Welcome to Gesund in downtown Toronto, where we prioritize your well-being not only during your treatments but also in navigating the intricacies of insurance billing. Our commitment to transparency and convenience extends to offering direct insurance billing services, making your wellness journey smoother. Let’s dive into the details, addressing key questions and providing essential information for a seamless insurance experience.
At Gesund, all our Registered Massage Therapists (RMTs) and Chiropractors are licensed practitioners in Ontario. To enhance your experience, our professionals always provide receipts that can be submitted to all Extended Health Benefits programs for potential rebates. To further streamline the insurance process, our clinic offers direct electronic billing to over 30 major insurance companies.
To ensure a hassle-free insurance claims process, we request specific information for direct electronic billing:
Contract Number and Member ID: For electronic claims, provide your contract number and member ID from your insurance ID card or app. These details are crucial for accurate and efficient processing.
Electronic Transmission Authorization and Consent Form: Complete this form during your visit or online beforehand. This form grants us permission to submit claims on your behalf, streamlining the entire process.
Rest assured, your insurance details are securely stored in your patient file, ensuring seamless future transactions. Your comfort and peace of mind are our top priorities throughout this process.
Understanding your insurance coverage is key to making informed decisions about your wellness journey. Each insurance contract is unique, dictating your coverage based on various factors:
Dollar Amount Per Year: Your coverage may be limited by a specific dollar amount per year, indicating the maximum the insurance company will reimburse within a given year.
Dollar Amount Per Individual Treatment: Some contracts specify a maximum dollar amount per individual treatment, capping the reimbursement for each session.
Number of Treatments Per Year: Your coverage might be limited by the number of treatments allowed within a given year.
It’s essential to note that wellness clinics, including Gesund, lack access to detailed insurance contract information. We are authorized only to submit claims in your name. For comprehensive contract details, we recommend reaching out to your insurance company directly. Alternatively, you can access your coverage specifics by logging into your insurance company’s app.
Electronic submission to a patient’s secondary insurance account is currently not possible, except if both accounts are with Green Shield Canada. At this moment, Gesund can only submit your claim to your primary insurance. However, we are equipped to print an invoice with the full amount and the primary insurance coverage. This invoice, along with the proof of payment, can then be submitted to your secondary insurance company for reimbursement.
Understanding insurance fraud is crucial to maintaining the integrity of the insurance process. Here are some key points to be aware of:
Insurance Non-Transferability: Your insurance benefits are non-transferable. Only the person listed on the insurance account is legally allowed to use its benefits.
Accurate Treatment Submission: Your treatment is only allowed to be submitted exactly as it happens. For example, chiropractic appointments can only be submitted under chiropractic, and the treatment can be submitted only with the name of the therapist providing the service, and only under the name of the patient receiving the treatment.
Exact Date and Length of Treatment: Every claim is only allowed to be submitted with the exact date and the length of the treatment. Deviations from this accurate information could be considered fraudulent.
It’s essential to adhere to these guidelines to prevent any unintended wrongful use of your insurance coverage. Gesund values honesty and compliance in all insurance transactions.
One of the common queries we receive is whether a prescription from a Medical Doctor (MD) is required for booking and receiving our services. The good news is that patients are not required to present an MD’s prescription for most services. However, for Massage therapy treatments, the contract between your employer and the insurance company may necessitate an MD’s prescription. These medical prescriptions must be submitted to the insurance company by the patient annually or once every two years.
To find out if your contract requires a medical doctor’s prescription, we recommend referring to your insurance manual or contacting your insurance company directly for clarity on this matter.
In the digital age, many insurance companies offer easy submission of claims through their phone apps. It’s a convenient way for patients to manage their insurance-related processes. However, the availability of electronic submission through apps varies among insurance providers.
We encourage patients to check with their insurance company to confirm whether they allow electronic submission of claims through their app. Embracing technology can enhance the efficiency of your insurance interactions and provide you with greater control over your healthcare financials.
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