It is not uncommon for physiotherapists to have backgrounds and additional training in areas that extend outside their usual physiotherapy practice. You can find physiotherapists who teach dance or yoga classes, but they aren’t doing so as part of their work as a physiotherapist. However, those same physiotherapists could also incorporate aspects of dance and yoga into their physiotherapy practice to help you recover from an injury or help you return to the activities you enjoy. Actions such as these may lead to confusion and questions about what is or isn’t physiotherapy practice (and what is and isn’t covered by insurance/benefits).
The College of Physiotherapists of Alberta has expectations of physiotherapists when it comes to providing services that are not considered to be physiotherapy. These expectations are in place to ensure that patients and the public clearly understand when services are physiotherapy and avoid misunderstandings and misrepresentation of non-physiotherapy services. The physiotherapist is expected to:
- Clearly communicate with you and other parties that can be involved in aspects of your care (such as family members or insurers) when the service being proposed is not considered a physiotherapy service.
- Obtain informed consent from you for all services they provide, including clear informed consent to receive non-physiotherapy services.
- Advise you of the implications of receiving non-physiotherapy services, including potential funding implications.
- Provide separate invoices and receipts that are easy to read and clearly describe what service was provided.
A receipt for any service that is considered a physiotherapy service must have the physiotherapist’s College of Physiotherapists of Alberta registration number attached. A receipt for any non-physiotherapy service must not include the physiotherapist’s College of Physiotherapists of Alberta registration number.
Now that you have a better understanding of what the College expects from physiotherapists who offer services in addition to physiotherapy, let’s pose 5 questions you should be asking the physiotherapist.
1.Why would the clinic be advertising things like personal training and yoga?
Often physiotherapists branch out into other areas of health and well being to provide more comprehensive care for their patients and to create more potential business for the clinic or practice setting. These can include completely different business streams such as massage therapy, chiropractic, mental health services, or sports medicine physician services that are performed by other practitioners.
But physiotherapists themselves may also branch out into other non-physiotherapy services. Sometimes it’s due to a passion they have, or they may be trying to fill a need in the community. It may be a way for them to increase their revenue, or it could be a little of all three. Regardless, you may come across your physiotherapist or other physiotherapists in the practice setting offering things that are not physiotherapy.
2. My physiotherapist is suggesting we switch my physiotherapy sessions to personal training sessions, is this switch ok?
While there’s nothing wrong with making the switch, it is important to ask why they are proposing a change. Importantly, if you wanted physiotherapy services initially, they should be providing you with physiotherapy services. You shouldn’t book a physiotherapy session and then show up to be told by the physiotherapist that you are actually there for personal training or a one-on-one yoga session.
If you have been receiving physiotherapy and your physiotherapist thinks you are ready to stop physiotherapy but may benefit from some ongoing personal training for your general health and fitness you or they may suggest that as an option as the physiotherapy services come to an end. In this case, the physiotherapist who also offers personal training as a separate business offering may suggest that you could see them for ongoing personal training. However, if this happens the physiotherapist is expected to be clear that this is not a physiotherapy service and should also advise you of your other options for ongoing self-management, such as other exercise options that would be recommended to help you maintain your health and avoid re-injury.
The next part involves gaining your informed consent. Any changes in your treatment plan and the rationale behind the recommended change should be communicated to you before gaining your consent. When it comes to altering treatment plans, your informed consent is required before the treatment plan is altered. Informed consent is a very important process in health care so if you wish to read more on informed consent you can do so here and here.
3. What about my insurance coverage if I switch. What happens to it?
An important factor to consider is the availability of funding for your treatment plan. Many patients rely on external funding to pay for some or all of their physiotherapy sessions. If your physiotherapist is altering your care plan to move into a non-physiotherapy service, then you should be asking about any potential changes to your funding. Insurers often have limitations on what services they will pay for. Each benefit plan varies, and some may have coverage for services outside of physiotherapy while others may not.
The best way to find out if the non-physiotherapy services are covered by your benefits provider is to call them directly to ask. The physiotherapist should be discussing these aspects with you as part of the initial discussion around the proposed changes to your treatment plan. This discussion must be part of the process of getting your informed consent to proceed.
4. If they won’t cover non-physiotherapy sessions, can I still claim it as physiotherapy?
No. For a service to be considered physiotherapy, it must meet certain requirements set out in the Standards of Practice for Physiotherapists in Alberta. When it does not meet those requirements, it may not be misrepresented as a physiotherapy service.
As physiotherapy is often covered by extended health benefits there is often financial pressure to call a service such as personal training physiotherapy, even if it is clearly not. The College is aware of instances where both patients and physiotherapists have proposed this plan. For example, if the patient wanted the personal training but doesn’t want to pay out of pocket for it, or if the physiotherapist assumes the patient won’t pursue personal training if the sessions aren’t covered by their insurance coverage.
Neither is acceptable as both may be seen to constitute fraudulent billing and misrepresentation of the services to an insurer.
If the session is a non-physiotherapy session, then the physiotherapist should have informed you. If you try and claim it as a physiotherapy session, then your insurer may take issue and there could be consequences with trying to file a false claim.
5. Is there a reason why my receipt doesn’t say physiotherapy on it and doesn’t list the physiotherapist’s registration number?
Anything billed as a physiotherapy service should have “physiotherapy” and a description of the service written somewhere on the receipt such as “Physiotherapy Assessment” or “Physiotherapy Treatment.” The cost of the service, as well as your physiotherapist’s name, professional designation, and College registration number should also be on the receipt.
If non-physiotherapy services was provided, the receipt would not include the registration number, physiotherapist professional designation, or describe the services as physiotherapy.
Most often issues on whether a service is physiotherapy or not result from insufficient communication. If your physiotherapist is suggesting that you receive services that are not considered physiotherapy, they should be providing you with information on the nature of the service provided and advise you on the implications of receiving these services before providing them. If the physiotherapist doesn’t provide the information, you should be asking them about how the change in services will help you reach your goals and if there are any funding implications related to the change. The physiotherapist is required to obtain your ongoing informed consent to the services you are receiving, so feel free to ask questions of your physiotherapist so that no misunderstandings occur.Sean FitzGerald, PT