Billing, Insurance & Alberta Mental Healthcare – Let’s Break it Down…
- Victoria LaBerge
- Mar 14
- 5 min read
Here’s the scoop – Alberta Health Services (AHS) and government-funded programs offer various mental health services such as psychiatric assessments, crisis counselling, or short-term counselling, but individuals typically require a doctor’s referral. In addition, there can often be longer waitlists, extra steps and middlemen, and you don’t get to select the mental health practitioner you work with.
Psychologists, Social Workers, and Counsellors outside of publicly funded programs and in private practice (e.g., Balance Psychological Services) are not funded, and you’ll need to use private insurance (e.g., Greenshield, Sunlife) or pay out-of-pocket for their services. However, accessing private therapy allows you to often receive more individualized care, and beat the wait times.
If you decide to seek a therapist in private practice, here are the ways you can pay, bill, or use insurance to cover your therapy sessions…
Ways to Pay for Therapy
Direct Billing (THEY pay, hooray!)
Direct billing is a professional partnership or arrangement between your Alberta mental healthcare provider or clinic and the insurance company, and invoices are sent directly to your insurance company by the practitioner. However, it is important to know exactly how much coverage your insurance company will provide (i.e., number of sessions, percentage of cost covered, etc…). Nothing worse than leaving your therapist’s office only to find out you have maxed out your benefits!
“Pay & Submit” (YOU pay, THEN they pay… sort of hooray)
“Pay & Submit” means that, even if you have insurance coverage or benefits, your insurance company will require you to pay your therapist first (e.g., credit card) and then submit a claim to be reimbursed later.
If you pay out of pocket or with a credit card and are waiting for reimbursement via claim, some insurance providers are quick to reimburse you, whereas others can take upwards to weeks or a month to pay up – VERY important to remember when budgeting and accounting for the cost of a therapist. Like direct billing, every insurance company will vary in how much or how many sessions per year they will cover.
Regular Rate or Sliding Scale (You pay the full fee OR negotiate a rate with your therapist)
The Regular Rate is the standard fee a Counsellor or Psychologist charges. These fees are dictated by Alberta’s regulatory colleges, such as the College of Alberta Psychologists or the Canadian Counselling and Psychotherapy Association.
Sliding Scale is a negotiated fee between the client and their counsellor. A therapist may offer a sliding scale to clients who cannot afford the full fee, or will offer lower-priced services for at-risk clients or clients in need. Counselling interns and students will often offer free or very low-cost therapy as well.
Benefits & Coverage – Who is Covered and Who is Not
Insurance companies vary in which mental health professionals they will cover. Some insurance companies will cover Psychologists but not Provisional Psychologists; some will cover Psychologists but not Counsellors, and so on…
Many health plans will offer a maximum (e.g., $500) per year for mental health. However, more companies are starting to acknowledge the importance of mental health supports and are increasing their coverage and benefits for therapy.
By contacting your insurance company, you can learn a) the types of mental health practitioners they will cover or reimburse you for, b) the amount or number of sessions covered per year AND the percentage covered, c) when insurance renews each year, and d) whether they can be directly billed by a provider. Your benefits may cover the full cost of therapy, a dollar portion or percentage, or a limited number of sessions.
Companies that offer direct billing OR reimbursement in Alberta may include:
Alberta Blue Cross
Alberta School Employee Benefit Program (ASEBP)
Alberta Retired Teachers’ Association (ARTA)
Beneva
Canada Life (formerly Great West Life)
Chambers of Commerce Group Insurance Plan
CIMUP
D.A. Townley
Desjardins
Equitable Life
First Canadian
Green Shield Canada
GroupHEALTH
GroupSource
Industrial Alliance Insurance and Financial Services (iAFinancial Group)
Johnson Group
Manion
Manulife Financial
Maximum Benefit
Medavie Blue Cross (CAF, IIRC, RCMP, and VAC)
RWAM
SSQ Insurance
Sun Life
The Claims Xchange/Nexgen Rx
UV Insurance
*This is not a comprehensive list.
*Clients are responsible to check with their insurance provider to know whether they are eligible for direct billing or submit receipts for reimbursement.
Registered Provisional Psychologists and Alberta Mental Healthcare
Provisional Psychologists are common in Alberta, you can find one in nearly every clinic. While Provisionals can offer varying treatments and support, they are not able to register (yet) as providers with all insurance companies that a Registered Psychologist can.
Insurance companies may also have different coverage for the types of therapeutic services, such as assessments and diagnoses, documentation, or interventions and treatments. For example, seeing a Registered Psychologist to assess you for depression versus hiring a Provisional Psychologist to learn coping strategies for depression may not receive equal amounts of coverage.
When considering hiring a Provisional, check out these insights and suggestions… and remember, the extent of your coverage and number of sessions insured varies plan to plan!
Insurance Company | Billing Options & Possible Coverage for Registered Provisional Psychologists |
Alberta Blue Cross | Direct billing |
Greenshield | Direct billing |
Medavie | a. Royal Canadian Mounted Police (RCMP) and the Canadian Armed Forces (CAF) do NOT cover services by a Provisional in private practice b. Veterans Affairs Canada (VAC) allows for direct billing |
PCVRS (Partners in Canadian Veterans Rehabilitation Services) | Direct billing for CAF Veterans |
Telus Health | Provisionals cannot directly bill through the Telus portal, for example: a. Desjardins - allows direct billing for some, but not all b. Manulife Financial - allows direct billing for some, but not all c. Sun Life Financial, Canada Life - require payment upfront and to submit receipts or a claim for reimbursement; Sun Life does not allow for direct billing for psychological counselling. |
Workers Compensation Board (WCB) | Does NOT allow Provisionals to be providers; no coverage or benefits available when working with Provisionals. Registered Psychologists are accepted. |
When In Doubt, Ask Questions
If you ever find yourself in a confusing or overwhelming situation trying to search for a therapist, you are not alone! Consider finding therapists who offer free phone consultations to ask them the necessary questions in understanding their role and services offered.
Finding the right therapist can take a little research and investigation, but once you find them, I promise it’s worth it!
If you'd like to book a free 15-minute consultation with a Balance Psych Services therapist to see if they are a good fit for you, you can contact our admin team! info@balancepsychservices.ca
587-985-3132
Related Posts
If you're interested in understanding the credentials of mental health practitioners in Alberta, head to the first blog post in this series:
A Guide to Understanding the Credentials of Mental Health Practitioners in Alberta
About Balance Psychological Services
Balance Psychological Services is a psychological private practice aimed toward healing, growth, and balance. Our mission is to ensure that every person who walks through our doors feels seen and accepted for exactly who they are, no matter the circumstances they are facing. With offices conveniently located in Stony Plain, Edmonton, and Beaumont, we are here and ready to help you find your balance. Book an appointment today.
Disclaimer
Information provided through Balance Psychological Services' blog posts is meant for educational purposes only. This is NOT medical or mental health advice. If you are seeking mental health advice, please contact us directly at (587) 985-3132.