416-465-8737

 

TORONTO CHIROPODIST, D.Ch., B.Sc., PODIATRIC MEDICINE

Archive:

Tags

 

 

 

 

 

 

 

 

Posts for tag: extended health benefits

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.

page1image20656

IN ONTARIO WE HAVE A UNIQUE SITUATION WHERE THERE ARE TWO DIFFERENT CLASSES OF FOOT SPECIALIST REGULATED BY THE SAME COLLEGE.  THERE ARE SOME DIFFERENCES BETWEEN THE TWO.  PODIATRISTS, GENERALLY HAVE BEEN TRAINED IN THE UNITED STATES AND GENERALLY THEIR COURSE IS ONE YEAR LONGER THAN CHIROPODY WHICH IS TAUGHT IN TORONTO AT THE MICHNER INSTITUTE.  AFTER 1993 ALL PODIATRISTS WHO COME TO ONTARIO TO PRACTICE MUST PRACTICE UNDER THE SAME RULES AND REGULATIONS AS CHIROPODISTS.  PODIATRISTS WHO WHERE ALREADY PRACTICING BEFORE 1991 HAVE A FEW MORE PRIVILEDGES SUCH AS CONVEYING A DIAGNOSIS, TAKING RADIOGRAPHS OF THE FOOT AND PERFORMING SURGERY  TO THE BONES OF THE FOREFOOT AND CAN PARTIALLY BILL O.H.I.P.  I WILL TALK ABOUT O.H.I.P. BILLING IN A MINUTE MORE THOROUGHLY.  IN 1991 ONTARIO PODIATRISTS LOST THEIR PRIVILEDGE TO PERFORM SURGERY TO THE BONES OF TH HINDFOOT AND ARE NOT LEGALLY ALLOWED TO CALL THEMSELVES DOCTORS, WHERAS IN 1991 CHIROPRACTORS GAINED THAT PRIVILEDGE.

CHIROPODISTS CAN PERFORM SURGERY TO THE SOFT TISSUES, TENDONS, MUSCLES, NAIL, ETC AND PRESCRIBE MEDICATIONS AS CAN PODIATRISTS.  CHIROPODISTS CAN TREAT ALL THE SAME CONDITIONS AS AN ONTARIO PODIATRIST.  UNFORTUNATELY DUE TO THE FACT THAT ONTARIO PODIATRISTS ARE ALLOWED TO PARTIALLY BILL O.H.I.P. MANY PATIENTS EXTENDED HEALTH INSURANCE PLANS WILL NOT REIMBURSE THEM.  THIS IS AN UNFAIR TO THE PODIATRISTS AND THEY WOULD BE BETTER OFF IF THEY WERE NOT IN O.H.I.P. AT ALL.  I KNOW AS A CHIROPRACTOR WHO HAD PARTIAL O.H.I.P. BILLING PRIVILEGES FOR OVER 20 YEARS, THE BEST THING THAT HAPPENED TO MY PRACTICE IS WHEN WE WERE NOT ALLOWED TO BILL O.H.I.P. ANYMORE.  IT WORKED OUT MUCH BETTER FOR MY PATIENTS AND MY PRACTICE.  CHIROPODISTS ARE COVERED UNDER EXTENDED HEALTH INSURANCE PLANS FROM DAY ONE WHEREAS IN MANY CASES YOU WILL NOT BE REIMBERSED IF YOU ATTEND A PODIATRIST.  WE HAVE HAD MANY PATIENTS CHOOSE A CHIROPODIST RATHER THAN A PODIATRIST, DUE TO THE FACT THAT THEIR TREATMENTS WILL BE REIMBURSED BY THEIR EXTENDED HEALTH PLAN.  IF YOU ARE CONSIDERING ATTEND A FOOT SPECIALIST YOU SHOULD PHONE YOUR EXTENDED HEALTH PLAN TO SEE IF THEY WILL REIMBURSE YOU IF THE PODIATRIST IS GOING TO BILL O.H.I.P.  MANY TIMES IS MORE ADVANTAGES FOR A PATIENT TO SEEK THE SERVICES OF A CHIROPODIST RATHER THAN A PODIATRIST IF THE ARE CONCERNED WHETHER THEY WILL BE REIMBURSED BY THEIR EXTENDED HEALTH PLAN.

BROUGHT TO YOU BY DR. JOHN A. HARDY, OWNER OF ACADEMY FOOT AND ORTHOTIC CLINICS.



Academy Clinics has a special interest in high quality custom orthotics.

 

416-465-8737

Toronto, ON Chiropodist
Academy Foot and Orthotic

752 BROADVIEW AVENUE
Toronto, ON M4K 2P1 

Across from the Broadview Subway
Professional  Family  Foot  Care

PROFESSIONAL
FOOT CLINIC

CHIROPODIST / FOOT SPECIALIST,  B.Sc. PODIATRIC MEDICINE / ACADEMY FOOT & ORTHOTIC CLINICS, 752 Broadview Ave , Toronto ON, M4K 2P1 416-465-8737