What Direct Billing Covers, and What It Does Not

Direct billing means the clinic submits your claim to your insurer for you, and you pay whatever portion is left rather than the full amount up front. It is straightforward most of the time, and there are a few details worth knowing.

Confirm Your Plan Allows It

Not every plan allows it. Some insurers do not support direct billing at all, and some support it for certain services but not others. It is common for a plan to direct bill physiotherapy but not massage therapy, or the reverse.

Know Your Coverage Limit

Coverage is usually capped, either as a dollar amount per year or a number of visits, and the cap is often per service rather than shared. It is worth knowing your remaining balance before a course of care rather than partway through it.

Check Referral Requirements

Some plans require a doctor's referral before they will reimburse, even where the practitioner does not need one to treat you. This catches people out, because the appointment goes ahead perfectly well and the claim is the thing that gets declined.

What to Bring

Bring your policy and member numbers to your first visit and the front desk can check what applies. If something is not covered, you will hear it before the appointment rather than at the end of it.