Physician referrals for chiropractic services reimbursed through health plansRelease Date: 04/27/2016 Staff Reference: Stephen Frank
April 27, 2016
Dr. Mike Toth
Ontario Medical Association
150 Bloor Street West,
Toronto, ON M5S 3C1
Dear Dr. Toth,
Thank you for your letter dated March 22, 2016, drawing our attention to the subject of requiring prescriber referrals for chiropractic services reimbursed through health plans.
Over the past several years, our industry has moved significantly away from requiring physician referrals for chiropractic and other paramedical services in order for them be reimbursed under a health plan. However, the ultimate decision on what controls to implement in any health plan rest with the plan sponsor. As such, there are some plans in Ontario that have not fully eliminated the requirement for a referral.
You raise excellent points that we will share with our members in an effort to increase awareness of the impact on physicians. We understand that patients are not required to obtain a referral through regulation. However, the reality is that some plan sponsors continue to see value in the requirement for a referral to have been made as part of the reimbursement process. In some cases, where unions are involved, making such a change would have to be done as part of the collective bargaining process.
The other point worth mentioning is that plan members may not always be aware that the requirement for a referral has been eliminated. Insurers always encourage plan sponsors to ensure that their employees have access to the most up-to-date plan information.
I appreciate you raising this subject. We will continue to dialogue with our members. In the meantime, should you have any questions, please contact myself or Joan Weir, Director Health and Dental Policy (email@example.com, 416-359-2003).
(original signed by Stephen Frank)
Vice President, Policy Development and Health
cc: Bob Haig, CEO, Ontario Chiropractic Association