benefit?

   For the online “physiotherapy treatment rendered by a physiotherapist” benefit, Pacific Blue Cross’ scope of coverage only includes dedicated time spent by an actively registered physiotherapist with one client i.e. a member or dependent, during a real-time videoconference to provide physiotherapy services to eliminate the signs and symptoms of an injury or disease. The scope of coverage is limited to dedicated one-on-one time between a physiotherapist and one client, i.e. a member or dependent; any time spent by a physiotherapist with two or more clients at the same time is not within Pacific Blue Cross’ scope of coverage and therefore is not an eligible expense for reimbursement under your extended health benefits plan. The scope of coverage also does not include time spent by a physiotherapist sending or receiving e-mail correspondence to or other communications with a client i.e. a member or dependent before or after an online physiotherapy appointment. 

4. Who is considered a physiotherapist under the physiotherapist benefit?

   A physiotherapist is a practitioner who is an active registrant of the provincial body that regulates physiotherapy activities in the province where they practice. In British Columbia, this means the individual is actively registered as a physical therapist with the College of Health and Care Professionals of BC (CHCPBC).

5. Are there services that are not covered under the physiotherapist benefit?

   Services not provided in relation to reducing or eliminating signs and symptoms of an injury or disease are not eligible under the physiotherapist benefit. This includes services used for fitness or weight loss programs, sports conditioning or personal training sessions. 

   Services that are related to a motor vehicle incident, workplace incident, or any other accident where ICBC, WorkSafe BC, or any other liable third party may become involved, are not within Pacific Blue Cross’ scope of coverage and therefore is not an eligible expense for reimbursement under your extended health benefits plan.

6. Are group physiotherapy sessions eligible under the physiotherapist benefit?

   Group sessions are not within Pacific Blue Cross’ scope of coverage under the physiotherapist benefit. Any time spent with two or more clients at the same time is not an eligible expense for reimbursement under your extended health benefits plan.

7. My physiotherapist referred/assigned me to another practitioner; can I claim those services under the physiotherapist benefit?

   Services provided by practitioners who are not physiotherapists are not within Pacific Blue Cross’ scope of coverage under the physiotherapist benefit. This includes both regulated and non-regulated practitioners such as Chiropractors, Kinesiologists, Massage Therapists, Naturopaths, Osteopaths, Personal Trainers, Pilates Instructors, Physical Therapist Support Workers, Physical Therapist Assistants, or Yoga Instructors. Services provided to a member or dependent by other eligible practitioners must be claimed under the applicable practitioner benefit and provider number, as applicable.

8. I have/my dependent has an illness or condition that requires ongoing physiotherapy services. Is this still covered under the physiotherapist benefit?

   Services under the scope of coverage will continue to be eligible for reimbursement, up to your extended health benefits plan limits and maximums.

9. What information is required to submit a physiotherapist claim?

   To submit a claim under your physiotherapist benefit, you will need a receipt that includes the following details:

   • Name of the person treated;
   • Date of service;
   • Name and registration of the physiotherapist who provided the physiotherapy service;
   • Length of time of the physiotherapy service;
   • Amount charged for the physiotherapy service; and
   • Amounts paid by the client or another payer.

   The receipt must clearly specify who provided the service (e.g., a physiotherapist or another practitioner) and the type of service provided. You will need to keep a copy of your receipt showing the details listed above. Please ensure that the information you provide is accurate and reflects the treatment received.

    

   Please note that, in some instances, Pacific Blue Cross may request additional information from you, your physiotherapist, and/or your physician to determine the eligibility of the physiotherapist claims submitted under your plan.

10. Do I need to submit a pre-determination before getting physiotherapy services?

    You do not need to submit a pre-determination before getting physiotherapy services. If you have any questions about coverage under your health benefits plan, please do not hesitate to contact us at 604-419-2000 or 1-877-PAC-BLUE (722-2583)

11. Will Pacific Blue Cross choose which treatment my physiotherapist can provide?

    It is up to you and your physiotherapist to choose the appropriate treatment, in accordance with the standards of practice set by your practitioner’s regulatory body. However, you can only submit claims to Pacific Blue Cross for expenses eligible under our scope of coverage, and you may be responsible for expenses that are not within the scope of coverage. 

12. Pacific Blue Cross is my secondary insurance payer, do these requirements apply to me?

    Yes, all members must meet Pacific Blue Cross’ requirements including claims that are submitted to Pacific Blue Cross as a second payer.

13. Is this a change in the physiotherapist benefit?

    There are no changes to the scope of coverage of the physiotherapist benefit. This information is intended to clarify the existing physiotherapist benefit coverage.