The Alberta Health Care Funding Model Explained
Some of the most common questions we field in physical therapy are concerning the funding model for assessment and treatment through Alberta Health Care.
A number of clinics in the Edmonton area are allotted a monthly and yearly allowance for community rehabilitation. Wait times vary depending on demand, though clients typically are seen within the week for their initial assessment at Corona Station Physical Therapy.
Those clients who have undergone surgery or suffered a fracture are automatically approved for an additional six visits through Alberta Health Care. Clients who are on certain government subsidy programs, or are considered to be low income will qualify for a one time per year allowance of six additional visits with three treatments covered for any subsequent injuries that are not fractures or surgeries. Should further treatment be needed at the completion of these treatments, the physical therapist can complete a Request for Review Funding form, applications are reviewed on a case by case basis with some individuals receiving additional treatment if it is determined to be necessary.
Those clients who have not had a fracture or surgery or are not low income may qualify for an additional two visits as determined by the Determination of Need rubric that is completed by the physical therapist. This tool takes into account the severity of the person’s injury, the benefit they are likely to receive from treatment and the impact that delay would have on a favourable outcome. The funding is based on certain body areas so, for example, if a client fractures their wrist and has the misfortune of later injuring a second body part, they can again access Alberta Health Care funding. The health care year renews annually in April.
If clients are dissatisfied with an assessment where they are deemed ineligible for funding, they are entitled to a second assessment through Alberta Health Care. Those individuals injured in a motor vehicle accident or at work must access different funding sources for their treatment. Some services, such as vestibular rehabilitation, women’s health, concussion management and running gait analysis are not covered by the community rehabilitation program and must be paid for privately. For further information, visit http://www.albertahealthservices.ca/info/service.aspx?id=1028551 or contact us at the clinic at 780-424-4804.