What Happens If You Overuse Your Benefits? And How to Avoid It
Intro: Great Care… Until the Claim Gets Denied
Massage therapy. Chiropractic care. Acupuncture. It all adds up — and before you know it, you’ve submitted one too many claims.
Now your insurer sends you a notice:
❗ “Claim denied – annual maximum exceeded.”
What happens next? Do you owe money? Will it affect future claims? Can your clinic help fix it?
Let’s break it down so you don’t get caught off guard.
💥 What “Overusing” Your Benefits Actually Means
Most extended health plans in Canada have annual maximums for each service type:
| Service | Typical Annual Limit |
| Massage Therapy | $500–$1,000 |
| Physiotherapy | $300–$750 |
| Chiropractic | $300–$600 |
| Acupuncture | $300–$600 |
Once you hit that limit, your insurance stops reimbursing you — even if you keep going for treatment.
✅ Your coverage resets every year, usually on January 1.
⚠️ Common Ways Patients Accidentally Go Over
- 💡 Not tracking their usage across multiple providers
- 🧾 Assuming direct billing = “free” care (it’s not)
- ❌ Not realizing family members are using the same benefit pool
- 🗓️ Booking appointments near year-end after the limit is hit
❗ What Happens When You Submit a Claim Over Your Limit
| Scenario | Outcome |
| Claim goes over by $20 | You owe the balance |
| Claim submitted after limit reached | Denied — no reimbursement |
| Clinic direct billed beyond limit | You may receive an invoice from clinic |
| Plan resets Jan 1 but you submit too late | Prior-year benefits are lost |
💬 Pro tip: Ruby at insurance.rmtclinic.net can help you track your usage in real time.
💰 How to Protect Yourself From Overclaiming
- ✅ Know your limits. Check your benefit booklet or insurer app
- ✅ Ask your clinic how much your plan has paid YTD
- ✅ Keep all receipts and track what was claimed, when, and for how much
- ✅ Split large claims between family plans using Coordination of Benefits
- ✅ Avoid back-to-back appointments late in the year if close to maxing out
📍 What to Do If You Already Overused Your Plan
If your insurance says “denied” or “max reached,” don’t panic:
- 🧾 Contact the clinic and ask if a revised invoice can help
- 💬 Ask the provider if the service can be rescheduled under next year’s benefits
- 💸 Be prepared to pay out-of-pocket for anything above your limit
- 📅 Set a reminder for next year to space visits more strategically
✅ Smarter Strategy: Use RMTClinic.net to Book Clinics That Help You Track Limits
Some clinics offer:
- Live insurance usage lookups
- Reminders before your plan maxes out
- Benefit planning based on your needs
💬 Ask Ruby to match you with clinics that understand your benefits plan and will help you stay within limits.
✅ Action Steps
- 📑 Track your visits, receipts & remaining coverage → RMTClinic.net/insurance
- 🔍 Search verified clinics near you → RMTClinic.net
- 💬 Ask Ruby to alert you before you go over your plan → insurance.rmtclinic.net
