Holistic health practices are vital to the health and wellness of Canadians. A publication on complementary and alternative medicine reports that 79 per cent of Canadians have used at least one complementary or alternative therapy sometime in their lives, with 44 per cent of all Canadians having tried massage therapy.
As a holistic practitioner, being an eligible service provider with insurance companies means that your clients can have treatments covered through their extended health benefit plans.
More Canadians are able to access complementary health treatments, such as massage therapy and reflexology, when they are not an out-of-pocket expense.
To maintain your eligibility with insurance providers, you must meet the company's expectations for professional practice, preventing insurance fraud and benefit plan abuse.
Practitioners and clinics can lose their eligibility (or be delisted) with an insurance company if found to be non-compliant with the provider's expectations.
What is Insurance Fraud?
To detect fraud and abuse, insurance companies have investigators that gather claims data, conduct audits on service providers and clinics, and use analytics to identify irregular billing patterns.
Examples of insurance fraud include:
Examples of insurance abuse include:
The National Post reported in 2018 that Canadians underestimate the consequences of health benefits fraud. While 75 per cent of Canadians believe that the punishment for benefits fraud is higher premiums or reimbursing claim payouts, other consequences include job loss and criminal charges.
To ensure that you remain an eligible service provider with insurance companies it is crucial that you adhere to the standards of practice for your modality. Insurance companies need to know that as a practitioner you will:
If you have questions about your ethical and professional responsibilities as a practitioner, or you are a client and have concerns about a treatment, the NHPC offers one-on-one practice management advice to both members and the public.
If you work at a clinic where someone else writes out the client's receipt or completes the financial transactions, you must ensure that they meet the insurance company's expectations as well. It is your responsibility to ensure your name and association number are not used fraudulently.
To protect yourself, follow these best practices:
Paul Donovan, NHPC Industry Relations Manager, explains that "professional associations, including the NHPC and massage therapy regulatory colleges, ultimately have no authority over insurance companies and their decisions to delist providers."
For more information regarding insurance best practices, contact the following NHPC team members:
Paul Donovan, Industry Relations Manager
email@example.com, 1-888-711-7701 ext. 222
Brian Jordan, Insurance Liaison Coordinator
firstname.lastname@example.org, 1-888-711-7701 ext. 238