Physiotherapists are turning to virtual visits — but insurance can be a pain in the neck

For Patricia, a Toronto woman living with endometriosis, pelvic physiotherapy is a critical tool for her painful chronic condition.

Global News has chosen to use a pseudonym to protect her privacy.

Unfortunately, Patricia’s clinic is now closed due to concerns over the coronavirus outbreak. Her physiotherapist is offering virtual sessions, but her insurance provider refuses to cover the cost.

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“Physio helps me come back into a relationship with an area of my body from which I’ve disassociated because of long-term chronic pain,” Patricia told Global News.

Endometriosis is when cells that normally make up the lining of the uterus are found elsewhere in the abdomen, usually in the pelvic region. This can cause severe pain, particularly during menstruation, and can contribute to infertility.

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Without access to her physiotherapist, Patricia said she feels “out of balance.”

“It feels like I created a constellation of care for myself and one of the [brightest] stars has gone dim.”

Patricia isn’t alone. Adam Brown, a registered physiotherapist at Cornerstone Physiotherapy in Toronto, says much of his client base is living without access to physiotherapy during the coronavirus outbreak.

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This concerns him for a number of reasons — the most pressing being that, in situations of trauma, physiotherapy is most successful if the patient is treated almost immediately after the accident.

“There’s a window of time after a trauma where it is reasonable to expect to get mobility back,” Brown told Global News.

With every day and week that treatment is delayed, it gets substantially more difficult to restore full mobility in a patient.

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Brown and other physiotherapists at his clinic have started offering virtual sessions, but it’s difficult to be as effective as possible without physical touch.

“We’re using virtual [options] to encourage [patients] to get moving and to show them how to move, and in some cases, even getting somebody who also lives in their household to help them out,” he said.

“We’re trying our best to look after everybody as best we can … but there are a number of patients whose outcomes will change.”

‘Better than nothing’

Many physiotherapists across Canada are dedicated to providing care virtually for as long as the coronavirus outbreak prevents in-person appointments.

For registered physiotherapists like Nate Tsang, providing help over the phone or computer is better than nothing at all.

“It’s harder to monitor when I’m not seeing them, but virtual care allows us to incorporate [access programs] and do that through a videoconferencing mechanism,” Tsang said.

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“It’s definitely hardest for … people who have been injured recently. It’s can be difficult to manage their pain.”

Tsang is offering virtual services to his clients, but he’s also concerned about the inconsistency in coverage offered by insurance providers.

“I would say that is a barrier to receiving virtual care,” Tsang said.

Insurance coverage

When Patricia inquired with her insurance provider, Equitable Life of Canada, the company said it would not provide coverage for virtual services.

“They didn’t give me a reason,” Patricia said. Global News contacted Equitable Life of Canada for comment, but the company did not respond before time of publication.

Some other insurance providers have slowly started to change their coverage plans to include virtual options.

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Sun Life extended its care coverage to include virtual physiotherapy appointments in response to the COVID-19 outbreak.

The provider will also cover the costs of virtual services provided by naturopaths, registered dietitians, psychologists and social workers. For a full list of coverage, click here.

For customers of Manulife, virtual appointments are an eligible expense, provided the health-care practitioner is licensed and registered in the province in which they are practising, has an eligible qualification as determined by Manulife, and is practising within the guidelines of their governing body.

“All practitioners who offer virtual appointments must be allowed to do so by their college or governing body,” said a spokesperson for Manulife in a statement to Global News.

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This sort of piecemeal response from Canadian insurance providers leaves too many gaps, said Michael Koonar, a registered physiotherapist and founder of Koonar Physiotherapy in Windsor, Ont.

“Number one, insurance is usually what most people pay with. Number two, most people are concerned about cash flow right now … so paying out of pocket is tough,” Koonar told Global News.

“One of the things we’re hoping for is that this doesn’t just slide under the radar … It needs to be industry-wide.”

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Viivi Riis, chair of the board of directors at the Canadian Physiotherapy Association (CPA), agrees.

“We’re really happy to see the insurance companies that are willing to cover virtual care,” she said. “There’s a robust body of literature that shows virtual care can be very effective and cost-effective, too.”

Ultimately, physiotherapists like Koonar and Riis are just concerned about providing adequate care — especially since the end of the outbreak is not yet in sight.

“We just want people to get the care,” Koonar said.

Questions about COVID-19? Here are some things you need to know:

Health officials caution against all international travel. Returning travellers are legally obligated to self-isolate for 14 days, beginning March 26, in case they develop symptoms and to prevent spreading the virus to others. Some provinces and territories have also implemented additional recommendations or enforcement measures to ensure those returning to the area self-isolate.

Symptoms can include fever, cough and difficulty breathing — very similar to a cold or flu. Some people can develop a more severe illness. People most at risk of this include older adults and people with severe chronic medical conditions like heart, lung or kidney disease. If you develop symptoms, contact public health authorities.

To prevent the virus from spreading, experts recommend frequent handwashing and coughing into your sleeve. They also recommend minimizing contact with others, staying home as much as possible and maintaining a distance of two metres from other people if you go out.

For full COVID-19 coverage from Global News, click here.

— With files from Global News’ Leslie Young

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