Paramedical Coverage

Apr 24, 2012

Paramedical practitioner coverage is an integral part of a benefit plan and includes services like massage therapy, chiropractors, physiotherapy etc. They are often the second highest claimed category after prescription drugs in extended health care coverage. This can be a conundrum for plan sponsors because on one hand, employees can prevent absenteeism and/or presenteeism by taking care of their health instead of taking time off or using long-term medication. On the other hand, these claims are costly and there could be the question of whether employees are using these practitioners as a “feel good” tool instead of using them when they are medically necessary.

It is important to note that insurance companies have controls set in place for the payment of these claims. They will verify that practitioners are registered before payments are issued and they will only pay up to their reasonable & customary (R&C) guide. It is important that employees understand that there are R&C limits within their plan and that a $200 one hour massage would not be fully reimbursed regardless of how much is left in their maximum.

We are also seeing technological advancements with certain insurance companies where paramedical practitioners can submit claims directly to them for reimbursement as opposed to having the employee submit a claim form.  In the future, employees will be available to search for these practitioners through smart phone technology.

We encourage employers to review their paramedical claims with their benefit consultant because there are many ways in which a plan sponsor can help control claims.  Most of this can be done through plan design.  However, it is equally as important to ensure that employees understand that any abuse or fraud will affect future pricing of the benefit plan and ultimately the design and cost sharing parameters of the plan.

We can help you with your paramedical claims… just ask us how!

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