by Marianne Van der Wel

I spent a wonderful summer walking back and forth to McMaster University's Sports Medicine clinic twice a week for physiotherapy to get my knees “realigned” after I had a knee injury a year ago. I was aware that I had some retiree health insurance coverage through McMaster but I was not aware that being over 65 years of age I was eligible for coverage under OHIP. I received excellent treatment at McMaster's Sports clinic, a private clinic not eligible for OHIP reimbursement. Regrettably, it will take a while for my pocket book to recover. Thanks to an inquiry from a fellow MURA member, Jean Emberley, and with the benefit of some subsequent research, I am now a lot better informed about physio coverage in Ontario. Here's the scoop:

1) Conditions under which you can get OHIP coverage

• If you are 65 years and over or 19 years and younger, you can get coverage for up to 100 visits per year if you get your treatments at a designated OHIP physiotherapy clinic.
• For ages 20-64 if you had a recent condition that required an overnight stay as an inpatient in a hospital, you are covered at those designated clinics for up to 50 visits. NOTE: The initial physio assessment fee is NOT covered by OHIP regardless of your eligibility for treatment coverage.

2) OHIP-recognized clinics versus private clinics

Since Ontario changed its regulations regarding tax supported physiotherapy in 2005, Ontarians now have a mixture of private and OHIP-designated physio clinics. OHIP will only cover the cost of treatment at OHIP-recognized clinics. For more information call the Ontario College of Physiotherapists at 416-591-3828 or 1-800-583-5885 or visit their website. On the website, you can find OHIP-supported clinics in your area by following the Publicly-Funded Physiotherapy Clinics link on the home page. When visiting such clinics, you will need a physician’s referral.

3) Varying Rates and Facilities

Rates at both private and OHIP-designated clinics vary considerably. Initial assessment fees (which OHIP does not cover) can range from $45-$85. Treatment sessions that follow can range from $45-$75. Even at OHIP-supported facilities, OHIP may not pick up the entire treatment fee. Be sure to check with the clinic of your choice how much above the OHIP fee (if any) you will need to pay or have covered by any private insurance you have.

Facilities: In researching this article, I found that the equipment, number of employees, proportion of licensed physiotherapists to clinic assistants, hours of operation and allotted space for the various physio facilities vary considerably at both private and OHIP-supported clinics. Some are state-of-the-art and others not. Please be on guard!

4) Private Coverage

McMaster’s retiree health benefit plans provide partial coverage. Generally this amounts to $15 or more per visit, up to a maximum of $250-$300 per year. Check your benefits booklet or call McMaster Human Resources (905-525-9140 Ext. 22247) for your personal coverage.

5) Conclusion

Although my wallet is lighter, my knees are doing much better. I do wish I had this information at the start of the summer so I could have made an informed choice when choosing a clinic. Hopefully, this information will assist you in choosing a physio clinic in Ontario.