Is acupuncture covered by insurance in Ontario? Plans, OHIP and direct billing

Does OHIP cover acupuncture?

No. OHIP does not pay for acupuncture. For most people in Ontario, the route is an extended health plan: through work, a spouse’s or parent’s work, a union, a school, or a private policy you buy yourself.

How extended health plans pay for acupuncture

Many extended health plans list acupuncture as a benefit of its own. Each plan sets its own rules, but they usually come down to a few numbers:

• A per-visit amount: the most the plan pays for one visit.
• A percentage: the share of each visit the plan reimburses, for example 80% or 100% up to the per-visit amount.
• A yearly maximum: the most the plan pays for acupuncture in a calendar or benefit year. Some plans share one maximum across several paramedical services.

Your benefits booklet or your insurer’s app lists these. If you cannot find them, call the number on your benefits card and ask: does my plan cover acupuncture, and how much per visit and per year?

Acupuncture with a Registered Acupuncturist

At Pro Motion Healthcare, acupuncture is given by Registered Acupuncturists (R. Ac), members of the College of Traditional Chinese Medicine Practitioners and Acupuncturists of Ontario (CTCMPAO). Visits with an R. Ac are claimed under your plan’s acupuncture benefit, where your plan has one.

How much is acupuncture in Ontario?

Fees vary from clinic to clinic, and a first visit often costs more than a follow-up because it includes the consultation. Pro Motion Healthcare does not publish its fees online, so call the clinic for the current fee. To work out what you will pay yourself, compare the fee with your plan’s per-visit amount and percentage, and keep an eye on the yearly maximum if you expect a course of visits. The clinic’s own guide is that a course is often around 4 to 8 sessions.

Direct billing or claiming yourself

With direct billing, the clinic sends the claim to your insurer and you pay only the part your plan does not cover. Pro Motion Healthcare offers direct billing for acupuncture; bring your insurance information, and ask about your plan when you book.

If you claim yourself, you pay the clinic and send the receipt to your insurer, usually through its app or website. Keep every receipt. It should show the practitioner’s name, title and registration, the date and the amount paid. Most insurers set a time limit for submitting claims, often counted from the date of the visit, so send receipts in promptly.

Making your acupuncture benefit go further

• Know your benefit year. Some plans reset on January 1, others on the date your plan started. If you are near your yearly maximum, a visit after the reset may be paid in full.
• Check a second plan. If you are also covered under a spouse’s or parent’s plan, the second plan may pay part of what the first does not. Ask both insurers how they coordinate.
• Keep every receipt. Even with direct billing, keep your receipts for your records and for a second plan.
• Ask about a health spending account. Some employers add one, and it can pay toward what your plan leaves over.

Talk with your acupuncturist about how many visits they expect, so you can plan them around your yearly amount. If your benefit is close to running out, say so: the plan can often be spaced out, or timed around your plan’s reset date.

Before you book: a short checklist

1. Check whether your plan has an acupuncture benefit, and its per-visit amount, percentage and yearly maximum.
2. Ask the clinic who will treat you.
3. Ask whether the clinic can bill your plan directly.
4. Bring your insurance information: your benefits card, or your plan and member numbers.

More on the practitioners is on acupuncturist Barrie, and the first visit on acupuncture clinic Barrie. If you are comparing clinics, see how to choose the best acupuncture in Barrie.

Questions people ask