Understanding Extended Health Care:
The chiropractor’s guide to patient support and administrative compliance
Welcome to the Understanding Extended Health Care guide. This guide is designed to be a one-stop, leading practices resource.
It is thoughtfully designed to help you care for Ontarians by facilitating accurate, efficient and transparent interactions with extended health care (EHC) insurers. It provides you with information, infographics, checklists, a glossary of terms, supplementary reading suggestions and more.
We developed this guide in consultation with the OCA Extended Health Care Advisory Council.
Privately administered EHC insurance comes in individual and group forms. The latter is the most common. Typically employers (plan sponsors) offer it to employees (plan members) as part of their total compensation packages.[1]
EHC coverage products may include EHC insurance, Health Spending Accounts or personal spending accounts. Many people rely on EHC coverage to pay for health services not covered by the publicly administered Ontario Health Insurance Plan (OHIP) or the Workplace Safety and Insurance Board (WSIB).
Most chiropractors deliver some, if not all, of the care they provide to patients through the private health care system. Indeed, an Environics survey the Ontario Chiropractic Association (OCA) commissioned in 2019 found that four out of five chiropractic patients in Ontario pay for their care through private insurance coverage.
Beyond being a crucial source of payment for chiropractic care, EHC administration is a complex and rapidly evolving field. We developed this guide to assist you in understanding:
- How the field is changing
- What this means for your practice
- How you can use this knowledge to support your patients and build relationships of trust and transparency with EHC insurance providers
Organization of the Guide
We organized this guide into ten distinct sections covering a wide range of topics, including how to register with Third-party direct billing services; billing and receipts leading practices; Virtual Care; EHC insurance for products and services and Fraud prevention and awareness.
This guide also contains lots of practical checklists, templates, and infographics. There is also a separate Patients Guide, which includes frequently asked questions (FAQs) to help clarify commonly misunderstood issues, as well as an Additional Resources list.
We designed this guide to enhance the support and services we provide to you. We welcome your feedback so we can continue and provide the timely and important information you need as a health care professional.
[1] Please note, we recognize there are instances where unions and associations also sponsor EHC benefit plans. Likewise, there are situations where an employee is not necessarily enrolled in a benefits plan, and therefore not a Plan member. For simplicity, we use “employee” and “employer” throughout this guide.
Table of Contents
What is Extended Health Care Insurance?
Section highlights:
Regulation and policy
CCO compliance
Types of benefit plans
Coverage levels and premiums
Key Trends in Extended Health Care: Preferred Provider Networks, Cost containment, Big data and Artificial Intelligence
Section highlights:
Preferred Provider Networks
Cost containment
Big Data, Machine learning & artificial intelligence
Getting Started: Registering for Direct Billing Services
Section highlights:
Overview of direct billing services
Pro tip: Banking fees
Ready to Register!?
Working with Patients and their Extended Health Care Insurance Providers
Section highlights:
Supporting patients to understand their extended health care insurance
Submitting predetermination requests
Patients’ extended health care coverage checklist
Acupuncture and chiropractic care letter template
Leading Practices: Billing and Receipts
Section highlights:
Billing and receipts overview
Billing and receipts “Golden Rules”
Billing and receipts Infographic: A visual guide to industry standards
Compassionate care letter template
Leading Practices: Virtual Care
Section highlights:
Virtual care and the chiropractic scope of practice
Privacy requirements
Virtual care Guidelines
Virtual chiropractic care checklist
Leading Practices: Orthotics and Other Assistive devices
Section highlights:
Assistive devices overview
Clear, complete and clinically supported documentation
Pricing and billing for devices
Spotlight on incentives
Patients’ coverage checklist for orthotics or other assistive devices
Benefits fraud and Abuse
Section highlights:
Overview of the problem
Recognizing benefits fraud and benefits abuse
Protect yourself against professional Identity theft
Preventing fraud and abuse, protecting plan sustainability
Spotlight on incentives
The Patient’s Guide to Extended Health Care Coverage
Section highlights:
Patients’ extended health care coverage checklist
FAQs: Answers to (some of) the most important questions patients ask about their extended health care coverage
