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Please also check the
insurance billing manual updates and the
blog for more information.
Massage Insurance Billing : State InformationThe State of Billing Insurance Companies... I am in the process of collecting information on what is allowed in each state to show just what a mess the state of insurance billing is...please post your information on my other site www.massagetherapycareers.com and I will post it. WA- We are able to become contracted providers with major medical carriers such as Blue Cross and Blue Shield. We are required to go through a credentialling process and sign contracts accepting the rules that the insurance companies make. While AMTA has a representative reading the contracts, they only share this information with their members. There is a major Third Party Network called American Whole Health which I think just changed their name to Axia who manages 3 of the major medical insurance companies and a group of auto insurance companies called Corvel. When I first signed up with them, I had no idea who they were nor was any information sent on the details of their company. It turns out they manage a group of auto insurance companies (which I have yet to get a list of) which means when you participate in this group you have to accept a discounted rate of reimbursements from the auto insurance companies. This means that my $132 UCR for Seattle doesn't mean anything and the allowable fee is usually $30-$60 less. I really think that it is only a matter of time before the rest of the states and auto insurers catch on to this. While you don't have to be part of this group to bill for a MVA, if you become a provider with Axia you will automatically be a provider unless you opt out. What happened is that most massage therapists had no clue who they were and all of a sudden were getting paid a substantial amount less for mva's. So as a provider with these groups and networks, they determine what the allowable fee is. When I first started in 2000 (I think it was), I was paid about $99 per massage from one company. That amount has decreased every year to about $58-68 per 4 units. While this year (2007) stayed the same, there was no increase for cost of living. The other insurance companies pay between $59 - $69 per hour which is less than my cash rate for clients. Basically my cash clients are subsidizing my insurance work as I have to keep increasing my fees for cash clients. The other things that are happening:
Basically, taking insurance has probably helped stabilize my income, but I have to work more hours for the same amount of income. People also tend to become less responsible for their health when they come in under insurance policies. This is not to say that all are doing this. It has indeed helped people who were seriously hurt or with chronic conditions etc. Axia represents Group Health Co-op here and they are creating a "medical massage credentialing". Some Insurance companies will only let us bill the CPT code 97124 while others allow 97140 and 97112. There is a great discrepancy in allowable fees. In general, since the Every Category Law was passed making it mandatory for
insurance companies to allow us to become providers, the insurance companies are
constantly finding new ways to not pay us. Some have closed their list
permanently meaning no one else can join. You also cannot sell your
business to anyone other than someone who is already a provider. We can also bill automobile insurance companies, but there are a few companies who are joining the third party networks which means we have to accept discounted fees!! Every category Law
Please also check the
insurance billing manual updates and the
blog for more information.
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