Direct Billing

Each plan opts in for specific professional designations. It is helpful to confirm what providers your plan covers. 

• Registered Social Worker (RSW)
• Master of Social Work (MSW)
• Canadian Certified Counsellor (CCC)
• Registered Psychotherapist (RP), including qualifying status

* Please confirm with your insurance provider whether services provided by an RP (Qualifying) are covered, as this designation is not always eligible for reimbursement.

*Please note for RP (Qualfiying) we do not included external supervisors credentials.

**Please note we do not have Psychologist services.

Most plans will have a maximum dollar amount per year. 

Some people find it helpful to determine their budget when it comes to frequency of appointments. 

Some plans may only cover up to a certain dollar amount or percentage.

Benefit plans have a start and end date for coverage.  ex: Calendar or fiscal year, etc.

Each plan has its own determination of whether it has opted in for providers to direct bill. 

It is the responsibility of the client to verify with their extended benefits their coverage, approved providers, limitations, etc. 

We offer direct billing only for the clinic to receive payment. 

In the event a claim is rejected or not fully covered by insurance the client will be required to private pay for the session.

The plans below are the extended benefits, that have approved direct billing. *subject to their terms and conditions*

If you have have other benefits, you may have covered for services, however you would need to submit your own claim submission

Primary Insurance plan: 

A primary insurance plan is the insurance policy that is processed first when a claim is submitted. Insurance providers have specific rules that determine which plan is considered primary.

When direct billing is permitted by your plan, Maternal Health Niagara will submit eligible claims to the primary insurance provider only.

Maternal Health Niagara does not coordinate benefits between multiple insurance plans.

If a session is not covered in full, the remaining balance will be charged to the credit card on file, unless alternative arrangements have been communicated in advance.

Primary Insurance is determined as follows: 

• For adults, the primary plan is the client’s own insurance plan
• If both a client and their partner have coverage, we are only able to submit claims to the client’s plan
• For children with coverage under two parents, the primary plan is determined by the parent whose birthday occurs first in the calendar year (month and day)

Most plans allow people to submit their claims manually online or through the mail. Your benefit provider can tell you how they accept claims. They can also let you know their processing times and if they issue direct deposits or mail a cheque. 

After you have paid for your appointment, you will receive a receipt with your therapist's credentials, including their registration number. Most plans require these details at the time of submission. 

It is the responsibility of the client to have accurate information regarding their extended benefits and to notify Maternal Health Niagara in the event of any changes.