Understanding Insurance Platforms and Predeterminations

While platforms like Telus Health are commonly used for direct billing, it’s important to note that access to this service is not universal for manual osteopaths, particularly because manual osteopathy is not a regulated profession in Canada. At the time of writing, direct billing for manual osteopathy is only supported by BlueCross (Medavie), Provider Connect (Greenshield & SSQ), and The ClaimsXchange, each of which uses its own platform. Although some insurance providers, like Sunlife, previously allowed direct billing through their platform, this option was abruptly discontinued in March 2024. The regulations surrounding direct billing are constantly evolving, so practitioners and patients should stay informed about current policies. Clinics should be transparent with their patients about these limitations to manage expectations and avoid billing challenges.

Insurance Providers and Their Platforms

Insurance companies rely on different platforms to process claims. The most common platform is Telus Health, but some insurance providers, for example Sunlife and Greenshield, have use their own Below is a breakdown of some notable insurance providers and the platforms they use:

Here are the links to set up your account with each of the above mentioned insurances / platforms:

1. Telus Health Portal: https://registry.telushealth.co/
2. Medavie (BlueCross): https://www.medaviebc.ca/en/health-professionals/register
3. Sunlife: https://acces.sunlife.ca/s/login/SelfRegister?language=en_CA
4. Provider Connect: https://providerconnect.ca/ProviderEnrolment/HPPSApplication.aspx
5. The ClaimsxChange:https://www.theclaimsxchange.com/register.aspx

Predeterminations

While Telus Health is widely used, one significant limitation is the inconsistent availability of predeterminations across insurance providers. A predetermination is a preliminary assessment of a patient’s coverage and eligibility for a specific service. It helps avoid surprises for both the clinic and the patient.

However, several providers on Telus Health do not offer this feature directly through the platform. This lack of transparency can lead to delays in processing claims and unexpected out-of-pocket costs for patients.

Here is a list of insurance providers that do not have predetermination functionality enabled through the TELUS Health Portal:

• Cowan Insurance
• Equitable Life
• Great West Life
• Industrial Alliance
• Manulife

Please note that this information is subject to change. For the most current details, it’s advisable to consult the TELUS Health eClaims portal directly or contact the respective insurance companies.

It is important to note that either a practitioner or a patient can submit a predetermination or estimate for services or products directly to the insurance provider. However, it is essential to keep in mind that the insurance provider’s response may not be immediate.

Click here, to learn how to submit a predetermination.

Why Predeterminations Matter

1. For clinics, predeterminations can:

• Improve patient experience: Patients get a clear understanding of their coverage upfront.
• Reduce financial risks: Clinics can avoid disputes over unpaid claims.
• Save time: Clinics spend less time handling claims issues after services are rendered.

1. For patients, predeterminations:

• Provide clarity on costs: Patients know what to expect regarding out-of-pocket expenses.
• Help with financial planning: Patients can plan for treatments without unexpected costs.

When dealing with insurance claims, understanding which providers support predeterminations is crucial. Clinics should educate their patients about the limitations of certain platforms like Telus Health to ensure a smoother billing process. As the digital claims landscape evolves, encouraging insurance providers to adopt more transparent practices will benefit both healthcare professionals and patients alike.