Reasonable and Customary Charges for Paramedical Services
Extended Health Care plans generally include coverage for the services of several types of healthcare practitioners such as chiropractor and massage therapists. There is a range of usual fees most practitioners in each province typically charge for certain services. Insurance companies use these “reasonable and customary” fees as the basis for pricing their benefit plans and determining the maximum eligible amount that they will reimburse. Most provider associations publish a suggested fee schedule for their practitioners. However, there is no requirement for them to charge according to this and fees for similar services can sometimes substantially differ from one practitioner to another.
Most paramedical expenses claimed by plan members fall within the reasonable and customary fee range. If a health care practitioner chooses to charge more, the member is responsible for the extra cost. Below, you will find the reasonable and customary charges for each type of practitioner in BC. Please note: Some carriers do not publish their listing as they believe it helps protect the plan member (as some service providers will then charge the maximum allowable rate) as well as limit any fraudulent or excessive service fees.
Your plan may not cover all the practitioners listed; check your contract or contact your group benefits representative if you are unsure.
- Acupuncturist (For Initial assessment and Subsequent visit) – $100
- Audiologist (per hour) – $125
- Chiropodist or Podiatrist – (For Initial assessment and Subsequent visit) – $100
- Chiropractor – Initial assessment $135; Subsequent visit $60
- Dietician (per hour) – $150
- Massage Therapist (per hour) – $100
- Naturopath – Initial assessment $210; Subsequent visit $155
- Occupational Therapist (per hour) – $140
- Optometrist (For Initial assessment and Subsequent visit) – $120
- Ophthalmologist (For Initial assessment and Subsequent visit) – $200
- Osteopath – (For Initial assessment and Subsequent visit) – $120
- Physiotherapist – Initial assessment $80; Subsequent visit $135
- Psychologist (per hour) – $190
- Social Worker (per hour) – $175
- Speech Therapist (per hour) – $120
Please note:
This list only reflects the maximum Reasonable and Customary amount allowed per treatment. Claims will still be subject to the terms of the policy.
Usually, a plan limits paramedical services to one treatment per service per person per day.
Also, please remember that it is the plan member’s responsibility to ensure their paramedical providers possess the credentials accepted by their insurance carrier.