The Good, the Bad and the Ugly…….in the ever-changing world, we rely more and more on electronic submission. This is true of our direct billing procedures, we do require the following paperwork.
We are pleased to offer direct billing for physiotherapy and massage therapy to a number of extended health carriers (see list below). Availability of this service depends on your carrier and/or plan. Please note that all treatment fees are the responsibility of the patient. If online direct billing is not available, you will be asked to pay for your visit up front and we will provide you with a receipt which you can submit to your extended health carrier for reimbursement. If your carrier pays you directly, payment is required prior to our office submitting the claim for you if this is available.
This Form MUST be signed by the person who holds the insurance policy.
For example – if it is through your spouse’s job and you (or your child coming for treatments) are covered as a dependent, your spouse must sign it and a copy provided to us before we can do any direct billing. If you have your own plan and have secondary coverage through your spouse, we need a copy for each plan.
To set up your account to have automatic submission to your insurance company (if it is supported by your insurance company):
- Click on the correct button below.
- Print out the form.
- Have the Policy Holder fill out and sign the form.
- Bring this completed and signed form to your appointment.
The form needs to be signed by the
- BPA (Benefit Plan Administrators)
- Canada Life (Formerly Great West Life)
- Canadian Constructions Workers Union
- Chambers of Commerce Group Insurance
- Claim secure
- Desjardins Insurance
- First Canadian
- GMS Carrier 49
- GMS Carrier 50
- Industrial Alliance Financial Group
- Johnston Group
- LiUNA Local 183
- LiUNA Local 506
- Manion Financial
- Maximum Benefit
- Standard Life
- Sun Life Financial
- TELUS AdjudiCare
Benefit Assignment Form
This form must be filled out giving PhysioWorks permission to collect reimbursement on your behalf for the services provided.
Treatments for Car Accidents
Are your injuries related to a car accident? Please complete the AB-1 form and bring it to your first appointment if you have not yet submitted it to your insurance company.
If your benefits are under your spouse or parent, we will not be able to direct bill your insurance plan until the Electronic Transmission Authorization and Consent is signed by the policyholder.
Consent for Treatment & Release of Information
A link to complete the registration forms and consent will be sent to you by e-mail. Please ensure you complete these prior to your appointment.