One of the most common questions we are asked at pt Health clinics across Ontario is whether or not our physiotherapy services are covered by the Ontario Health Insurance Plan, or OHIP.
The short answer is yes and no.
Read on to understand the specific cases where physiotherapy is covered by OHIP, as well as cases where it is not.
When is Physiotherapy Covered by OHIP?
Ontario’s Community Physiotherapy Clinic Program is available to eligible patients, free of charge.
The Program funds select clinics to help people recover from recent illnesses, injuries and surgeries, or flare-ups of chronic conditions.
Who is Eligible for the Ontario Community Physiotherapy Clinic Program?
You can enter the Program if you are referred by a doctor or nurse practitioner and have experienced:
- A recent illness, injury, accident or surgery that led to a decline in function or movement or
- A flare-up or worsening of symptoms from a previous fall, accident, surgery, or chronic condition that led to a decline in function or movement
You must also:
- Have a valid Ontario health card, and
- Be 65 years or older, 19 years or younger, or any age if you were admitted to a hospital for an overnight stay within the last 12 months as the reason for your referral
You can also participate if you are approved for Ontario Disability Support (ODSP) or Ontario Works (OW). In that case, an Ontario health card is not required and there are also no age requirements.
Visit our OHIP page and find an OHIP physiotherapy clinic near you to book an assessment today.
Who is Not Eligible for the Ontario Community Physiotherapy Clinic Program?
You are not eligible to participate in the Program if you:
- Want to keep an existing level of function or ability to move
- Want long-term rehabilitation (talk to your health care provider for options)
- Need specialized services (e.g. for stroke and heart attack recovery)
- Receive other physiotherapy services funded through auto insurance, the Workplace Safety Insurance Board (WSIB) or by other government-funded healthcare programs (e.g. in-home physiotherapy).
Note: a referral from a doctor or nurse practitioner does not mean you are automatically approved to receive physiotherapy under this Program.
How Does the Ontario Community Physiotherapy Clinic Program Work?
Eligibility
A doctor or nurse practitioner must first refer you to the Program. A physiotherapist will then determine if you are eligible.
If you are not eligible, you may:
- Get coverage through private or workplace insurance, or
- Pay for physiotherapy services on your own
You may also have to pay for the assessment if you are not eligible.
Assessment
If you are eligible, the physiotherapist will do an assessment, diagnose your condition and develop a treatment plan.
Your plan will include goals that are based on your assessment that are reasonable and measurable (e.g. to walk to the grocery store again).
Treatment
There is no pre-set limit to the number of visits you can receive.
The number of visits you receive with your physiotherapist will be based on your treatment plan and the progress you are making towards achieving your goals.
You can also be treated for more than one condition at the same time.
Discharge
Your physiotherapy will end when:
- You’ve achieved the goal(s) in your treatment plan, or
- You can achieve your goals on your own or through a home exercise, exercise and falls program, or similar program, or
- Continuing physiotherapy would not help you improve
The physiotherapy clinic will send a report to your referring doctor or nurse practitioner once your visits have ended. The report will list the treatment you received and the goals you achieved.
The physiotherapy clinic should also give you exercises to do at home. You may also be given a list of support services in your community.
Visit our OHIP page and find an OHIP physiotherapy clinic near you to book an assessment today.
What If I Want More Physiotherapy After I’ve Been Discharged?
You may be eligible to receive additional physiotherapy under the Program as long as you meet all of the requirements outlined above.
You will not be eligible for further treatment if you wish to maintain your level of function or ability to move, or if your physiotherapist finds your function or mobility has remained the same since you were discharged—even if you have a referral from your doctor or nurse practitioner.
If you are not eligible to receive additional physiotherapy under the Program, you can:
- Get coverage through private or workplace insurance, or
- Pay for physiotherapy on your own
Do I Have to Wait?
Wait times for physiotherapy under the Program vary.
Clinics manage their wait lists based on the urgency of a patient’s condition. Be sure to ask the clinic about their wait times.
Find Your Local OHIP Clinic Today
Visit our OHIP page and find an OHIP physiotherapy clinic near you to book an assessment today.