Thinking About Starting Therapy? Fees & Insurance.
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EXTENDED HEALTH INSURANCE BENEFITS COVERAGE
Fees & Insurance Coverage
Psychotherapy provided through a private practice is not covered by OHIP. OHIP may cover certain mental health services provided through hospitals, including emergency departments and hospital outpatient programs, but private psychotherapy services are generally not covered.
Your extended health insurance plan may cover some or all of the cost of psychotherapy. Coverage varies by insurance provider and individual plan. Many plans provide coverage for services provided by a Registered Psychotherapist (RP), while some plans may also provide coverage when services are provided by a Registered Psychotherapist under the supervision of a Registered Psychologist.
We recommend contacting your insurance provider before beginning therapy to confirm your coverage, including whether your specific therapist and the services provided are eligible for reimbursement, what portion of your fees is covered, and whether your plan has any annual limits, deductibles, or other requirements.
Payment & Insurance Reimbursement
Payment is due at the time of your appointment. Following your session, we provide a receipt that you can submit to your insurance company for reimbursement according to the terms of your plan.
Any portion of your psychotherapy fees that is not reimbursed by your insurance may be eligible to be claimed as a medical expense on your income tax return, subject to Canada Revenue Agency requirements.
Direct Billing
We are able to direct bill WSIB and Sun Life on your behalf when the requirements for direct billing are met.
If you have questions about fees, insurance coverage, or direct billing, please contact our office. We are happy to help you understand the payment process, but your insurance provider is ultimately responsible for confirming your individual coverage.
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UNDERSTANDING YOUR INSURANCE BENEFITS
Insurance coverage for psychotherapy varies between insurance companies and individual benefit plans. Before booking an appointment, we strongly recommend contacting your insurance provider to confirm that our services are eligible for reimbursement under your specific plan. When speaking with your insurance provider, it is important to ask:
- Which mental health professionals are covered?
Does your plan cover services provided by a Registered Psychotherapist (RP), Registered Psychologist, or Social Worker? If you are seeing a Registered Psychotherapist who is practising under the supervision of a Registered Psychologist, ask your insurer specifically whether services provided by that clinician are eligible for reimbursement under your plan. - Is a referral required?
Does your insurance provider require a referral from your family doctor or another healthcare professional before psychotherapy services will be covered? - How much coverage do you have?
Ask about your coverage per session and per benefit year, including whether separate limits apply to each person when receiving couples or family therapy. - When does your benefit year begin and end?
Knowing your benefit year can help you understand when your coverage renews and how much of your annual benefit remains available. - Can you coordinate benefits?
If you or your partner has coverage through different employers or insurance plans, ask whether your plans allow you to coordinate benefits. This may allow you to submit eligible expenses to more than one plan.
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EMPLOYEE ASSISTANCE PROGRAM (EAP) & EXTENDED BENEFITS
An Employee Assistance Program (EAP) is different from your regular extended health insurance benefits.
Many employers and universities offer an EAP as part of their employee or student benefit package. An EAP may provide a specific number of counselling sessions at no cost to you, with the cost arranged directly between the EAP provider and the employer or organization. If you are accessing therapy through an EAP, your EAP provider will determine your eligibility, the number of sessions available, and any requirements for accessing the service.
Before booking, check with your employer, university, or EAP provider to confirm your eligibility and whether Switzer Counselling & Psychotherapy Associates is an approved provider.
If you have both EAP coverage and extended health benefits, ask your provider how the two work together. In some circumstances, EAP sessions and extended health benefits are administered separately.
Keep Your Coverage Up to Date
Your EAP and extended health benefits can change. Employers and universities may change providers or benefit plans, and your coverage may change when a new benefit year begins.
It is your responsibility to confirm your eligibility and coverage before booking an appointment.
Switzer Counselling & Psychotherapy Associates cannot guarantee that an EAP or insurance provider will reimburse the cost of your sessions. If you have questions about our fees, payment process, receipts, or direct billing, please contact our office. We are happy to help with questions about our services and payment procedures. Your EAP or insurance provider is responsible for confirming your individual eligibility and coverage.