Physiotherapy Benefits FAQMonday, Dec 11, 2023
Pacific Blue Cross (PBC) has the responsibility of ensuring health plans remain affordable and sustainable for everyone’s benefit. We are committed to ensuring that members who would clinically benefit from physiotherapy services have access to these services.
What is covered under the physiotherapy benefit?
Under the physiotherapy benefit, members are covered for the professional services of a physiotherapist, to the maximum amounts in their plan benefits.
Who is considered a physiotherapist under the physiotherapy benefit?
A physiotherapist is a practitioner that 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 an active registrant of the College of Physical Therapists of British Columbia (CPTBC): cptbc.org. These practitioners also use the term physical therapist.
What type of services are covered under the physiotherapy benefit?
PBC covers the services provided by a physiotherapist, as defined in the Health Professions Act – Physical Therapists Regulation: “… the treatment of the human body by physical or mechanical means, by manipulation, massage, exercise, the application of bandages, hydrotherapy and medical electricity, for the therapeutic purpose of maintaining or restoring function that has been impaired by injury or disease.”
We understand that physiotherapists can provide other services and member benefits do not always cover the practitioners’ full range of practice.
Are there services that are not covered under the physiotherapy benefit?
Services that are not provided in relation to impairment by injury or disease are not eligible under the physiotherapy benefit. This includes services used for fitness or weight loss, sports conditioning or personal training sessions.
Services that are related in any way 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 eligible for coverage under the extended health benefits.
I lead group physiotherapy sessions. Are these sessions eligible under the physiotherapy benefit?
Group sessions are not eligible under the physiotherapy benefit.
I have assigned my client’s physiotherapy services to another practitioner; can those services be claimed under the physiotherapy benefit?
Services provided by another practitioner that is not a registered physiotherapist are not eligible under the physiotherapy benefit. This includes regulated and non-regulated practitioners such as Chiropractors, Kinesiologists, Massage Therapists, Naturopaths, Osteopaths, Personal Trainers, Pilates Instructors, Physical Therapist Support Workers, or Yoga Instructors etc. Services provided by other eligible practitioners must be claimed under the applicable practitioner benefit.
Can the physiotherapy services provided with a student or interim registrant that I am supervising be claimed under the physiotherapy benefit?
Services provided by another practitioner that is an active registrant of, and allowed to provide physiotherapy services by, the applicable regulatory body are eligible under the physiotherapy benefit.
My client has an illness or condition that requires ongoing physiotherapy services. Are they still covered under the physiotherapy benefit?
If your client’s condition is related to an impairment by injury or disease, they will continue to be covered for services provided by a registered physiotherapist, up to their plan limits and maximums.
What information is required to submit a physiotherapy claim?
If the client paid you for the service and they wish to submit a physiotherapy claim under their plan, you are required to issue the client a receipt that includes the name of the person treated, the date of service, name of the physiotherapist that provided the physiotherapy service, length of time of the physiotherapy service, and the amount charged for the physiotherapy service. The receipt should always be clear about who provided the service, e.g., a physiotherapist or another practitioner and the type of service provided.
If you or the clinic you work at is registered with PBC for direct billing physiotherapy services, the physiotherapy expense can be submitted on behalf of the client through our online PROVIDERnet portal, in accordance with the Provider Health Reference Guide and the Terms and Conditions for submitting provider claims, which includes ensuring an accurate account of services rendered, as well as charges billed.
Please note that in some instances PBC may request additional information from you, your client, and/or your client’s physician to determine the eligibility of the physiotherapy claims submitted under your client’s plan.
Does my client need to submit a pre-determination before I can provide them with physiotherapy services?
Your client does not need to submit a pre-determination before providing physiotherapy services.
Will PBC choose which physiotherapy treatment I can provide?
It is up to you to choose the right treatment for your client, in accordance with your regulatory body’s standards of practice.
Is this a change in the physiotherapy benefit?
There are no changes to the physiotherapy benefit. This document is intended to clarify the current physiotherapy benefit coverage.
We are here to answer any questions you may have about PBC’s benefits, please contact us at 604 419-2000.