Show Notes

Kayla: Welcome back to The Designer Practice Podcast, and I’m your host, Kayla Das.

Are you a therapist in Canada wondering how to direct bill insurance companies?

In today’s episode, Monique Sousa, Registered Psychotherapist, will share how to direct bill insurances in your Canadian practice.

Hi Monique, welcome to the show. I’m so glad to have you here today.

Monique: Thank you for having me. As you mentioned, my name is Monique. I am from Toronto, Ontario. I knew from about 16 years old I wanted to go into therapy, and then once I got into my twenties, I knew that private practice would meet all of my professional goals where I could choose the flexibility of when I wanted to work and ultimately grow as a team. I initially registered my private practice in April of 2021, just months into starting my practicum, and then I officially started seeing clients through there in July.

Once I started, I dived right into how to best market myself as well as my practice. And a big part of that of what clients wanted was direct billing. I did a solo practice for about a year, and then I started taking on students with a partner site, providing their supervision.

ThoughtWorks therapy is now a team of eight with one to two people getting added on every four months. And part of my onboarding is making sure that everyone is set up on insurance platforms as soon as possible.

Kayla: Amazing. And I do want to highlight for any American listeners that the Canadian billing system is a little bit different than the American. So, if you’re American, some of this might be relevant, but I am gonna say that it’s quite different than the Canadian. So, if you’re American listener. This may not be the episode for you. But in saying that for Canadians, this is going to be a really helpful, helpful episode.

So, first of all, for anyone who might not know, what do we mean by direct billing insurances in private practice? Because I know that some of our listeners might still be thinking about going into private practice, but have not even considered direct billing or even know what it is.

Monique: Great question. Direct billing, what it means is that rather than collecting money from the clients and then having the client submit for reimbursement, we as the practitioners use their plan information to build their insurance provider directly.

Kayla: Perfect. So how does direct billing differ from, say, a private pay type of payment, where you give a client a receipt so that they get a reimbursement?

Monique: So normally with private pay, they would pay using either a credit card or e-transfer, and then it would be on the client’s onus to then submit that through their insurance provider after the session. With direct billing, we as a provider to bill a company directly, so it avoids that extra step that the client has to take.

Kayla: So why should someone consider direct billing in Canada versus having their clients submit a receipt to their insurance providers themselves?

Monique: The easiest answer is client demand. I had a lot of clients specifically looking out to work with a site that offers direct billing. Some people are more forgetful than others, and this takes one less thing off of their to-do list. It can help provide greater access to those clients who also maybe don’t have the funds available for counseling in their accounts, or whose credit cards are already maxed out.

On the provider side, it’s a free platform to sign up on and to use, and unlike credit cards, there are no fees per transaction, which means you get the full amount that you submit directly into your bank account.

Kayla: I know this is a question for some therapists, and actually I didn’t direct bill in my private practice, so I actually don’t know the answer to this, so you might be able to help. When you are direct billing a client, how do you know that they have enough coverage to cover your session or not?

Monique: Great question. With every insurance platform, you can do an eligibility check for any individual person’s claim coverage amount. All you need is their insurance information. Normally it’ll ask for the client’s name, their date of birth, their plan member, their plan ID number, and if they’re not the account holder, then all of the account holder’s information as well.

With that, it’s a pretty quick search. It takes about a second to process, maybe a little longer during regular business hours because of high demand on the websites, but you get the full amount. It’ll tell you if the amount is covered or not, and to what allocation.

Plans can differ quite dramatically. Some people have a hundred percent coverage, some people have 80, some people have less. And so because of that, it allows you to know exactly how much of your session is going to be covered. And also, if there’s session cap.

For example, I believe there was one insurance clients that I had submitted a claim for, and they were only eligible for up to $184 per session cap at an 80% coverage. So all the rates that are higher than that wouldn’t get covered in that allocation amount.

Kayla: That is super helpful. So, in Canada, who are the main insurance companies to consider direct billing with as a therapist?

Monique: The main insurers that allow for direct billing are Green Shield, Blue Cross, and then there’s Telus E-claims, which encompasses all of the smaller insurance providers that could be Canada Life, Manulife, Desjardin, as well as many of those other smaller insurance providers.

Kayla: Yeah. And it’s funny because like I mentioned earlier, I personally haven’t direct billed in my practice. But when I first started out, I was going to with Alberta Blue Cross. And interestingly enough, and I think this is really important for people to know, is that there’s actually, at least here in Alberta, Alberta Blue Cross. And like the federal Blue Cross. So, Blue Cross Medavie. They are actually different platforms.

And it’s interesting because the first and only direct billing experience I had someone had a Blue Cross Medavie and I tried to process it on Alberta Blue Cross and it didn’t work. I wasn’t actually approved with Blue Cross Medavie So it’s really important, that at least for Alberta therapists, that if you do choose to go with Blue Cross, that you register with both Alberta Blue Cross and Blue Cross Medavie just so that you don’t have the same experience happen with any clients that you might have.

Monique: There’s also an additional one that’s unique to BC, which is called Pacific Blue Cross. So Blue Cross is the larger company, and then the subsidiaries are, believe so is Pacific Blue Cross is BC. Alberta is Alberta Blue Cross and then Medavie Blue Cross.

And it’s unique to where the client receives their benefits from. It usually has to do with also where they reside, unless they’re working virtually and traveling across Canada.

Kayla: That’s really good to know. And so I think, for any listener listening, it’s really ensuring, are there any variations in your specific province, because even though some of these are the bigger type of insurance companies. But there provincial specific to, so just ensuring like what people are using in your particular province before you start accepting direct billing, especially if you’re direct billing after, and not necessarily looking up for prequalifications because I didn’t actually look up the prequalifications first, which I might have been able to determine in advance that it was the wrong system.

Kayla: So, although I know it’s slightly different across each provider, but in general, how can therapists register for direct billing? In other words, like where do they start to get their names on here so that they can create their accounts and start direct billing clients?

Monique: First step is to go on Google and type in the name of the insurance provider and then the words provider registration next to it.

So, this might look like “Blue Cross Provider Registration” in your search, and that usually pulls up the registration portal right to the top. From there, it’s normally a one-to-two-page application, asking for your credentials, your business number, and your direct deposit information. It’s never taken me more than five minutes to register as a new provider.

Kayla: That’s really helpful. And they would need to register with each individual insurance, correct?

Monique: Yes, they would need to register with each individual insurance. Every insurance would have a different portal. So, it would be the three major ones that I mentioned before, the Blue Cross, Green Shield and Telus E-claims.

Kayla: So how does Telus E-claims work?

Monique: So, one thing that’s unique about Telus e-claims that’s important to mention is that different from Blue Cross and Green Shield. To be registered as a provider on Telus e-claims as a psychotherapist, you can no longer be in the qualifying stage. That being said, you apply the same way that you apply for the other two. It’s the same one-to-two-page application. It just links to other insurance providers.

So, when you’re doing that initial insurance search, it also goes into what specific insurance company is that client with. So, they’ll have a dropdown and then you’ll be able to put in whether it’s, let’s say, for example, Canada Life, and then you’ll input their Canada Life information.

Kayla: Really helpful tips. So are there any other considerations to keep in mind when direct billing.

Monique: Yeah. A couple things to keep in mind when direct billing. Payment times do take longer. Typically, there’s a two-week delay from when you submit the claim to when you get paid out as a practitioner. And approval for getting registered for direct billing can take up to six weeks. So, it’s important to register early on.

Another thing to keep in mind is that if a client has a type of insurance where a lot of professional services are lumped together, for example, they might have a thousand dollars and it’s shared between psychotherapy, massage therapy, physio, if you forget to submit the claim right away, and they have now went on for back-to-back massages. There won’t be any allocation left over to go to you, so make sure to submit those claims right after the session or end of day for timely payments.

I always do a check prior to taking on new clients who requested direct billing to see if their benefits will cover my full-service amount when direct billing, which can all be done through their platforms. So again, it’s just to make sure that my full amount is covered under their billing. It’s to make sure that my service fee is covered under their insurance provider in full, or to what allocation.

Kayla: Amazing. Do you have any additional advice, insights, or tips for listeners about how to direct bill insurances in Canada?

Monique: Make sure to register early on because the lengthy processing time to get approved. And if you end up adding that, you now offer direct billing. It can also help with your SEO function on your website as well. Because it’s now a new searchable results that clients will look for.

Kayla: Oh, we love SEO here on the Designer Practice podcast. So, I love hearing that. That’s amazing.

Monique, you have courses that you offer to new and aspiring therapists. Can you tell us what it is and how it can help listeners?

Monique: At Therapist Haven we offer two courses. The first one is called How to Start a Private Practice. It’s run by two Ontario practitioners who got their full caseload in less than six months. They’ll go through the business structure, the difference between starting a sole proprietorship versus a corporation, and everything you need to know on how to set it up and the resources you’ll need thereafter, as well as a breakdown of all the financial costs involved.

Now the second is called How to Grow a private Practice where it goes into more depth on the marketing side, as well as how to transition those consults into bookings.

For the first one I mentioned, the how to start a private practice. We are actually hosting it live on November 19th, 2025 between 12:00 PM to 1:30 PM and with the live webinar showings, there’s an opportunity for a 30-minute Q&A at the end with both of those practitioners who went through both business routes as well as pricing examples that are specific to Ontario legislation. However, the methods and structure of starting a business are all the same across Canada.

Plus, you’ll also receive discounts and preferred pricing on exclusive packages with our partners from Jane to government registration, to website developers, and more.

Kayla: Amazing. So, to sign up for Monique’s courses, check out therapisthaven.ca.

Also, I know you have a free Facebook group that you’d like to share with listeners. Can you tell us a little bit about what to expect when joining your Facebook group?

Monique: Yeah, so the Facebook community is free. You can join and it’s a place where you can ask questions related to private practice, host gatherings, as well as sharing referrals.

Perfect. And to sign up for Monique’s Facebook group, head to kayladas.com/moniquesousagroup

Or you could simply scroll down to the show notes and click on either link.

Monique, thank you so much for joining us on the podcast today to discuss how to direct bill insurance companies in your Canadian practice.

Thank you for having me today.

And thank you everyone for tuning into today’s episode, and I hope you join me again soon on the Designer Practice Podcast.

Until next time, bye for now.

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