FAQ's
Q: What is Section B and when did it change?
A: Section B is payment for medical costs that are made to the insured (client) by their own insurer (insurance company) for injuries due to a motor vehicle accident. As of October 1, 2004 a new insurance act (bill 53) came into effect. Section B changed. This new insurance system is referred to as the Diagnostic and Treatment Protocols (DTP's) and Section B effective October 1, 2004.
Q: What are the diagnostic and treatment protocols (DTP)?
A: The DTP applies only to sprains, strains, and whiplash injuries. All other injuries fall outside of the DTP. Under the DTP all patients may receive up to 10 or 21 preauthorized treatment visits based on the type of injury as follows:
- 1st or 2nd degree sprains, strains, or whiplash associated disorders (WAD) I injuries:
10 combined treatments are the preauthorized DTP. - 3rd degree sprains, strains, or WAD II injuries:
21 combined treatments are the preauthorized DTP.
- WAD III injuries fall outside of protocols:
No preauthorization under DTP. Go to section B system,
effective October 1, 2004.
Q: How long does a patient have to utilize the preauthorized visits?
A: There is a 90-day time limit from the date of the accident to access the preauthorized treatments.
Q: Who determines the diagnosis of injury for the patient and the treatment that will be received?
A: A PHCP (primary healthcare provider) will determine the diagnosis and the number of treatments to be received by each modality within the DTP.
Q: Who is considered a PHCP?
A: A PHCP can be a medical doctor, physiotherapist or chiropractor. It is the choice of the client. It is determined by the client signing an AB-2 form indicating the PHCP.
Q: Is a prescription required if a PHCP prescribes massage as an adjunct therapy within the DTP's?
A: No a prescription is not required. However a copy of the AB-2 form will indicate that a PHCP has indicated massage as adjunct therapy and is your confirmation for payment from an insurance company. This is to be obtained by fax or photocopy from the clients PHCP.
Q: Can I direct bill for treatments provided under the DTP's?
A: Yes. Direct billing is approved for all insurance companies for treatments provided under the DTP's.
Q: What if a PHCP does not prescribe massage as all or part of the treatment for a patient. Is there any other coverage available for massage?
A: If massage is not prescribed as part of the DTP by a PHCP, then the client falls outside of the protocols for massage therapy. The client must use any extended healthcare and collateral benefits that they may have, and provide confirmation to their motor vehicle insurance company that this coverage has been exhausted.
Once the extended healthcare and collateral benefits have been exhausted or if the client does not have any benefits then there is $250.00 pre-approved, hard-capped coverage under Section B effective October 1, 2004. The $250.00 is not automatic. The insurer may need justification that massage is reasonable and medically necessary.
A medical doctor's note or prescription is not required to access the $250.00; however it may be beneficial to have one, when trying to justify that massage is reasonable and medically necessary.
Q: Can I direct bill for treatments provided outside of the DTP?
A: Direct billing does not automatically apply. Each insurance company decides direct billing individually. You must inquire with each insurer.
Q: Is GST included in the $250.00?
A: GST will be paid for massage services provided in addition to the $250.00 if you clearly indicate your GST registration number on each of your invoices. As well, the GST must be clearly separated from your treatment cost on your invoice.
Q: Is the Task Force working on getting the legislation changed to better support massage therapists?
A: The government changed the legislation on October 1, 2004, and has no plans to change the legislation again. The purpose of the Task Force work with the government is to ensure that the concerns and problems of the massage therapists are heard and shared with the other health care providers, government, and insurance companies affected by the legislation as these groups develop understanding and solutions to facilitate the implementation of the legislation. Should the government choose to change the legislation in the future, the involvement of the Task Force now will ensure that massage therapists are consulted in any future legislation reviews.