FUNDING

Multiple Ways to Pay for Your Treatment

Patients often assume that because we are a Canadian company, all services should be publicly funded. While it is true that some essential services are publicly funded, others are not.

We will assist you to determine your funding options

  • Public/Government Funding.

  • WSIB (Workplace Safety & Insurance Board).

  • Private Extended Health Insurance.

  • MVA (Motor Vehicle Accident Insurance).

  • Interac/Out of Pocket Pay

The question of funding is very important because many people are not aware of all of their funding options other than paying “out of pocket.” If you are interested in receiving services at ACHIEVA HEALTH  and want to learn more about costs and funding options, please contact us.

Private Health Insurance

Do you have Private Health Insurance?

If you work for a company that has an Employee Health Benefit Plan, it is possible you have Private Insurance which will pay for all or some of the services at ACHIEVA HEALTH. These services may include:

  • Physiotherapy Assessment and Treatment.

  • Occupational Therapy Assessment and Treatment.

  • Speech Language Pathology Assessment and Treatment.

  • Kinesiology and Exercise Programs.

  • Fitness Programs.

All Insurance Plans are not created equal

Insurance Plans differ depending on the company you work for or the Carrier that provides the Insurance. If you have Private Insurance through your employer but do not know if your plan will pay for the services, we recommend the following:

  • Call your human resource department and ask if your plan will pay for the services you require.

  • Call us at Achieva Health! We are familiar with most Private Insurance Plans and will work with you to determine the coverage you have for your health care needs.

Motor Vehicle Accident Insurance

  • If you sustained injuries from a car accident, there are 2 ways to access services depending if you have Private Insurance or not

With Private Extended Health Insurance

  • If you have private health insurance that covers Physiotherapy services through ACHIEVA HEALTH, Ontario Motor Vehicle Insurance companies require that you claim through your private health care plan first. Any additional costs will be covered (with approval) by your Automobile Insurance Plan.

  • In this case, with your consent, we may send claims to your Private Healthcare Insurance on your behalf. Your Motor Vehicle Insurer will require documentation outlining coverage by your Private Health Care Inusrance first. This documentation will allow us to bill any unpaid amounts to your Motor Vehicle Insurer.

Without Private Extended Health Insurance

  • If you do not have any private healthcare Inusrance which covers Physiotherapy, your treatments may be billed directly to your Motor Vehicle Accident Insurance company

Workplace Safety Insurance Board (WSIB)

  • If you have sustained a work related injury then you may be eligible for Workplace Safety Insurance Board (WSIB). In many instances, there may be more treatment options available when your company pays directly.

  • There may be a possibility that the private insurance coverage included in your company benefits plan, may fund your healthcare needs. You would need to speak to your HR rep for more details

Government Funded Physiotherapy

  • Government Funded Physiotherapy may be accessible for some patients. ACHIEVA HEALTH has funding agreements with the Ministry of Health that provides public funded Episodes of Care for patients in Community Clinics who meet the eligibility criteria.

  • ACHIEVA HEALTH provides government funded Physiotherapy to Residents in 250+ Long Term Care Homes across Ontario

Episode of Care Goals

  • An Episode of Care is one group of condition/diagnosis-specific, time-limited, goal-oriented physiotherapy treatments provided to a Patient.

  • The number, frequency, and duration of visits offered during each Episode of Care must be necessary and reasonable for the treatment of the condition as determined by the treating Physiotherapist based on the Patient’s individual needs and evidence-based Best Practices.

  • While there is no fixed limit to the number of Episodes of Care a person may receive, all eligibility criteria, including a separate referral, must be met for each episode of care.

Patient Eligibility Criteria

To be eligible for the government funded Clinic, Patients must, for each Episode of Care, be assessed by a qualified Physiotherapist as experiencing acute episodes or worsening of symptoms that lead to decreased function or mobility and must also meet the other eligibility requirements of the program as follows.

  • Be insured under the Ontario Health Insurance Plan and referred by a Physician or Nurse Practitioner based on an assessment that the person requires Physiotherapy Services and is within one of the following categories:

  • Age 65 years and older

  • Age 19 years and younger

  • Recently discharged from hospital following an outpatient/day surgery procedure to access physiotherapy for the condition, illness, or injury that occasioned the procedure.

OR

  • Be referred by a Physician or Nurse practitioner based on an Assessment that the Person requires Physiotherapy Services and is eligible for funding of services under the Ontario Disability Support (ODSP) or Ontario Works (OW) Programs

In addition, the Person must not be concurrently receiving Physiotherapy Services for the same condition or diagnosis provided or funded by other Ministry of Health and Long-Term Care (Ministry) or Health System Programs or through Automotive Insurance or the Insurance Plans established under the Workplace Safety and Insurance Act. Only Patients who meet the eligibility criteria above and who are assessed on or after the effective date of the Agreement are eligible for treatment under the Program.

Publicly Funded Physiotherapy in LTC

  • A Resident in LTC may qualify to access government funded Physiotherapy services through Achieva Health provided they meet the eligibility criteria

  • The Physiotherapy Services funded under this program include assessment, diagnosis, and treatment to improve, develop or rehabilitate physical function and/or promote mobility when that function and/or mobility has been lost or impaired as a result of a debilitating event or disease, pain, injury or surgical procedure.

  • The services must be provided in accordance with a written treatment plan for an episode of care and be of a level of complexity that requires the clinical knowledge, skills or judgment of a Physiotherapist.

  • The services must be performed by either a Physiotherapist or a Physiotherapist Support Personnel who has been assigned the performance of the services in accordance with the College of Physiotherapists of Ontario Standards of Practice.

For more information about Funding

Contact Us