Insurance Billing Manual for Massage Therapists
2.
Types of Insurance Coverage (Overview)
In general, there are three
different instances where
insurance companies can be billed for your services:
·
Motor Vehicle accidents or other accidents such as slipping and
falling.
·
Worker’s compensation (WC) (sometimes known as Labor & Industries,
L&I) which involves injuries that happen while a person is at work .
·
Private health insurance companies such as a Health Maintenance
Organization (HMO) or Preferred Provider Organization (PPO).
Motor vehicle accidents and
Personal Injury allow payments for services that are medically necessary.
Massage Therapy in all 50 states is recognized as being medically necessary as
long as you can verify treatment and show improvement. Auto insurance policies,
for the most part, will pay the fees that you charge, if all paperwork is in
order. (I am starting to hear stories about massage therapists not getting paid
in some states. The issue has something to do with how we define ourselves.)
·
Personal Injury Insurance- part of an insurance policy that
covers bodily and property damage. Can be a car insurance policy, a home-owners
policy or commercial building insurance. The most common is a Motor Vehicle
Accident (MVA).
·
Personal injury protection (PIP) or Med-Pay (MP) PIP is
part of an automobile insurance policy that is purchased separately with varied
limits and coverage. Here in Washington State, it is a required part of the
policy. A person can elect not to purchase PIP coverage, if they can prove they
have other health insurance coverage and if they sign a waiver rejecting the
PIP. PIP policies usually have a time limit for which services can be billed.
Each state varies. When it comes time to settle the case, your services will
come under scrutiny by lawyers and insurance companies. Med- Pay is the no
fault insurance version of PIP. The benefits will pay for all medical needs no
matter who is at fault for the accident. PIP will pay for your clients’
medical treatment until it is time to settle the case or the benefits run out.
·
Third party coverage/liability. This refers to the
liability coverage of the party who is at fault. Some companies will pay
directly when it is clear who is at fault. Other times you may have to wait
until the liability is determined and the case is settled, which may be up to
the time limit which varies state to state (i.e.-1-3 years). You are usually
paid when the case is settled. Cases can be settled with or without a lawyer.
Lawyers are usually involved when there are complicated injuries and property
damage. Cases may be settled using arbitration, mediation, or jury trials.
Developing a good working relationship with a law firm will increase your
chances of getting paid. It is advisable to file a health care lien (more
about
liens later) when you are skeptical about being paid. This involves filing
papers in your county court and you must remember to have them removed when the
payment is made. Often you can charge interest while you are waiting to be
paid. You can also charge for making copies of chart notes and other things in
the client’s file when they are requested by the third party. There may be
legal limits as to what you can charge for copies.
·
Uninsured motorists. When the party who caused the
accident is at fault and they don’t have any car insurance, the accident is
covered by the injured parties uninsured motorist protection. They usually pay
for damages and injuries up front and get the money later from the party at
fault.
Private health insurance –
includes managed care plans (PPO-Preferred Provider Organizations, HMO-Health
Maintenance Organizations) major medical, Medicare and Medicaid.
·
Indemnity plans or fee-for service – type of plan where the
insurance companies pay fees for the services provided to the insured people
covered by the policy. You go to the doctor and do whatever is necessary and
the bill is sent to the insurance company.
·
Managed Care Plans: include Preferred Provider Organizations (PPO),
Health Maintenance Organizations (HMO). Florida and Washington are the only two
states that officially allow massage therapists to become a contracted
provider. This does not mean that you won’t be able to get paid by such
organizations in your area. It will require extra efforts to prove that you
work can save the company money in the long run.
·
Private Health Insurance: includes Major medical, Medicare and
Medicaid plans. Medicare and Medicaid do not pay for massage therapy services
at this time.
Worker’s compensation or
Labor and Industries-
ALL Injuries that happen at work must be sent through the worker’s
compensation plan. This will include a motor vehicle accident that occurs while
working. Often other insurance coverage such as a PPO will deny payment when an
injury is due to a work situation. (i.e.- when a person who is injured at work
tries to bill their PPO for the services, coverage can be denied) There are
usually limits to treatments times, number of sessions and who can provide the
treatments. You may have to apply to become a provider in each state and abide
by the provider contracts. The goal is usually to get the worker back to work
as soon as possible. There are limits to the policies
