Physiotherapy is covered by OHIP if the person is under 19 or above 65 years and has had a recent injury, a flare-up or has a valid recommendation by a physician or nurse practitioner. However, the particular physiotherapist also has a say in deciding whether you really need the treatment.
Who is eligible for OHIP funded physiotherapy?
In Ontario, the terms state that physiotherapy can be covered by the provincial health insurance (OHIP) for persons who are aged below 19 or above 65. People classified under this age group are eligible to receive services for recent injuries, also known as acute injuries.
Another consideration is provided for flare-ups of long-standing injuries like a previous back pain re-emerging in the present scenario.
For a person who does not fall in the aforementioned age groups, he or she is eligible to receive the services if he or she has just been released from the hospital from a minimum of an overnight stay. In these cases, one is considered eligible for OHIP covered physiotherapy Hamilton.
If you do not meet the conditions mentioned above, you will not be considered eligible.
Who is Not Eligible for the Ontario Community Physiotherapy Clinic Program?
1. Someone who can and wishes to continue to move around and maintain a level of mobility will not be considered eligible.
2. Someone who is looking for long-term rehabilitation will not be considered eligible.
3. Someone who needs specialized services like post-heart surgery care will not be considered eligible.
4. Someone who receives external funding through insurance policies like the Workplace Safety Insurance Board (WSIB) or by other government-funded healthcare programs will not be considered eligible.
If I’m Eligible What Do I Do Next?
If you are eligible, you will have to visit a physiotherapist for an assessment of your condition. This assessment enables the physiotherapist to diagnose the problem and create a personalised treatment plan. The plan will include specific goals based on your diagnosis.
How Does the Ontario Community Physiotherapy Clinic Program Work?
The eligibility criteria include age groups of people under 19 years and above 65 years. You can continue to make visits to the physiotherapist’s clinic as long as you meet these requirements.
The eligibility criterion is also dependant on the physiotherapist’s analysis of your condition. If the physiotherapist feels you need more treatment, you are considered eligible. But if the physiotherapist feels that your condition is similar to that of when you were discharged or better, then you will not be considered eligible.
The assessment is conducted by the physiotherapist for diagnosis and creating a reasonable treatment plan.
For the treatment, you can visit as many times as required. The number of visits is dependent on the treatment plan and how you are responding to the particular program. If you are showing signs of progress, the number of visits can be reduced. If your condition is deteriorating, you can increase the number of visits.