Understanding Your Physiotherapy BenefitsMonday, Dec 11, 2023
We recognize the importance of physiotherapy and want to provide clarity on coverage for those that have access to this benefit.
We recognize the importance of physiotherapy and want to provide clarity on coverage for those that have access to this benefit. This is not a policy change or a change in coverage. Our aim is to help ensure that your claims are processed in accordance with your plan design, to ensure sustainable coverage for all members.
Eligibility Criteria for Reimbursement
The following eligibility criteria are provided to aid in understanding the types of services and/or treatments that qualify for reimbursement under the physiotherapy benefit:
- Physiotherapy coverage is intended for “…the therapeutic purpose of maintaining or restoring function that has been impaired by injury or disease,” as defined in the Health Professions Act – Physical Therapists Regulation. This includes existing illnesses or conditions that require ongoing physiotherapy services.
- Physiotherapy coverage does not cover services when they are used as a fitness or weight loss program, sports conditioning, or personal training sessions.
- For physiotherapy expenses to be eligible for reimbursement by Pacific Blue Cross, the services/treatments must be rendered by a registered physiotherapist in their province of practice. This means the physiotherapist is an active registrant of the provincial regulatory body where they practice. In British Columbia, physiotherapists are regulated by the College of Physical Therapists of British Columbia (CPTBC): cptbc.org. These practitioners also use the term physical therapist.
Please note that in some instances Pacific Blue Cross may request additional information from you, your physician and/or your physiotherapist to determine the eligibility of the physiotherapy claims submitted under your plan. Please provide all requested information as soon as possible to avoid delays in processing your claim. We always provide an opportunity for plan members to share feedback about a claim decision through an appeal process.
The health and wellbeing of our members remains our top priority. If you have any questions or concerns, our team is here to provide any information or assistance you may need.