Ontario Insurance FAQs
PLEASE READ CAREFULLY AS NEW INFORMATION IS AVAILABLE REGARDING INSURANCE REIMBURSEMENT FOR ACUPUNCTURE SERVICES PROVIDED BY LICENSED ACUPUNCTURISTS AND BY REGULATED HEALTH CARE PROFESSIONALS WITH ACUPUNCTURE WITHIN THEIR SCOPE OF PRACTICE
For years, there has been great confusion in Ontario regarding acupuncture and reimbursement for acupuncture treatments. The origin of the confusion is easy to identify: [inappropriately] acupuncture has been treated simultaneously as a modality and as a profession by insurers, by practitioners with acupuncture within their scope of practice, and by the general public.
Still many continue to make the same mistake, but for clarification: Acupuncture in Ontario is not a profession, it is a therapeutic modality shared by 11 professions (one of which happens to have a professional denomination derived from this word).
None of these 11 professions has exclusive rights to the practice of acupuncture as a modality, although, since April 1, 2013, a new regulated profession in Ontario, Licensed Acupuncturist, has the exclusive right to use a derivative of this word (the word “Acupuncturist”) as part of their professional denomination.
License Acupuncturist is a new, self-regulated profession with acupuncture within its scope of practice, like the new profession of TCM Practitioner. Nothing has changed for the previously existing nine professions with acupuncture within their scope of practice.
All these professions have equal rights to provide professional services that include acupuncture to the general public and to invoice and get paid for doing so.
All professional services provided by these 11 professions are equally eligible to be reimbursed to an insured person with coverage for the specific services claimed.
Incidentally, it is illegal for anyone in Ontario to provide health care related professional services unless the provider belongs to the regulatory college that governs the practice of that profession in Ontario.
To further understand this relatively straightforward topic:
In Ontario, Extended Health Care Insurers provide reimbursement to their insured customers for specific health interventions included in their policies, such as physiotherapy, chiropractic, or massage therapy, when these services are provided by the regulated health care professional whose profession matches the professional services covered by the policy: for instance the benefit of physiotherapy to be eligible for reimbursement must be provided by a physiotherapist, as chiropractic services must be provided by a chiropractor and massage therapy by a registered massage therapist.
In addition to reimburse professional services provided by a specific professional, some policies also provide reimbursement for miscellaneous benefits (goods or services) such as orthotics. These miscellaneous benefits are eligible for reimbursement when provided by any regulated professional part of an accepted list of providers by that company (of course, eligibility criteria vary from company to company).
Who can then be reimbursed for “acupuncture” in Ontario?
As explained above, in Ontario most Extended Health Care Insurers do not reimburse modalities (such as acupuncture or soft tissue treatment), instead they reimburse professional services.
Unfortunately before April 1, 2013, acupuncture was treated by many Extended Health Care Insurers as a modality, and considered a special benefit where reimbursement was provided to their insured if the services had been provided by any of a list of eligible providers.
Of course, as it happens in this industry, the list of eligible practitioners varied from company to company. Due to the lobbying efforts of some private acupuncture associations (like the Canadian Contemporary Acupuncture Association, the AFCI or the ACO) one of the common eligibility requirement was that practitioners provided a number that demonstrated membership on an association (official or not) on the list of acceptable associations by each particular insurance company.
Unfortunately, this rather unusual insurance practice regarding reimbursement of “acupuncture” has created a great degree of confusion among practitioners and insured patients alike in Ontario.
Some regulated health professionals with acupuncture within their scope of practice have [inappropriately] become accustomed to have their professional services involving acupuncture treated by the Extended Health Care Insurers as a separate benefit (from their professional services).
Incidentally, this practice is against the official recommendations of most colleges governing the health professions with acupuncture within their scope of practice.
The good news is that this irregular situation is coming to an end soon, because with the official existence of Licensed Acupuncturists, now Extended Health Care Insurers will stop this practice.
From now on, every service in which the modality of acupuncture is used, will just be eligible for reimbursement under the professional services of the professional providing the treatment, whether Licensed Acupuncturists, Physiotherapist, Chiropractors, Registered Massage Therapists, Naturopathic Doctors, or any of the other nine professions with the ability to provide acupuncture within their scope of practice.
What most people are now still [wrongly] calling “acupuncture coverage” simply represents “licensed acupuncturists professional services coverage”, in the same way physiotherapy coverage refers to the specific professional services provided by physiotherapists, or chiropractic coverage to those provided by chiropractors.
This does not mean that a given professional cannot provide the same techniques (such as acupuncture or a specific soft tissue technique) as part of a given treatment. Indeed, many professionals provide the exact same techniques to their patients. However, professionals cannot invoice for techniques or modalities but for professional services.
The Extended Health Care Insurers’ general rules mean that each professional should always invoice for their professional services and not for the specific modalities used during the provision of these services.
Having said that, a degree of confusion regarding this topic is doomed to remain in Ontario as colloquially many are going to continue to use “acupuncture” and “professional services provided by a licensed acupuncturist” as synonyms, a common mistake that even insurers are still making in their official communications, but that should be detected and automatically corrected by any knowledgeable health care practitioner.
What happens to patients of Graduates of the McMaster University Contemporary Medical Acupuncture Program?
The good news is that all Graduates of the McMaster University Contemporary Medical Acupuncture Program will continue to be able to provide invoices for professional services to their patients, and Extended Health Care Insurers that cover those services will continue to reimburse their patients accordingly.
There are no changes in the general reimbursement rules by the Extended Health Care Insurers.
What is happening is that Licensed Acupuncturists (some our fellow Graduates from the Program), as they are now finally regulated by the new College of TCM and Acupuncturists of Ontario, will also be included in some of the benefits provided by some Extended Health Care Insurers.
These benefits refer to “licensed acupuncturist services”, but unfortunately, some companies will continue to call these services “acupuncture” instead of the correct professional denomination “licensed acupuncturist services”. Whatever the name, it is fair that these specific services are exclusively eligible for this profession as are the services provided by the other 10 on the list of professions with acupuncture within their scope of practice.
Predictably, all Extended Health Care Insurers will soon proceed as explained above, and will provide reimbursement exclusively for eligible professional services, not for modalities (which is never been the standard of reimbursement anyway).
Meanwhile, still some Extended Health Care Insurers may be reimbursing their patients for acupuncture treatments provided by regulated health professional graduates of the McMaster Contemporary Medical Acupuncture Program, therefore treating these treatments as a separate benefit from their specific professional services.
Even if the insurance companies are still doing this, this is something that has to end soon as it is in contradiction with the recommendations by the regulatory bodies of most professions with acupuncture within their scope of practice.
To the best of our knowledge the insurance companies below are either providing or denying reimbursement to their insured, for acupuncture treatments provided by regulated health professional graduates of the McMaster Contemporary Medical Acupuncture Program:
1. Still providing reimbursement for acupuncture as a “special benefit” (invoiced as acupuncture and not as a specific professional service):
- Standard Life – YES
- Empire Life – YES
- Green Shield – YES
2. Before April 1, 2013, was in the process of considering providing reimbursement:
- Manulife – NO but reviewing the request by the McMaster CMA Program
3. Now refusing to provide reimbursement:
- Blue Cross – NO
- Equitable Life – NO
- Great West Life – YES until now. NO from April onwards as former “acupuncture” benefits have become “licensed acupuncturist” benefits
- Sun Life – YES until now. NO from April onwards as former “acupuncture” benefits have become “licensed acupuncturist” benefits
Insurance practices change all the time. Benefits provided by different companies change all the time.
Change is part of life. Change is unpredictable. Change is good as it provides an opportunity for innovation and adaptability.
The Extended Health Care Insurance industry current trend is towards providing every insured with a maximum annual amount that can be spend on any of the eligible services covered by the policy.
This means that all the available coverage could be allocated to a single provider.
In this manner, the market will reward excellence as better practitioners will be selected by insured individuals to consume the maximum amount allocated to them, which will greatly exceed the current limited amount allocated now individually to separate professional services.
This trend will reward those who provide great services, instead consuming resources without quality control, as it is happening today.
Lets hope that the insurance industry soon makes this reimbursement practice the gold standard as then Graduates of the McMaster Contemporary Acupuncture Program will enjoy the competitive advantage provided by their superior training and performance.
Many Graduates of the McMaster Contemporary Acupuncture Program, who are applying what was taught to them, are already enjoying a position of dominance in their respective markets, and their practices are highly successful without the insurance benefits now being changed. Since this is the case for a significant number of Program Graduates, those failing to do so should accept personal responsibility for their situation, and put quick remedy to it by striving to provide an excellente service that the market rewards accordingly, with people willing to invest in their health regardless of how much of the treatment is reimbursed by their insurance plans.
Financial independence can only be achieved in a free market by providing massive value, that is why the McMaster Contemporary Acupuncture Program provides training that greatly exceeds the minimum standards of all the professions in Ontario with acupuncture within their scope of practice. Therefore, it should not be difficult for its graduates to provide services above the average, therefore generating rewards that match that value creation.