This is a question that we are asked at least once every week. OHIP does pay a small amount for physiotherapy but it’s only a small amount and is available only to eligible Ontarians. The following information will help you determine if you are eligible to receive OHIP funded physiotherapy and if it’s even worth it.
Firstly, you must have a valid OHIP card to receive OHIP funded physiotherapy. Qualifying for an OHIP card is another topic altogether. If you are interested in learning more you can click here.
Assuming that you do have a valid OHIP card you are eligible for government funded physiotherapy if you:
- Are a resident in long-term care.
- Have been discharged as a hospital inpatient after an overnight stay and require physiotherapy for the condition, injury or illness for which you were hospitalized. Talk to your doctor about accessing physiotherapy.
- Receive income from Ontario Works or ODSP. Talk to your doctor about accessing physiotherapy.
- Are 65 or older or 19 and younger. Talk to your doctor about accessing physiotherapy.
If you are not listed above the government will not cover your physiotherapy. If you are listed above keep reading to find out how to access government funded physiotherapy.
- Step One: Get a referral – If you need physiotherapy, you will need a referral from your doctor, nurse, or possibly another medical contact. You cannot access government funded physiotherapy services without an appropriate referral.
- Step Two: Find a clinic offering government-funded physiotherapy services – Not every clinic can provide OHIP funded physiotherapy. Only a handful of clinics in each area are licensed to provide OHIP funded physiotherapy. You can click here to find an OHIP funded physiotherapy clinic in your area.
If you qualify for OHIP funded physiotherapy, you have a referral and you’ve found a local clinic that is reasonably convenient for you please keep reading to learn a little more about Episode of Care funding for physiotherapy.
An Episode of Care (EOC) is defined as a discrete group of condition or diagnosis specific, time-limited, goal oriented physiotherapy services provided to a specific patient. The services must be initiated by a referral from a physician or a nurse practitioner and each EOC requires a separate referral. A patient can be referred more than once in a funding year; however, the number of patients with more than one referral will be very low.
The amount that the physiotherapy clinic receives for the EOC is $312.00 and from this funding they must provide all the necessary assessment and treatment supplies and access to equipment required for rehabilitation. There are no other fees payable by the patient for services covered under the EOC. Some funding is better than no funding but the reality is that OHIP funding for physiotherapy is woefully inadequate to provide quality care. With such limited funding, clinics are forced to rely on cost cutting strategies such as providing group treatment instead of private treatment, providing shorter visits, using less expensive support staff whenever possible, and relying on self directed exercise.
If you are an Ontarian who qualifies for OHIP funded physiotherapy treatment but you also have workplace extended health benefits or the means to pay out-of-pocket for physiotherapy you should consider your options. Opting to pay for your physiotherapy privately will likely result in higher quality care and possibly a faster recovery and/or a better outcome.