Hi, I’m Jules. I’m a practice owner and Registered Counselling Therapist who has operated both ways: with and without direct billing.

Almost ten years ago, I decided to start a private practice in Halifax, Canada because I wanted to counsel clients with approaches I was passionate about and be my own boss. Back then, private practices were scarce, and many insurance companies did not cover Registered Counselling Therapists. Oh, how things have changed!

Over the past decade, my private practice has evolved. As the practice grew and shifted, one of the most significant changes I made was introducing direct billing with insurance companies.

In this post, I’ll cover:

• Why I started without direct billing
• When I eventually decided to offer it
• The pros and cons of direct billing
• How to get the most out of Jane’s Insurance Billing and Payments features

Why I didn’t direct bill for seven years

When I started my private practice in 2016, most insurance companies didn’t cover Registered Counselling Therapists. So, it was an easy decision not to offer direct billing.

Without direct billing, I could charge the full fee and not have to take the time to see if a client’s insurance covered my services or submit invoices to insurance companies directly. Instead, the client paid their invoice in full, and, if their insurance did cover the service, they could submit themselves for reimbursement. I used Jane, my practice management software, to provide invoices and receipts that had the details required for reimbursement.

I made sure my clients were aware of the policy, and luckily, it didn’t stop my private practice from becoming full. Here’s how I made my policy clear to my clients.

Cash Pay Email Template:

Hi [Client Name],

We don’t directly bill insurance, but will provide you with an electronic invoice after payment is received. You can then submit the invoice to your insurance provider for potential reimbursement. We always recommend you clarify with your insurance company if Registered Counselling Therapists are covered in your insurance plan before you book an intake session.

Please let me know if you have any more questions.

Thank you,

As time went on, the profession grew and became recognized in more provinces. As this happened, more insurance companies began covering our services. Once counselling and psychotherapy services were added to TELUS Health eClaims (a free service for Canadian practitioners that allows you to submit insurance claims directly to multiple insurance providers on a single platform), making the change was an easy decision.

Adding direct billing

In 2024, TELUS eClaims added counsellors and psychotherapists to the list of practitioners who could use their platform to direct bill, and this was a big deal for my private practice. It meant that we could easily submit insurance invoices to multiple insurance providers, saving hours of time and energy. Plus, Jane’s integration with TELUS eClaims made it easy to start direct billing since you could check eligibility and submit to TELUS eClaims through Jane.

And if the insurance provider didn’t cover the entire cost of the session, Jane would automatically adjust how much the client needed to pay out of pocket. This would have taken me hours if I were to run it manually myself, but with Jane it only took a couple of extra minutes per client.

Getting set up with direct billing

Because TELUS eClaims doesn’t include Sun Life, GreenShield, and Medavie Blue Cross, I decided to sign up for direct billing with these three insurance companies and with TELUS eClaims. This system is pretty simple and has worked for me.

The only thing left to do was to add Insurance Billing to my Jane plan. This would allow me to easily provide insurance invoicing, use the TELUS eClaims integration, and get clients to upload their insurance card photo in their Intake Forms. Even though Insurance Billing would be an added monthly expense, I decided it was worth it due to the ease of managing direct billing through Jane and having access to the TELUS eClaims integration.

Curious about add-on costs? Check out the pricing page to learn more!

Finally, I needed to communicate this to my clients. Here’s the language I use in my intake emails.

Direct Billing Template:

We offer direct billing to most insurance providers. In the intake form, you’ll be asked to provide your insurance details, and then we’ll bill your insurer directly if they allow direct billing. Please confirm with your insurance provider that you’re eligible for direct billing and how much is covered per session. You will be responsible for paying any remaining balance not covered by your insurance.

The pros and cons of direct billing

The benefit

Incorporating direct billing can make therapy more accessible for clients and give you a competitive edge in a market that is getting more crowded. Since I added direct billing, clients with insurance have been appreciative that they don’t have to pay out of pocket for our services.

It has also allowed the practice to grow, as many people prefer finding a therapist who offers direct billing. It means they don’t have to worry about paying fees up front and taking on the admin of submitting invoices to insurance. Though it can be a learning curve to add direct billing, Jane’s Support Team can guide you through the process. For me, this change was worth it.

The drawbacks

Adding direct billing can add some time to your day-to-day processes. So, depending on the size of your practice and the amount of admin support you have, this time add is a consideration.

Here are things I’ve seen add a little extra time:

• Sometimes the billing form isn’t filled out correctly by the client, and you have to ask the client for the correct insurance information.
• If a client’s insurance runs out or their insurance company doesn’t offer direct billing, there’s extra communication needed about how to proceed with payment.
• With individual insurance companies, there is some extra admin time with forms, having to go to individual websites to input insurance claims, and documenting the claims process.
• And, of course, it can also take longer to get payment from the insurance company.

However, even with this added time, for me and my practice, it was worth it to add insurance billing.

Tips for direct billing using Jane

1. Many banks only include a certain amount of transaction fees in their business plans. Once that limit has been reached, you may have to pay per transaction depending on your business banking plan. To reduce the number of deposits to your bank account, you can set up Jane Payments payouts to only be deposited once a week! All you need to do is call the Jane Support Team and request this change.

2. In the billing section of your Jane account, you can easily keep track of draft, unsubmitted, and submitted claims in the Claim Submission section. This tool is especially useful for keeping track of payments for session invoices that you have to manually submit to insurance providers.

3. Once you have purchased the Insurance Billing add-on, make sure to include the Insurance Card Photo upload in the Intake Forms. Sometimes clients may input their insurance policy incorrectly in the intake form, so it can be helpful to have a photo of the insurance card to make sure that the policy and ID numbers match.

4. Most insurance companies do not pay for sessions that a client misses so making sure that clients have a credit card on file to collect fees not covered can be useful. It may also be helpful to add this disclaimer in the Intake Form so that clients are aware that they may have to pay for missed sessions. Here’s an example of the language I use.

Important: Missed appointments or late cancellations may not be covered by your insurance provider. In such cases, you may be responsible for paying the full session fee. We recommend checking with your provider to understand their policy on missed or late-cancelled appointments.

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If you’d like to learn more about Jane, check out their features or book a demo to see it in action. For me, Jane is a key part of my business and a tool I’ve used for years.

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About Jules Smith

Jules Smith, MEd, RCT, CCC is a Registered Counselling Therapist who owns a virtual group private practice in Halifax, Nova Scotia and longtime Jane Ambassador. They are also the owner of Fearless Practice and hosts the Fearless Practice podcast. Through the Fearless Practice podcast, they provide invaluable insights and practical advice on starting and growing a successful Canadian private practice.