What is direct billing?

Direct billing is when we submit a claim via a web based portal to the insurance company on your behalf.  After the claim is submitted, your insurer will give us an immediate response explaining how much your insurance plan will cover for your treatment and where payment will be directed.

If your plan allows assignment of benefits, then you will only have to pay for the remaining difference that your insurance plan doesn’t cover.  For example, if you are covered for 80% of a $95 treatment, you will pay $19.

If your plan rules only allow payment to the member, then we will still submit the claim for you but we will also collect payment in full at the time of your treatment.  Once the claim is processed by your insurance provider, the reimbursement will go directly to you.  If you have set up direct deposit then the funds will arrive to your bank account, otherwise you will receive a check in the mail.

Who qualifies for direct billing?

In order to qualify, your plan must allow for claims to be submitted online and belong to one of the insurance providers listed below.

What happens if my claim cannot be processed at the time of my appointment?

In some cases, the insurance portals are unavailable due to maintenance or there is a power outage.  If this happens, you will be required to pay in full for your appointment. We can try resubmitting electronically when the portal is back up and running and instruct the insurance company to send payment to you.

-Or-

After you pay in full, we can provide a receipt for your visit, and you can submit this to your insurance company.

Do I need a doctor’s prescription?

Some extended health plans do require one for coverage.  It is best to contact your insurance company to check your plan rules before your treatment.  If a note is needed, most plans require a new note annually.  We are required to retain a copy of your prescription at our clinic to submit claims.

Can you check my coverage or how many treatments will be covered?

Due to confidentiality and privacy laws, your insurance company will not provide a third party with any specific information about your benefit plan.  Since insurance is a contract between you and the insurance company, terms can vary dramatically from contract to contract.  It is the responsibility of each individual to keep track of their available amount of coverage and plan details.

I have multiple plans, can you coordinate benefits and direct bill for both?

Very few plans allow for COB (coordination of benefits) because their online claim submission does not facilitate a way to enter the amount paid by the primary coverage.

The exceptions where COB are possible:

The secondary plan is with Blue Cross, Greenshield or SunLife.

If we cannot coordinate for your secondary plan, we will provide a receipt for your visit showing the amount you paid that you can then submit to your secondary insurance company.

I have maxed out my benefits, can you direct bill my health spending account?

We do not have access to health spending accounts, but we can provide a receipt for you to submit directly to your plan.

When direct billing for my child, which parent’s plan is the primary?

The parent whose birthday comes first in the calendar year is usually the primary coverage.