Most people at PRT East York walk out of their first visit without paying a dollar out of pocket. Here's how that actually works, who we bill directly, and what to bring so it goes smoothly.
Direct billing is simple in theory. You book. You show up. We submit the claim to your insurer while you're still in the clinic. Whatever your plan covers gets paid straight to us. You only pay the difference, if there is one.
In practice, whether that goes smoothly comes down to one thing: having the right information in front of us when you arrive. That's what this post is for.
Who We Bill Directly
PRT East York is set up to direct bill the major Canadian insurers through Telus eClaims and Provider Connect. That covers most workplace and private plans our patients carry.
If your insurer is not listed, message us before your visit. Direct billing eligibility depends on your specific plan, not just your carrier, and many smaller insurers can still be billed through the networks we use.
What Your Plan Actually Covers
Direct billing doesn't mean free. It means we bill your insurer for what they cover, so you don't have to pay upfront and wait for reimbursement. Most plans in Ontario cover physiotherapy, chiropractic, massage therapy, and acupuncture, but the details vary by plan.
A few things worth checking before you come in:
- Annual maximum. Most plans cap each service at a dollar amount per calendar year. Common ranges: $300 to $1,500 per discipline.
- Per-visit coverage. Some plans reimburse 80% or 100% of each visit. Others cover a flat amount per visit.
- Referral requirement. A small number of plans still require a doctor's note before they'll cover physio or chiro. Worth a 30-second call to your insurer.
- Paramedical vs. medical. Physio, chiro, RMT, and acupuncture fall under paramedical benefits. Each one usually has its own separate maximum.
What to Bring to Your First Visit
To bill your insurer on the spot, we need the information on your benefits card. Either the physical card or a photo of it works.
- Your insurer name (Manulife, Sun Life, etc.)
- Your policy or group number
- Your member or certificate ID
- Date of birth of the primary plan holder (if that's not you)
- Your relationship to the plan holder (self, spouse, dependent)
If you have coordinated coverage through a spouse's plan, we can bill both. Bring both cards and we'll run the primary first, then submit the balance to the secondary.
Motor Vehicle Accident Claims
We also treat patients with motor vehicle accident claims. MVA follows a different process than private insurance and gets handled separately through your auto insurer. If you were in a car accident in the last two years, reach out before booking so we can set things up properly from the first visit.
We do not currently bill WSIB, so work-related injuries covered under WSIB would need to be treated at a WSIB-approved provider.
What If My Plan Doesn't Cover It
If direct billing isn't possible on your plan, or your annual maximum is already spent, we give you a receipt at checkout with all the info your insurer needs. You submit it, they reimburse you on whatever timeline they run on. Usually 5 to 10 business days.
The treatment you get is the same either way. Direct billing is a convenience, not a treatment approach.
The Bottom Line
If you're in East York, Leaside, the Danforth, or anywhere along the O'Connor corridor and you've been sitting on a benefits balance you haven't used, stop sitting on it. Most plans reset January 1, and unused benefits don't carry over.
Book an initial assessment at PRT East York. 45 minutes, 1-on-1 with your practitioner, at our clinic at 1400 O'Connor Drive, Suite 14. Bring your benefits card. We'll handle the rest.