Here in WA, we are one of two states (the other is Fl) who mandates that all massage therapists and alternative health care providers be allowed to become providers with health insurance provider networks. What this means is that we can become providers with insurance companies such as Premera Blue Cross and Regence Blue Shield among others.
I became a provider around 2000, after having a full time cash practice for about 11 years. At first it was great, providing additional income. We were paid a fair amount (almost $100 per session), the clients benefits were great and allowed as many sessions as needed. Payments came in 2-3 weeks without many hassles – not many follow up phone calls to see where the checks were or to see what was wrong. Clients found me regularly through the provider directory which meant I didn’t have to worry about a steady flow of clients. That created somewhat of a relief..
So now after 6 years the story is quite different. The allowable fees are constantly being reduced which means the insurance companies are paying us less and less each year. The allowable benefits of each client are constantly being reduced. One company used to allow 45 sessions of massage/physical therapy combined now only allows 14. We all know if someone has a herniated disc or a serious problem 14 sessions wouldn’t be enough. Another company consistently asks for our chart notes to slow down the process of payment and asks us to prove medical necessity and then usually denies continuation of treatment no matter what was said in the chart notes.
I constantly am calling to find out where payments are especially with one company who was bought out last summer by another-talk about nightmares. I have had to send bills 3-4 times because they never got into the system. I am still waiting on a bill from Aug. 05.
One of the other little known issues is that automobile insurance companies are also members of one of the provider networks. We were told when we joined that there was a company that we would be providers for, but since they weren’t local I didn’t think it mattered. It turns out they are a third party network of auto ins. companies. This means when I am billing an auto ins. claim with one of these companies, I will be paid less than my billed fee which is quite a loss. We were never provided a list of these companies.
So what is happening here in WA State is a mixed blessing. We are able to become providers which does help with client flow but it is becoming less and less profitable. Even doctors are getting out of the networks. Physical Therapist are in the same boat too!
Why are they constantly reducing our rates?
What can be done to get paid what we are worth?
AMTA is working on it, but the political machine is slow moving and is like pulling teeth.
My prediction is that it will soon be affecting other states. All 50 states allow massage therapists to bill for auto claims. I think that soon every state will be making massage therapists join provider networks and reducing their allowable fees and allowable benefits.
It will take a professional stance against this issue and a unified profession with a clear definition of medical massage to make any difference.
I even would go as far to say that we should not join the provider networks and work to keep our profession a strictly cash business. There are also so many emotional issues related to having an insurance company pay for “your” health issues. I fell when we can be more accepted by the general public as a valuable profession, we won’t need insurance companies to pay for our services.
To do this we need to begin discussing issues like these and learn to heal ourselves and our profession first before taking on the insurance companies if we even want to bother by that time.
What nightmares have you had in dealing with insurance companies?
What keeps you from charging what you need to charge your cash clients to have a totally cash practice and not be a slave to insurance companies?
What needs to be done about this issue?
What do you think about getting paid less and less?
