DIRECT BILLING GUIDE

We Direct Bill to Most Major Insurance Benefit Companies

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AFFILIATED COMPANIES

We direct bill to a large array of insurance benefit companies

INTRO TO DIRECT BILLING

The low down on direct billing, it's history, and what it can offer to clients

Direct billing is a wonderful service that allows a clinic to directly bill a client’s insurance benefit provider for their treatments, leaving little, to no, out-of-pocket expenses. By removing the step of having a client submit their receipts independently, this service streamlines the checkout process, adding convenience and efficiency to the billing portion of a treatment experience.

The process of direct billing has come a long way in the past many years, moving from mailed/faxed in forms to the new online portals, giving clinics instant confirmation of the amounts covered for their client’s treatments.

As insurance benefit plans have become increasingly common and far more diverse, not all of the plans function the same way with regards to the direct billing process. It is for this reason that we highly recommend contacting your insurance benefit provider, prior to attending your first appointment with us, to confirm that your benefit plan does in fact qualify for direct billing.

Please take the time to carefully read through our guide to ensure that your direct billing experience goes smooth and seamlessly.

HOW TO BEST BE PREPARED

THE FOLLOWING INFO WILL HELP TO REDUCE ANY UNWANTED SURPRISES

Prior to booking an appointment, we strongly recommend contacting your insurance benefit provider to confirm the level of massage / acupuncture coverage your plan offers. It is not the responsibility of your chosen practitioner to know your coverage as all insurance plans are unique and have different stipulations.

Some insurance plans require a doctor’s note to claim your massage / acupuncture treatments. In most cases, it is required that this note be mailed to your insurance provider in advance. This could take up to a few weeks. More recently, companies are now accepting faxed or email copies. Please contact your insurance provider if you are unsure as to what your policy requires. Refined Practitioners will be unable to successfully submit a claim for your massage or acupuncture treatment if you have not yet submitted a doctor’s note. In these circumstances, we ask kindly that you cover the cost of your treatments until a doctor’s note has been successfully submitted to insurance.

All practitioners who offer services at Refined Health & Wellness are fully accredited and trained to directly bill your wellness treatments, but do not have control over the potential limitations of your benefit plan(s).

Due to potential unforeseen circumstances, please make sure to bring an alternate means of payment in the case that your insurance company declines our direct billing request. A digital receipt will be provided to you so that you can manually submit it to your insurance company for reimbursement.

Only completed treatments are eligible to be claimed or directly billed. We are unable to direct bill for future treatments, missed treatments, or treatments paid for by gift card.

Student massage treatments are only covered by select insurance benefit providers, and benefit plans, that recognize 1100 hours of formal massage training. Each individual plan is unique. To confirm that your individual plan does cover student massage therapy, please contact your insurance provider directly.

SETTING UP YOUR DIRECT BILLING

WHAT YOU WILL NEED TO BRING TO YOUR APPOINTMENT TO SET UP YOUR DIRECT BILLING PROFILE

Upon booking an appointment with your chosen practitioner, you will receive our digital ‘Intake Form’ via the email address you supplied to us. If you have insurance benefits from one or more companies, you will be able to provide the data in this secure form to your practitioner.

Please ensure that the ‘Intake Form’ is completed and submitted prior to your appointment, as this will make your first experience with us much more seamless and efficient. The digital form can be completed on any device that has access to the internet and your email.

Once your benefit plan information has been entered into the system, your chosen practitioner will be able to submit claims directly to your insurance company. It will only be at the time of your treatment that we will be able to confirm if direct billing will work with your plan.

As every insurance plan is different, we cannot say for certain that direct billing will work, which is why we strongly recommend contacting your insurance provider to confirm the direct billing capabilities of your plan.

Some plans may or may not require a deductible.

THE DIRECT BILLING PROCESS

A step by step walkthrough of the direct billing process

After providing us with your policy number/ID, we will submit your treatment claim through the online insurance portal.

The online portal will provide us with the exact amount that your benefit plan will pay. You will be required to cover the remaining portion of the visit that is not covered or confirmed by your insurance company.

If, for some reason, the insurance portal is down, you will be billed the full amount of the treatment and will be required to submit your claim manually to your insurance company.

Despite our best efforts, we cannot guarantee direct billing at every appointment. Factors that could affect direct billing availability include: individual insurance plan attributes, problems with the submission portal, or clinic administration considerations.

Please make sure to bring an alternate means of payment in the case that your insurance company declines our direct billing request. A digital receipt will be provided to you so that you can manually submit it to your insurance company for reimbursement.

Coverage amounts depend on your individual plan’s attributes and the online portal response. There may also be a deductible that you have to pay before coverage begins. Please check with your insurance company to minimize any unforeseen surprises.

Thank you in advance for your patience with the direct billing process. Our intent is to provide a seamless and convenient experience.

SAMPLE DIRECT BILLING SCENARIO

A scenario that uses common insurance coverage values to demonstrate the process

Your wellness treatment concludes and you make your way to the reception desk for checkout.

As you have already confirmed your insurance policy information with your practitioner prior to receiving your treatment, your chosen practitioner is already well on their way to submitting your claim.

Today’s treatment total came to $105.00 (including GST) which is what we call the ‘eligible amount‘ that can be claimed. Your insurance company will provide us with the ‘confirmed‘ or ‘actual‘ amount that will be paid out.

After successfully submitting the claim, your insurance provider confirms that they will be covering $75.00 of today’s treatment’s eligible amount. This amount will be paid directly to the clinic.

Taking into account the amount covered by your insurance, your practitioner confirms the remaining balance to be $30.00. This out-of-pocket expense can be paid by credit card, debit, or cash. This can also be paid by gift card, but no receipt will be provided for further reimbursement as gift cards are not considered out-of-pocket expenses.

The digital receipt that you will receive via email for the portion you paid directly can be submitted to your insurance company for potential reimbursement.

That’s it! Quick and easy.

Please do not hesitate to contact us, at [email protected], if you have questions or concerns about direct billing to your insurance benefit company. We work with client insurance plans and coverage each and every day and would be glad to help!

RECEIPTS & DOCUMENTATION

THE TYPES OF RECEIPTS OR DOCUMENTS YOU MAY RECEIVE AT CHECKOUT

After a treatment is completed, your claim will be put through the insurance portal by your selected practitioner.

You will receive a digital receipt that confirms the amount covered by your insurance plan and the amount you have paid ‘out-of-pocket’. (Gift card transactions are NOT considered ‘out-of-pocket’ expenses.)

The ‘out-of-pocket’ receipt is important if you intend to have the amount reimbursed from an insurance provider manually or from a health spending account.

PRACTITIONER PERMISSIONS

What insurance coverage information is available to my practitioner?

Each online submission portal is designed for clinics to submit claims in real time; it is not designed to check statements, limits, policies, etc. It works very similar to a credit card terminal – it can collect the payment, but it cannot check the card balance.

Your practitioner is only able to submit the insurance claims and confirm payment amounts, they are not able to determine how much you have left in a certain benefit category.

Each insurance plan is unique to the member. Insurance companies can have many different plans. For example, we have seen plans that cover as little as 10% of the treatment cost and others that cover up to 100%.

If you want to check your coverage, remaining balance, deductible, or other benefits related policies, please contact your insurance provider directly.

NOTEWORTHY TIDBITS

INSURANCE COMPANY INFO

Sunlife may not offer direct billing for 2 hour massages (Restrictions in their system)