Essential Health Clinic
Practical Info

Insurance, OHIP, and direct billing.

Coverage in Ontario works differently for every discipline. This page explains what OHIP pays for, what an extended health plan usually pays for, and what you pay yourself.

OHIP and extended health plans are two different things.

OHIP is Ontario's public health plan. It pays for visits to a family doctor, most hospital care, and a short list of other services. It does not pay for the treatments most people book at a private clinic.

An extended health plan is separate. It usually arrives through an employer, a union, a school, or a policy you buy yourself. This is the plan that pays for massage therapy, chiropractic, physiotherapy, psychotherapy, and osteopathy at a private clinic.

Every extended health plan is different. Your plan sets its own yearly maximum, its own per visit limit, and its own rule about which practitioners it will pay for. Two people at the same workplace can have different coverage, which is why your own policy is the only reliable answer.

Direct Billing

How direct billing works.

Direct billing means the clinic sends the claim to your insurer for you. You pay only the part your plan does not cover, and you do not have to wait to be reimbursed. Direct billing is available for many extended health plans.

Bring your benefits card to your first visit and we will check your plan with you. Every plan sets its own rules, so what your coverage comes back as depends on your policy rather than on the clinic.

Where a plan cannot be billed directly, you pay at the visit and send the receipt to your insurer yourself. Your plan pays the same amount either way. Direct billing changes who does the paperwork and how long you wait for the money.

Coverage By Discipline

What each discipline is usually covered by.

The rules below are Ontario rules. They hold true no matter which clinic you book with. What your own plan pays is set by your policy, and your insurer is the only place that can tell you your balance.

Massage therapy

Massage therapy →

Massage at a private clinic in Ontario is not covered by OHIP. It is usually covered by an extended health plan.

Most extended health plans hold a yearly amount for registered massage therapy. The receipt has to come from a Registered Massage Therapist, and all six of our massage therapists are RMTs. Some plans ask for a doctor's note before they will pay, even though you do not need one to book. That is a plan rule rather than an Ontario one, so check your policy.

Prenatal massage

Prenatal massage →

Prenatal massage is treated the same way as any other massage on most plans.

It is not covered by OHIP. Where your plan holds a massage therapy amount, a prenatal session normally draws from it, because the receipt still comes from an RMT. Plans do not usually hold a separate pregnancy category. Every RMT on our roster is certified in prenatal massage.

OHIP does not pay for routine chiropractic visits in Ontario. Extended health plans are where chiropractic coverage sits.

Most extended health plans hold a yearly chiropractic amount, and it is usually separate from the massage amount. The receipt has to come from a chiropractor registered with the College of Chiropractors of Ontario. All three of our chiropractors are registered with the CCO.

Physiotherapy

Physiotherapy →

For most adults, OHIP does not pay for physiotherapy at a private clinic.

Ontario funds physiotherapy through a limited program at a set of designated clinics, and most adults do not qualify for it. Physiotherapy at a private clinic is normally paid by an extended health plan, or out of pocket. Plans usually hold a yearly physiotherapy amount that is separate from massage and chiropractic. The receipt has to come from a physiotherapist registered with the College of Physiotherapists of Ontario.

Pelvic floor physiotherapy

Pelvic floor physiotherapy →

Pelvic floor physiotherapy follows the same rules as any other physiotherapy.

OHIP does not pay for it at a private clinic for most adults. On an extended health plan it normally draws from the same physiotherapy amount as any other physio visit, because the receipt still comes from a registered physiotherapist. Plans do not usually hold a separate pelvic floor category. Our physiotherapist, Ramandeep Singh, MScPT, offers pelvic floor physiotherapy.

Psychotherapy

Psychotherapy →

OHIP pays for psychotherapy only in a narrow set of settings, and a private clinic is not one of them.

OHIP covers psychotherapy delivered by a physician, and some publicly funded programs. It does not cover sessions with a Registered Psychotherapist in private practice. On an extended health plan, coverage turns on the practitioner's registration. Most plans pay for Registered Psychotherapist sessions, and some name only psychologists or social workers, so check which titles your plan lists before you book. Nicole Bonich is a Registered Psychotherapist.

Osteopathy

Osteopathy →

Osteopathy is not a regulated health profession in Ontario, and that changes how insurers treat it.

There is no provincial college for manual osteopathy and the title is not protected. OHIP does not pay for it. Many extended health plans do pay for osteopathic manual practitioner visits, but each insurer sets its own rule about which qualifications and which associations it will accept. This is the one discipline here where the practitioner's credential, and not just the service, decides whether a claim is paid.

Aesthetic and skin treatments

Aesthetic treatments →

Cosmetic treatments are not a health plan category.

Treatments booked for appearance rather than for a medical problem are not covered by OHIP, and extended health plans do not include them either. Our skin and laser services fall into that group, so they are paid by the patient.

What To Bring

What to bring, and how a claim works.

  1. 01

    Bring your plan details

    Have your benefits card with you, or your policy number and member number if you do not carry a card. Bring them to the first visit rather than the second, so nothing has to be sorted out after the fact.

  2. 02

    Check your own limits first

    Call the number on your benefits card and ask three things. How much is left in this year's amount for the discipline you are booking. What the per visit limit is. Whether your plan wants a doctor's note. Your insurer is the only place that can tell you your balance.

  3. 03

    Keep the receipt

    A receipt an insurer will accept normally shows the practitioner's name, their registration number, the date of the visit, and the amount paid. Ask at reception if you need another copy later.

  4. 04

    Submit anything not billed directly

    If part of a visit was not sent to your insurer, send the receipt to them yourself. Most insurers accept claims through an app or a web portal. Claim deadlines vary by plan, so do not sit on it.

Service list and live prices: Pricing. Who you would see: Our Team.

Questions about your coverage?

Call 905-856-2299 before you book, or book online and bring your benefits card to your first visit.

FAQ

Common Questions About Coverage and Billing