Claims practices for osteopathic services

# 114 –  May 2007

At Sun Life Financial Group Benefits we regularly conduct reviews of our claims operations, and in a recent review, we noted a steady increase in the number of claims submitted for osteopathic treatments. To ensure you and your plan members understand that coverage for osteopathic treatment depends partly on the designation of the practitioner, we thought it would be helpful to clarify our claims practice under your group benefits plan.

If your Extended Health Care coverage includes the services of health practitioners, they must be licensed, registered or certified by a government-recognized regulatory body to be eligible under the plan. In Ontario, osteopathic treatment is sometimes provided by practitioners who are not licensed by a government-recognized regulatory body. Although this is currently an Ontario-based issue, we anticipate it will become a concern in most other provinces.

Osteopaths in Ontario
In Ontario, practitioners generally have one of these two designations:

• Doctor of Osteopathy (DO). DOs are physicians (MDs) who have additional qualifications in osteopathy. They are regulated and certified by the College of Physicians and Surgeons of Ontario. Services by these practitioners are eligible expenses under your group Extended Health Care plan.

• Diploma in Osteopathic Manual Practice (DOMP). DOMPs are not members of any regulatory agency recognized by the government. Therefore, services by these practitioners aren’t covered under your plan.

Some DOMPs have additional credentials such as massage therapy or physiotherapy; their services may be covered if the appropriate credentials are indicated on the receipt and are eligible under your plan.

At one time, osteopaths were regulated by the College of Osteopaths of Ontario. Expenses were handled the same way as chiropractic and podiatric services: they were covered by OHIP up to a maximum amount; group benefit plans covered the balance of the claim. When the College disbanded in the early 1990s, OHIP stopped covering the services of new osteopathic practitioners since they were no longer a regulated health profession in Ontario.

The osteopaths previously registered with the former College of Osteopaths moved to the College of Physicians and Surgeons of Ontario. They were graduates of American universities that grant doctorate degrees in osteopathic medicine equivalent to MDs. There are still several of these osteopathic doctors practicing, and they are covered by OHIP.

In 1991, the Canadian College of Osteopathy was founded. This school offers a course to become an osteopathic practitioner (DOMP). While there are various associations for osteopathic practitioners across Canada, they’re not regulatory bodies.

Coverage in Quebec
Quebec is the only province with a regulatory body for osteopaths. Your plan covers osteopathic services from practitioners registered with the Institut d’enseignement de l’ostéopathie du Québec (IEOQ).

What should plan members do?
As alternative treatments become more popular, it’s important for plan members to become informed consumers. To ensure that they receive treatment from properly qualified and regulated professionals, we encourage plan members to enquire about the qualifications and designation of any practitioner they consider before undergoing treatment. And they shouldn’t hesitate to call our Customer Care Centre if they’re unsure whether a particular treatment or service is covered under the plan.

If you have any questions about your group benefits plan, please contact your Customer Service Representative at 1-877-786-7227.