DR. HARDY SHARES SOME INFORMATION REGARDING EXTENDED INSURANCE AND ONTARIO PODIATRISTS

PODIATRY AND PRIVATE INSURANCE

In Ontario, most services performed by Podiatrists are covered by private insurance plans provided to employees and their dependants by employers or unions. While insurers place restrictions on eligibility of orthotics and orthopedic shoes, the services of podiatrists are generally not restricted. As such, podiatrists encourage their patients to claim the non-OHIP portion of their fees with their insurers.

WHERE OHIP COVERAGE FITS IN

Most of the services performed by podiatrists are partly covered by OHIP. This is why our office asks for your OHIP card. There is a per-visit amount OHIP covers up to an annual total maximum of $135. The amount OHIP covers per visit has not changed since 1989. When you visit, we claim to OHIP for the amounts covered by OHIP. This reduces the amount you have to pay or what should be claimed to your private insurance.

CLAIMING WITH YOUR INSURER

Our invoice to you reflects the amount you pay out-of-pocket after OHIP has covered its portion and what you should claim with your employer’s insurer by paper claim or, in some cases, on the insurer’s web site. Most insurance plans will reimburse 80% of your podiatrist’s fees up to a predefined annual maximum. If it is early in your insurance benefit year, the amount may also be subject to a deductible.

SOME INSURANCE PLANS FORCE PATIENTS TO WAIT UNTIL ALL THEIR OHIP BENEFITS ARE EXHAUSTED BEFORE CLAIMING

Unfortunately some insurance plans, as defined by the employer and/or union, force insurers to insist that their insureds can only claim for the services of podiatrists after the annual OHIP insurance benefit maximum has been reached. The OPMA and your podiatrist feel this puts an unfair burden on members of private insurance plans. There is no legal reason for this as Ontario law allows insurers to reimburse employees after each podiatrist treatment’s OHIP claim is processed.

WHAT YOU CAN DO IF DENIED A CLAIM WITH A PRIVATE INSURANCE PLAN BECAUSE YOU HAVEN'T EXHAUSTED THE OHIP MAXIMUM

Contact your employer’s human resources department or union representative and ask for this to be changed. The majority of large insurance plans no longer require employees to reach the OHIP maximum because it is not beneficial to employees, employers or the insurance plan itself. The more employees who request the change, the more likely it is to occur.

THIS INFORMATION WAS COPIED AND PASTED FROM THE ONTARIO PODIATRIC MEDICAL ASSOCIATION'S (OPMA) WEBSITE AND PROVIDED AS A PUBLIC SERVICE BY DR. JOHN A. HARDY, OWNER OF ACADEMY FOOT AND ORTHOTIC CLINICS.