Limitations on OHIP Coverage for Physiotherapy Sessions
Physiotherapy is a medical profession that deals with the assessment, diagnosis, treatment, and prevention of physical disabilities and pain. Physiotherapy can be beneficial for various conditions such as sports injuries, chronic pain, neurological disorders, and post-surgery rehabilitation. However, one of the concerns that people have is the cost of physiotherapy and whether it is covered by their health insurance plan. In this blog, we will discuss the coverage of physiotherapy sessions by OHIP (Ontario Health Insurance Plan).
What is OHIP?
The Ontario Health Insurance Plan (OHIP) is a provincial health insurance plan that provides coverage for medical services to eligible residents of Ontario. OHIP is funded by taxes and premiums paid by employers and employees. OHIP covers a wide range of medical services, including doctor visits, hospital stays, surgeries, and diagnostic tests.
What is covered by OHIP in terms of physiotherapy?
OHIP provides coverage for physiotherapy services for eligible individuals under specific circumstances. OHIP covers physiotherapy sessions for patients who are:
Hospitalized: OHIP covers the cost of physiotherapy for patients who are admitted to a hospital and require physiotherapy as part of their treatment.
Under the age of 19 or over 65: OHIP provides coverage for physiotherapy sessions for patients who are under the age of 19 or over the age of 65.
Eligible for Ontario Works or Ontario Disability Support Program: OHIP covers the cost of physiotherapy for individuals who are eligible for Ontario Works or Ontario Disability Support Program.
Eligible for Home Care: OHIP covers the cost of physiotherapy for individuals who are eligible for Home Care.
How many physiotherapy sessions are covered by OHIP?
OHIP provides coverage for physiotherapy sessions for eligible individuals up to a maximum amount per year. The maximum amount of coverage for physiotherapy sessions is $500 per year for patients who are under the age of 19 or over the age of 65. For patients who are not in these age categories, the maximum amount of coverage for physiotherapy sessions is $250 per year.
What if I need more than the maximum number of physiotherapy sessions covered by OHIP?
If you require more physiotherapy sessions than the maximum number covered by OHIP, you will need to pay for the additional sessions out of pocket or through private health insurance. It is important to note that some private health insurance plans may also have coverage limits or exclusions, so it is essential to check with your insurance provider.
Conclusion:
In summary, OHIP provides coverage for physiotherapy sessions for eligible individuals under specific circumstances, up to a maximum amount per year. The coverage amount varies based on the age category of the patient. If you require more physiotherapy sessions than the maximum number covered by OHIP, you will need to pay for the additional sessions out of pocket or through private health insurance. It is essential to understand the coverage limits and exclusions of your health insurance plan to ensure that you have adequate coverage for your healthcare needs.
FAQs for Limitations on OHIP Coverage for Physiotherapy Sessions
Q1. Who is eligible for physiotherapy coverage under OHIP?
Ans:
Patients who are hospitalized
Patients under the age of 19 or over the age of 65
Patients eligible for Ontario Works or Ontario Disability Support Program
Patients eligible for Home Care
Q2. How many physiotherapy sessions covered by OHIP?
Ans:
For patients under 19 or over 65, the maximum amount of coverage for physiotherapy sessions is $500 per year.
For patients not in these age categories, the maximum amount of coverage for physiotherapy sessions is $250 per year.
Q3. What if I need more physiotherapy sessions than the maximum amount covered by OHIP?
Ans: You will need to pay for the additional sessions out of pocket or through private health insurance.
Q4. What other medical services covered by OHIP?
Ans: OHIP covers a wide range of medical services, including doctor visits, hospital stays, surgeries, and diagnostic tests.
Q5. Is OHIP coverage available to non-Ontario residents?
Ans: No, OHIP coverage is only available to eligible residents of Ontario.
Q6. How do I apply for OHIP coverage?
Ans: You can apply for OHIP coverage by completing an application form and providing the required documentation to the Ministry of Health and Long-Term Care.
Q7. Can I choose any physiotherapist for my OHIP-covered sessions?
Ans: OHIP does not limit your choice of physiotherapist, but they must licensed and registered with the College of Physiotherapists of Ontario.
Q8. Do I need a referral from my doctor for OHIP-covered physiotherapy sessions?
Ans: It depends on the circumstances. If you hospitalized, a referral is not necessary. If you receiving physiotherapy outside of the hospital, a referral from a physician or nurse practitioner required.
Q9. Can I get physiotherapy coverage under OHIP for a work-related injury?
Ans: No, OHIP does not provide coverage for work-related injuries. Work-related injuries typically covered by the Workplace Safety and Insurance Board (WSIB).
Q10. Are there any limitations or exclusions for OHIP-covered physiotherapy?
Ans: Yes, there are some limitations and exclusions. For example, OHIP does not cover physiotherapy for conditions that not medically necessary or for conditions that have already treated and not expected to improve with further treatment. OHIP also does not cover physiotherapy for injuries sustained during high-risk activities such as skydiving or car racing.
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