Information about Insurance

Counselling, psychotherapy, and psychological services are not covered by OHIP. However, you may have coverage for these services under your employee, student, or another benefits plan. Each insurance plan specifies which types of counselling and psychotherapy are covered based on practitioner credentials and designations. 

The insurance plan will typically outline which of the following practitioner designations/credentials are covered by your insurance plan: Registered Psychotherapist (RP), Registered Social Worker (RSW), or Registered Psychologist. 

I am a Registered Psychotherapist and if your insurance plan covers this designation/credential it will specifically outline this in your benefits details. 

If you are unsure or cannot find this information in your plan, we would encourage you to call your benefits provider and ask if Registered Psychotherapist is covered.

You will pay the clinic prior to or immediately before the session. This money is paid directly from you, the client.

The clinic will provide you a receipt that you have paid in full for your session, the receipt will be complete with all information needed for insurance coverage purposes.

You can submit the receipt to your insurance company and get directly reimbursed from the insurer as per your insurance plan.

1) MetisNation of Ontario 

*you must start this process with your caseworker at MetisNation

2) Victim Quick Response Program (VQRP+)

*you must start this process and be approved by your caseworker at Victim Services first

3) Non-Insured Health Benefits (NIHB) program

4) Medavie BlueCross

5) Sunlife Financial/Lumino

6) Companies using ProviderConnect 

GreenShield, Canada Life, Empire Life

7) Companies using Telus eClaims

AGA Financial Group, belair direct, Chambers of Commerce Group Insurance, Canada Life, Benefit Plan Administrators, ClaimSecure, Cowan, Desjardins, GroupHEALTH, Group Secure, Industrial Alliance, Manion, Manulife, Simply Benefits, Telus Adjudicare, and more!

We encourage you to reach out to inquire if your insurance company is included under direct billing. 

1) What if I am not the primary benefit holder (ie. my spouse or parent is), can I still sign up for direct billing? 

       Usually YES! Most portals are set-up that we are able to include this information, and as long as you are covered under the benefit plan, we can still do direct billing.                

2) What if my insurance benefits only cover a certain percentage (ie. 80%) of an appointment? 

         This is very common, and simply means that you are responsible for any amount that is not covered. So if your coverage is 80%, and it is a standard session at $150 rate, this means insurance would cover $120 and you are responsible for the remaining $30. 

3) What if my insurance benefits only cover up to a certain amount (ie. $1000/year)? 

      You can still be eligible for direct billing! If you know what your maximum amount is than great, we can put that in when we add your insurance info and the Jane app will give us a warning when it seems to be getting close. Additionally, when we submit the claim to your benefits it lets us know immediately if the claim is approved or not, if you have maxed out your coverage for services. This may depend on how your specific benefits are categorized - ie. "mental health services" vs. "wellness services, including mental health, chiropractor, naturopath, massage therapy, etc."

4) I am not sure if my insurance benefits company accepts direct billing....or I have never done direct billing before, can we try claiming an appointment and then go from there?

        Absolutely! There is no harm in testing it to see if it goes through, or seeing if it is for you before diving right in. 

5) Do I have to sign up at the beginning of my benefits cycle or can I sign up later? Can I opt-out in the middle of a benefits cycle if I don't want to stay on direct billing?

            You can start and stop whenever you want, you're in charge! Even if you are signed up for direct billing and still have plenty of coverage left, but you want a one-off appointment put on your credit card so you get extra rewards on your card, that's fine! Communication is key - just make sure you're letting your therapist know. 

6) Is it a big, long process to sign up? 

             Not at all! We need key information such as your insurance company name, your Plan/Group number and your individual/ID number, and the full name of the primary policy holder (if it is not you), and we require a signed consent form that grants us permission to direct bill to insurance on your behalf. That's it!

7) If I sign-up for direct billing, does that mean my insurance company can call you anytime and ask questions about my appointments or care?

              Yes and no..... does it mean they can call and ask? Sure, they can always call and ask, whether you are on direct billing or you submit your receipt for reimbursement, they have the clinic information and your therapist's information, so yes they can technically call and ask. Does this mean I will answer any and all of their questions? No. Your confidentiality remains a top priority. If we have submitted a claim on your behalf and we have a signed consent, then we will acknowledge the claim, and confirm specific claim details if required (therapist's credentials/address/phone number, date/time/length of the appointment(s)). No questions will be answered about specifics of the session, what was discussed, your overall treatment, health and wellness, without understanding the purpose why AND your explicit and informed consent. 

IF a phone inquiry occurs, the client will be notified immediately after the call.

8) What if the insurance benefit company emails the clinic asking for information? 

             A response email would be sent indicating that information of that nature is not discussed via email, and that the person asking for the information needs to be verified to ensure legitimacy. This means the therapist would require a name, insurance company's name, their title, and their phone number, and that the therapist would then call and speak to them directly to ensure they are who they say they are. If caller is legitimate, then call would proceed as above. The client would be informed immediately afterwards of the details surrounding the interactions.