Paramedical Providers
Physiotherapy
What is covered?
- 100% of the reasonable and customary (R&C) limit, up to $1,500 every calendar year (January 1 to December 31)
What is not covered?
- Herbal medications, remedies, supplies and vitamins
- Insurance form completion charges
- Missed appointment charges
- Motor vehicle accident-related treatments
- Occupational disease or injury-related treatments
- X-rays
Reasonable and customary (R&C) limit for physiotherapy
To ensure members are not overcharged, every year GreenShield sets a reasonable and customary (R&C) limit for the cost of a visit for physiotherapy. Every time you visit the physiotherapist, the R&C limit is applied.
However…
Some providers charge more than the R&C limit.
And…
The R&C limit is the maximum amount your plan will cover for physiotherapy services.
That means…
If your provider charges more than the R&C limit, you will have to pay the remaining amount out of your own pocket.
You can check your eligibility and coverage limits by logging in to your account at greenshield.ca, emailing GreenShield at customer.service@greenshield.ca or by calling GreenShield at 1-877-266-5494 to use their interactive voice system. You will then see if your estimated payments are fully covered or not.
For Example:
Henry’s physiotherapist charges $175 for each appointment. The R&C limit at the time for this service is $130, which is the maximum amount your plan will pay.
Since Henry will be $45 out of pocket, he has two choices:
- Pay the remaining $45 out of pocket; OR
- Look for a physiotherapist that charges less.
Your coverage maximum resets every year on January 1.
If you reach the physiotherapy plan maximum partway through the year, the full coverage amount will again be available to you on January 1.
For Example:
Diane hurt herself playing tennis and was diagnosed with tennis elbow. As a result, she had regular appointments with a physiotherapist as part of her treatment and rehabilitation plan. Last year, she submitted these claims:
Diane reached the annual maximum in late October. She then had two choices:
- Continue to schedule physiotherapy appointments and pay out of pocket for the remainder of the year (until December 31); OR
- Wait until her coverage maximum refreshes on January 1, and begin physiotherapy visits again.
