Physiotherapy involves working with a trained and caring professional while you undergo a customized program designed to restore mobility, strength, balance, and function to several areas of the body that may have experienced some form of trauma, pain or injury. But is this covered by Alberta health insurance?
Unfortunately, physiotherapy generally isn’t covered under the Alberta Health Care Insurance Plan (AHCIP). However, there are some exceptions. If you’ve experienced a fracture or are suffering from post-surgery complications, physiotherapy coverage may be available. Additionally, if you’ve recently been in a workplace or motor vehicle accident, you may be covered.
What Does Alberta Health Insurance Cover?
The AHCIP offers medical insurance coverage to residents of Alberta. This program, offered by Alberta Health Services, aims to help provide Alberta residents with necessary medical care and covers several different forms of care. Primarily, the AHCIP covers most services that are deemed to be medically necessary by physicians but does extend to some other medical services.
AHCIP coverage includes:
- Surgeries deemed medically necessary
- Psychiatric visits
- Emergency oral, dental, and facial surgeries
- Eye exams for children 18 years and under or for seniors 65 and older
- Coverage for medical treatment provided by a licensed optometrist, to some extent
- Prescription medicine provided in a hospital setting
- Diagnostic medical services, like laboratory processing, X-rays, and radiation scanning
The AHCIP also partially covers services related to podiatry (the feet and legs). However, if the cost of the services is more than what the insurance covers, you may be required to pay the extra cost out of pocket or through a third-party insurance benefits provider.
Does Alberta Health Insurance Cover Physiotherapy?
The AHCIP program doesn’t cover:
- Any non-medically required surgery
- Vision care for residents between the ages of 19 and 64
- Laser eye surgery
- Routine dental care (such as fillings or cleanings)
- Any prescription drug provided outside of a hospital
- Vaccinations for travel purposes
- Physiotherapy
There are some factors that can affect your eligibility for extended coverage, such as low-income eligibility from certain benefits programs.
When Is Physiotherapy Covered in Alberta?
For a long time, physiotherapy wasn’t covered in Alberta. It was deemed to be a service that wasn’t being provided by a physician, making it ineligible for coverage. However, as of March 1, 2022, this changed to some extent.
Under the old program, it was rather inconsistent—coverage varied depending on your region and the specific nature of your therapy. Now, some aspects of physiotherapy may be covered.
If you need physiotherapy as a result of severe trauma, breakage, or fractures, it may be covered by AHCIP. It also may be covered if you’re experiencing pain as a side effect of a recent surgery.
In some situations, your physiotherapy may be covered if you’re receiving certain low-income benefits from the Alberta government.
There’s a good rule of thumb you can use as an estimate. If you’re in need of physiotherapy due to the following, you may be covered:
- A fracture or breakage of a bone
- You’re recovering from hip, knee, or joint surgery, or any other kind of orthopedic surgery
If you need physiotherapy due to one or more of the following, you may not be covered by AHCIP:
- A strain
- Tendonitis
- A sprain
If your physiotherapy isn’t covered by AHCIP, you may be required to pay either through a third-party insurance provider (such as a work benefits program) or out-of-pocket.
Physiotherapy Due to a Car Accident
The Alberta government states that when you are injured in an automobile accident in Alberta, you can receive accident benefits coverage—regardless of whether you were at fault for the accident. The benefits you receive may depend on the type of injury you have.
This means that if you’re injured in a vehicle collision and need physiotherapy—with some restrictions—your physiotherapy may be covered whether or not your automobile insurance agrees to pay. Your primary healthcare provider may be able to bill the insurer directly for the provided services.
If you don’t have extended health care coverage, you may be able to directly submit invoices for physiotherapy to your insurance provider—even if you’ve exhausted your benefits this year.
Physiotherapy Due to a Workplace Injury
The Workers Compensation Board mandates that when you are injured in a workplace accident in Alberta, you can receive accident benefits coverage for your injuries. Running Shoe Restorative Healthcare is here to be your partner in getting back to work as soon as possible after an injury. Physiotherapy and other necessary medical treatments are included in your WCB benefits. The proper care can help you deal with pain and promote healing, allowing you to return to work faster.
Alberta Health Services & Physiotherapy
Whether or not you’ll specifically be approved for physiotherapy under the AHCIP can be complicated, to say the least. Fortunately, there is a process you can follow to make it easier to determine through the Rehabilitation Advice Line (RAL).
This is a telephone service run by Alberta Health Services. When you call, the operator can perform a virtual assessment of your physical needs. They can provide you with some advice about at-home exercises and stretches you can do and can provide advice about the process of getting physiotherapy.
However, it’s important to note: they can’t book, manage, or cancel a physiotherapy appointment, and a call to RAL is not a substitute for in-person physiotherapy. Rather, they can assess your needs and provide you with up-to-date information on what to expect.
Support for Your Physical Health & Overall Wellness
If you’re unsure of whether or not you’ll be covered by AHCIP for your physiotherapy, you can also contact our team at Running Shoe Restorative Healthcare.
Our team of experienced physiotherapists is here to help answer your questions and provide you with care that meets your needs. We believe that you deserve a pain-free life, whether you’re an athlete or simply looking to be healthier overall.
Contact us today to schedule an appointment and get answers to your physiotherapy-related questions!
