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Our Financial Management Guidelines

Financial Policy

  • Financial Policy

Table of contents

  1. PMHS Sliding Scale Program (PSSP)
  2. Quality of Care and PSSP
  3. How our PSSP works
  4. When we determine your PSSP eligibility
  5. Clients with access to Third Party Insurance
  6. Confirm whether the Policy includes Social Services
  7. Client pays for first session
  8. Claims declined by Insurance Providers

PMHS Financial policy

Since our services are not covered by the Ontario Health Insurance Program (OHIP), PMHS understands the financial challenge that such absence of OHIP coverage could pose to our clients. To ensure that will continue to be accessible and affordable to Ontarian living with low income and those without a third party non-governmental insurance coverage, we have introduced measures to help bridge the gap and make all our services accessible to everyone, irrespective of their financial status. Part of the ways we breach the gap for our clients is to introduce PMHS sliding scale program (PSSP) for individuals that are financially supported through the government financial benefits such as Ontario Disability Support Program (ODSP), Ontario Works (OW) and any other government financial benefits.

PMHS Sliding Scale Program (PSSP)

PMHS sliding scale modern was designed to make counselling and therapy even more affordable to those with limited financial resources. Our goal for offering sliding scale is to remain committed to our core values of Promoting Mental Health Equity, Closing the Mental Health Gap among individuals and families, Redefining Mental Health Solution, Tailoring Social and Mental Health Services to client’s needs, Championing Mental Wellness and remain Client-Centric in our approaches. Mental health support is essential to everyone’s mental wellbeing, so we believe that everyone should have access irrespective of your social economic status.

Quality of Care and PSSP

PMHS is committed to providing the highest quality of care possible, as such, accessing services through our PSSP will not in any way negatively impact the quality of care our clients receive from us. Our therapist expends the same amount of expertise, professionality, enthusiasm, empathy, and compassion towards our all clients, regardless how they fund their treatment with us

How our PSSP Works

PMHS is strongly committed to respecting human dignity and worth of the person. Though we have the option of requesting that clients provide their proof of acceptable income verification documents such as tax documents, pay stubs, notice of assessment, ODSP pay statement, OW pay statement etc., so we can determine their eligibility for PSSP, we have decided to trust our clients to do the right thing by being truthful. Because we trust that our client would the right thing, we have opted to follow the Honors System. With the honor system, our therapist and counsellors are only required to ask their clients about their financial situations and how they intent to pay for their services without obtaining formal proof. We rely on the honesty of our clients to report their accurate financial situation. To ensure fairness and equity, PSSP eligibility is at the discretion of our intake manager. However, PSSP can only apply to hourly rate of each session, and the amount client is deemed to be eligible for cannot be more than 30% of total hourly rate of the session. The exact amount of percentage to apply as PSSP is determined by therapists or counsellors.

When We Determine Your PSSP Eligibility

PMHS will determine the eligibility of our clients for PSSP fees during their initial consultations. At clients’ free 15-minute consultation sessions, our intake manager would ask a few questions about your financial situation to determine your eligibility. Once your means of payment for services is confirmed, and your therapist versus client match is confirmed, your first session will be booked. A client can also complete their booking on our website by clicking on the “Appointments” or “Book a Session” tab. Following your booking, you (client) will receive an email confirmation of your booking and login information to our CRMS web-based client Portal where you can access all your session information and intake forms.

Clients with Access to Third Party Insurance

At PMHS, we offer direct billing to most insurance companies; this is also known as Assignment of Benefits (AOB). AOB is an agreement that transfers the insurance claims rights or benefits of an insurance policy to a third party, in this case, PMHS. AOB gives the third party the right to claim insurance benefits on behalf of the policyholder or owner as a form of payment for services rendered.

We understand that mental health insurance or insurance coverages of social work services can be multifaceted and confusing, that is why we prioritize helping our clients understand their insurance coverages to be sure they include services that are provided by social workers, counsellors, therapists, or mental health clinicians.

Confirm Whether The Policy Includes Social Services

At PMHS, we do our best to prioritize our clients’ care by communicating with their insurance companies to the extent that the insurance providers allow us. When we communicate with our clients’ insurance companies, we do our best to encourage insurance providers to provide us with detailed information about clients’ coverage breakdown, including the maximum or percentage they cover, the annual amount the client is eligible for, frequencies of services they allow and any other limitations clause that may exist in the policy. To guarantee accuracy when dealing with insurance providers, we do our best to encourage our clients to provide us with their most up-to-date insurance information for each of their services.

At PMHS, we understand that paying for mental health treatment can be stressful, that is why we do our best to communicate all costs to our clients at their initial consultation. Because insurance coverage can vary, some companies may not provide 100% coverage for every service.

We know that not all insurance companies provide coverage for social work, counselling, and therapist services, we encourage our clients to check with their insurance providers before agreeing or booking services with us

Client Pays for First Session

To establish an alternate method of payment for services, PMHS shall collect payment for the first appointment, after which an agreement can be reached between the client and counsellor on alternate methods of payment that the client intends to provide for subsequent services. During the orientation session, the client and therapist can then establish whether direct billing will be provided to their insurance providers or client intends to continue to self-fund services. PMHS will issue receipt(s) for all payments received from clients. Clients can utilize receipts provided to claim their expenses with their respective insurance providers.

On the website, clients can book services themselves. We have done our best to streamline all processes on our site for easy scaling and navigation. For the client that can utilize their credit or debit cards, we accept all major cards for payment. To book a session, the client can go to our website, click on either the “Appointments” or “Book a Session” tab and follow the prompt. If booking support is needed, the client is encouraged to use our free 15-minute consultation tab and call or email our intake manager for support.

Claims Declined by Insurance Providers

In the instance where the insurance provider declines claims for any reason(s) or pays an amount lower than claimed, the client shall continue to be responsible for ensuring that full payment is made for services provided. If the insurance provider paid less than was claimed or declined to pay claims for any reason(s), PMHS will generate an invoice and send it to the client for payment. Failure to pay for services provided would result in the amount owed to be sent to the collection agency.

Table of contents

  1. PMHS Sliding Scale Program (PSSP)
  2. Quality of Care and PSSP
  3. How our PSSP works
  4. When we determine your PSSP eligibility
  5. Clients with access to Third Party Insurance
  6. Confirm whether the Policy includes Social Services
  7. Client pays for first session
  8. Claims declined by Insurance Providers

Eligible Insurance Providers

We accept most major insurance providers. We encourage our clients to check with their insurance providers to confirm whether they’re covered for social work services before requesting an appointment, except if there is a plan to self-fund services.

Please call our intake line: (647) 819-8173 or Email us at: intake@primementalhealthwellness.ca for any inquiries.