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Pay My Physio Bills

Nov 20, 2019

The Case

The College received a complaint from a patient who was attending physiotherapy following a motor vehicle accident. The patient was surprised when her sessions stopped after a few months as she exceeded the maximum funding available from her insurance provider. 

Although the patient didn’t have any issue with the care she received from the physiotherapist, she indicated that she did not see a billing summary until after receiving treatment, that she did not understand the fee structure, and that she was charged unnecessarily high fees for items like “preparation” and “concussion kit.” 

The patient did not understand how approximately 30 sessions over the course of a few months could amount to nearly $4,500. As the services outlined in her bills were largely undefined and not attributed to a specific physiotherapist and she was unsure what she was being charged for. 

The PT said that the patient was advised of the fee structure before starting treatment. He also provided copies of the signed OCF-18 form that highlighted the $99.75 hourly rate for physiotherapy as outlined by the Financial Services Commission of Ontario as well as the clinic’s billing policy and procedures form. The physiotherapist noted that the hourly fee did not include any preparation, planning or administrative tasks which were billed as additional costs. The PT specified that this is standard practice for the clinic.

The patient record listed additional costs like the completion of the OCF form, administrative costs for approximately $25 for each occurrence and a concussion kit for $800. 

The Standards

The College’s Fees, Billing and Accounts Standard states that physiotherapists are accountable for any fee, billing or account that uses their registration number. PTs must also ensure that any fee, billing or account that uses their name and registration number is an accurate reflection of the services and products provided. They must never charge fees or create billings or accounts that are inaccurate, false or misleading.

There must be a written fee schedule for each funding stream including fees for assessment, reassessment, treatment, other services or products and administrative tasks. The fees must not be excessive. Before providing care, physiotherapists must ensure that patients are given clear information about fees, and that they understand the information.

The Outcome

In reviewing the available evidence, the College was satisfied that the PT discussed the fees and billing structure with the patient before starting treatment and no action was taken.  

It is unfortunate that the patient’s insurance was no longer accessible for treatment, however the majority of the fees over the course of her treatment did not seem excessive. Additionally, she did sign the OCF-18 form and the clinic’s billing policy and procedure form and checked the boxes that indicated she had a discussion with the PT about fees and billing. 

The College did make note of the relatively high fee for the concussion kit and encouraged the physiotherapist to review the fee for that service and make improvements if possible. 

Fees, Billing and Accounts Standard
 

 

 
Leave a comment
  1. DEMELIN C. TANYAG | Jun 24, 2024
    In this scenario the PT must tell the patient clear and concise how much he is going to charge the insurance and how many times the patient will receive the treatment. Patient was undergoing issues physically that the first day she was not properly oriented of what PT had explained. The PT should / must explain for the second time of what the patient 's coverage/payment and how many sessions she is going to get. 
  2. Mansi Patel | Oct 02, 2023
    Having a fees schedule on the clinic wall always help as patients can see that when they are in the waiting area. 
  3. Komal Patel | Feb 23, 2023
    In this case, PT was right as he provided him with all the billing information. 
  4. Gregory Nason | Dec 05, 2022
    I understand that the PT outlined the fee structure and the patient signed the documents. Looking at the patient's perspective, there is a lot of information being thrown at them which can be overwhelming. It would be beneficial if the PT could go over the fee structure if the patient has any questions.
  5. Mohammad Yazdchi | Aug 25, 2022
    I think the PT is in correct position as long as the PT notify the patient about costs and also the patient signed OCF 18 form included costs.
  6. Sanil Taneja | Jul 28, 2022
    In this case PT provided full information to the patient beforehand and patient signed the forms after reviewing it. Hence PT is at correct position.
  7. Avanti Shah | May 29, 2022

    I would explain fees and billing structure on the very first day of assessment , I always explain patient that how this claim work , what will be the number of sessions patients are eligible to attend and what will be the cost of each form and treatment sessions. I also always make sure that patient understand how much money patient is entitled to receive any Supplementary goods and services.

     

     

  8. Rutali Prabhu | Mar 25, 2022
    I would always thoroughly review the OCF 18 before the patient signs and before submitting it so that the patient is fully aware of the rationale for certain services and why the team believes it is medically necessary for their recovery. These days patients also receive billing invoices sent by insurance company and that helps them keep a track record of what services we have billed their insurance company for.
  9. Jaskirat Kaur | Mar 17, 2022
    The PT in this case had communicated fees and billing structure to the patient before starting treatment. The patient was aware of the cost of treatment sessions. I appreciate the decision of the College to support the physiotherapist in this situation. 
  10. VARUN SINGH | Feb 27, 2022
    In above scenario. PT is ethical and right by providing detailed information to the patient before starting treatment and having patient sign the form confirming the understanding. 
  11. Prateek Gupta | Feb 13, 2022
    All information was provided by the PT; therefore, they are correct in this situation. 
  12. Soubhagya | Jan 27, 2022
    The PT was right , he did provide all the billing information and also in auto insurance ,the adjustor also explains the fee structure .
  13. Mitchell Caprelli | Jan 11, 2022
    The PT was right in this situation, all information was laid out to the patient and the appropriate actions were taken. This is unfortunate but it was laid out to the patient and they were aware of the billings 
  14. Michael | Nov 24, 2019
    She signed everything, got the treatment, and now complains its too expensive. She should own up and be responsible for what she reads and signs. Our services are not cheap. We spent 6+ years in school. If you want cheap services, go see an Rkin, and they will still bill you 60/hr

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