Understanding insurance coverage for physiotherapy in Toronto can be complex. This guide breaks down what services are typically covered and how to navigate your benefits.
If you’re considering physiotherapy in Toronto, one of the first questions you might have is whether it’s covered by insurance. The good news? In many cases, yes — physiotherapy is often covered, but the specifics depend on your insurance plan and provider.
1. Is Physiotherapy Covered by OHIP?
In Ontario, the Ontario Health Insurance Plan (OHIP) does provide limited coverage for physiotherapy, but only under specific conditions:
- You must be under 19 or over 65, or be a recipient of Ontario Works or the Ontario Disability Support Program (ODSP).
- The treatment must be provided at a publicly funded physiotherapy clinic.
- You’ll need a referral from a physician or nurse practitioner.
For most adults between the ages of 20 and 64, physiotherapy is not covered by OHIP unless you meet the criteria above.
2. Private Health Insurance & Extended Benefits
Many Torontonians have extended health benefits through their employer or a private insurance plan (e.g., Manulife, Sun Life, Canada Life, Green Shield). These plans often include partial or full coverage for physiotherapy, such as:
- A set number of visits per year (e.g., 10 or 20 sessions)
- A dollar amount cap (e.g., $500 per calendar year)
- Reimbursement of a percentage of the cost (e.g., 80%)
It’s always a good idea to check your policy details or contact your insurer directly to confirm what’s included.
3. Direct Billing Available
At many physiotherapy clinics in Toronto, direct billing is available, meaning the clinic can bill your insurance company on your behalf. This saves you from having to submit claims manually and wait for reimbursement.
Tip: Be sure to ask your clinic if they support direct billing for your specific provider.
4. What If You Don’t Have Insurance?
If you’re paying out of pocket, many clinics offer affordable options or payment plans. Some also offer discounted rates for students or seniors. Don’t hesitate to ask about this — clinics are often happy to work with you to find a solution.
Final Thoughts
Physiotherapy can be a crucial part of your recovery and long-term wellness — and in many cases, insurance can help cover the cost. Whether you’re navigating OHIP, employer benefits, or private insurance, the key is to understand your coverage and ask the right questions.
If you’re unsure where to start, our clinic is happy to walk you through the options and help you get the care you need.
