Direct Billing Physiotherapy in Edmonton: What to Ask Your Insurer First

Direct billing physiotherapy in Edmonton means the clinic sends your claim to your insurer at the visit, so you don't have to file it yourself. It does not change what your plan covers. Your plan still decides how much it pays per visit and per year, and whether it needs a doctor's referral to reimburse you. At Aura Physiotherapy you can book without a referral, and we direct bill a long list of insurers, including WCB Alberta.

This article explains what direct billing does and does not do, the questions worth asking your insurer before your first visit, what an initial assessment costs, how car accident and work injury claims differ from your benefits plan, and what to bring with you.

General information only, not a diagnosis. Our physiotherapists, chiropractor and massage therapists assess every patient first.

What direct billing means, and what it does not

Direct billing is a paperwork service. Instead of paying the full fee, collecting a receipt and sending a claim to your insurer later, the clinic submits the claim electronically while you are there. Your insurer replies with the amount it will pay, and you pay whatever is left.

That last part is where people get caught off guard. Direct billing is not the same as free physiotherapy. If your plan pays part of a visit, you pay the rest at the clinic. If you have already used your yearly maximum, your insurer may pay nothing, and the full fee is yours. If your plan needs a referral to reimburse and you don't have one, the claim may be declined.

So the useful way to think about it is this: direct billing changes who sends the claim, not what the claim pays. The rules of your plan stay the same either way. A few minutes with your plan booklet, or a call to your insurer, before your first visit tells you what to expect at the front desk.

How direct billing works at Aura

The process at Aura Physiotherapy is short, and most of it happens in the background:

1. You give us your plan details when you book or arrive: your insurer, your plan or policy number and your member ID.
2. After your visit, we submit the claim to your insurer electronically.
3. Your insurer replies with what it will pay. You pay any amount your plan does not cover.

If your insurer is not on our list, ask us whether we can bill it. If we can't, we give you a paid receipt so you can submit the claim yourself.

It helps if the name on your booking matches the name on your plan. If your details change, such as a new employer or a new plan, tell us before your next visit so the claim goes to the right place.

Does insurance cover physiotherapy in Alberta?

Alberta Health Care (AHCIP) does not cover physiotherapy at a private clinic. When you book at a private clinic, payment usually comes from one of three places: an extended health benefits plan, a claim with a separate system such as WCB Alberta or auto insurance, or paying privately.

Extended health benefits are the supplementary plans many people have through an employer, a union, a professional association or a plan they buy on their own. The details vary from plan to plan, and two coworkers with the same insurer can have quite different coverage.

That is why we don't make blanket statements about what "most plans" pay. The only reliable answer comes from your own plan. If you want a plain-language overview of how supplementary health plans work, the Canadian Life and Health Insurance Association keeps a directory of consumer guides, including one on supplementary health insurance: CLHIA consumer guides.

Physiotherapy is direct access in Alberta, so you do not need a doctor's referral to book an assessment. A referral question only comes up when your plan needs one to pay the claim.

Questions to ask your insurer before your first visit

A short call to your insurer, or a look at your plan booklet or member app, answers most billing questions before they come up. These are the ones worth asking:

• Per-visit and yearly maximums. How much physiotherapy coverage do I have per visit, and per calendar or benefit year? How much have I already used?
• Coinsurance. What percentage of each visit does the plan pay?
• Deductible. Is there a deductible I must pay before the plan starts paying?
• Referral for reimbursement. Do I need a doctor's referral to be reimbursed? You don't need one to book at Aura, but your plan may need one to pay.
• Shared maximums. Which provider types are covered: physiotherapy, massage therapy, chiropractic? Do they share one maximum, or does each have its own?
• Direct billing. Does my plan allow the clinic to bill directly, or do I have to claim myself?
• Health spending account. Do I have a health spending account that can cover what my main plan does not?
• Coordination of benefits. If two plans cover me, for example my own and my spouse's, which one pays first, and can the second plan pick up the balance?

Write the answers down, with the date and the name of the person you spoke to if you call. It makes the conversation at the front desk much simpler.

How much does physiotherapy cost in Edmonton?

Fees vary from clinic to clinic, so the honest answer is to check the clinic you plan to visit. At Aura Physiotherapy, the initial physiotherapy assessment is 40 minutes and costs $130. A follow-up physiotherapy visit is 20 minutes and costs $90. Current prices for every service are on our online booking page.

What you pay out of pocket depends on your plan. A simple hypothetical shows how coinsurance works: if a plan paid 80 percent of the $130 initial assessment, the insurer would pay $104 and you would pay $26 at the clinic. If you had already reached your yearly maximum, you would pay the full $130. If a deductible applied, the first part of your claims in the plan year would come out of your pocket before the plan started paying.

These numbers are an example only. Your own plan's percentage, maximum and deductible are what count.

If you are paying privately, your physiotherapist sets out your treatment plan in writing after the assessment, and you can ask about the number and spacing of visits at any point.

Insurers Aura direct bills

Aura Physiotherapy direct bills these insurers and programs:

• Alberta Blue Cross
• Pacific Blue Cross
• Canada Life
• Manulife
• Sun Life
• Green Shield Canada
• Desjardins
• Industrial Alliance
• Equitable Life
• Empire Life
• Beneva
• Chambers of Commerce
• ClaimSecure
• GMS
• NIHB
• WCB Alberta

Plans and billing arrangements change over time, so confirm yours when you book. Coverage and what you pay depend on your plan, not on whether your insurer appears on this list. If your insurer is not listed, ask us. If we can't bill it, you get a paid receipt to submit yourself. You can also find this information in the insurance section of our FAQ.

Car accident and work injury claims are separate systems

If your injury came from a car accident or happened at work, your extended health plan is usually not the place to start. These claims run through their own systems with their own rules.

Car accident (MVA)

Treatment for injuries from a collision in Alberta follows the province's Diagnostic and Treatment Protocols Regulation, and your auto insurance claim, not your workplace benefits plan, decides what is covered. Bring your claim number, your adjuster's contact details and the date of the accident. The Government of Alberta automobile insurance page and the DTPR interpretative guide explain the framework. Our article on physiotherapy after a car accident in Edmonton walks through it in more detail. Ask our front desk how billing works for your auto claim.

Work injury (WCB Alberta)

Report the injury to your employer and to WCB. WCB Alberta's procedures say it pays the physiotherapy assessment and first treatment for claims still awaiting a decision once the Worker Report of Injury is filed, and that further treatment needs WCB approval. WCB explains how to report on its reporting an injury page for workers. Our guide to WCB physiotherapy in Edmonton covers the steps.

What to bring to your first visit

A little preparation keeps your first visit focused on you rather than on forms. Bring:

• Your insurance card or plan details, and your spouse's plan details if you are covered by both
• Any referral, if your plan requires one for reimbursement
• For a car accident: your claim number, your adjuster's contact details and the date of the accident
• For a work injury: your WCB claim number, if you have one

If your plan needs a referral and you don't have one yet, you can still book. Just know the claim may not be paid until the referral is on file with your insurer. Wear clothing that lets you move comfortably. Our article on what to expect at your initial physiotherapy assessment explains the visit itself.

How an assessment at Aura works

Your first visit is a 40-minute initial assessment with a physiotherapist. There is time to talk through how your symptoms started, what makes them better or worse, and what you want to get back to. Your physiotherapist then looks at how you move and builds a treatment plan with you, written in plain language so you know what each step is for.

You see the same therapist every visit, so you are not repeating your story to someone new. No referral is needed to book, and we direct bill supported insurers, so the claim is sent while you are at the clinic. If you have billing questions, ask at the front desk before or after your visit.

Billing should never delay urgent care. If you have severe pain after a crash or a fall, numbness or weakness that is getting worse, loss of bladder or bowel control, chest pain, or a head injury with confusion, vomiting or worsening headache, go to an emergency department or call 911 first. The paperwork can wait.

When you are ready, you can book your initial assessment online. Our programs and claims services page explains the claim types we work with.

Frequently asked questions about direct billing physiotherapy in Edmonton

Does direct billing mean my physiotherapy visit is free?

No. Direct billing means we send the claim to your insurer for you. Your plan decides how much it pays, and you pay any amount it does not cover at the clinic.

Do I need a doctor's referral for physiotherapy in Alberta?

Not to book at Aura. Physiotherapy is direct access in Alberta. Some insurers need a referral to reimburse you, so check your plan before your first visit.

Does Alberta Health Care cover physiotherapy at a private clinic?

No. AHCIP does not cover private physiotherapy. Payment usually comes from an extended health benefits plan, a WCB or auto insurance claim, or paying privately.

What if my insurer is not on the list?

Ask us whether we can bill it. If we can't, we give you a paid receipt so you can submit the claim to your insurer yourself.

Is massage or lymphatic therapy billed the same way as physiotherapy?

Not always. Plans often treat provider types separately, with their own maximums or a shared one. Check with your insurer before you book. Ask us how lymphatic sessions are billed when you book.

Important: This article is general information only. It is not medical advice and it cannot be used to diagnose or treat any condition. Every patient is assessed first by one of our registered physiotherapists, our chiropractor or our registered massage therapists before any treatment, and your care plan is based on that assessment. If you have symptoms, please book an assessment.

Related service: Programs and claims: WCB, MVA and direct billing

Related reading: WCB physiotherapy in Edmonton and physiotherapy after a car accident in Edmonton