www.thebodyworker.com

Currently only Florida and Washington state make it mandatory for insurance companies to bill your health insurance for massage therapy services.

In WA State, massage therapists are allowed to become contracted insurance providers.  In Fl, the law states that insurance companies must pay for massage therapy to be covered when referred by a physician.

In other states there may be a few insurance companies that are now paying bills from massage therapists.

In all states, massage therapists are able to bill auto insurance when there is an injury caused by a motor vehicle accident and massage therapists are able to bill Labor and Industries (or workman’s compensation) when there is an injury on the job.

Currently the state of insurance billing is questionable.  Here in WA State, we are paid less than $75.00 per massage.  When we were first able to bill insurance companies, I was paid almost $100 per session.  The allowable fees have steadily decreased and the clients benefits have steadily decreased also.   Auto insurance companies who once paid whatever was billed for are now becoming part of networks which means the allowable fees are being determined by the networks and we are getting paid less.  It is only a matter of time before the rest of the insurance companies start this procedure.

The insurance companies are also in the process of definining what the definition of medical massage is and they are ruling out various modalites of massage and setting criteria to be a provider.

The future of insurance billing looks grim.  While you may think that it is good for the profession to be able to bill insurance companies and that it will help you build your practice, you may be better off focusing on building a cash practice.

I wrote a guest editorial for Massage Magazine in 2005 addressing this issue.

You can also see Deane Juhans article in Massage and Bodywork Jan issue.

If you are going to be billing insurance companies next year you will need a National Provider Number.

Vivian Madison Mahoney outlines the process in this article for Massage today.

You will also need to start using a new billing form called the CMS 1500 for most billing by March of 2007.

I haven’t taken a look at it yet and am hoping I won’t have to as I am planning on getting out of doing insurance work soon!

More info on NPI numbers

In 2005 I wrote the latest addition of the Insurance Billing Manual.

After some thought about what I want to be doing with this blog and my websites, I have decided to put all of the manual online for free for some various reasons:

• I am phasing insurance billing out of my practice because I no longer want to be a slave to insurance companies who are deciding our future. They are making steps to define medical massage by requiring special training above and beyond what is required for State Licensing. Our profession just sits and takes it.
• Here in WA as a contracted provider for HMO’s and PPO’s like Regence Blue Shield and Premera Blue Cross, I am paid less than my going rates and they are constantly reducing their allowable fees again because they can and no one is standing up to them with any success.
• One of the reasons things like this are happening is because massage therapists do not understand the severity of the issue. People in other states go where they are only allowed to bill for MVA’s or L&I are being paid fair amounts (and in my opinion -too much) for their services. Massage therapists are continually seeking to be accepted by such companies because they think it will be an easy way to get clients – it may help get clients but at what expense???
• It also has become more difficult to work with people who are on insurance as they don’t really understand that it is not for their stressful lives that causes the muscle tension and pain. They think the insurance companies should be responsible, but in reality it is the client who should be taking more responsibility. (This does not include people who are really hurt or injured)
• Insurance companies require that we “fix” clients and be able to prove it which really is not about healing in my opinion. Sure injuries have to repair themselves but what is the meaning of healing?
• Insurance companies are reducing their allowable fees, reducing benefits and delaying payments.
• Insurance companies do not take into account the power of the therapeutic relationship. They are attempting to eliminate so called “relaxation” massage and other types of massage that does not directly influence the injury or problem. This will eliminate many types of touch that are healing from being covered.
• Have you tried to find a good doctor lately? Most are opting out and taking cash only. They long ago got sick of having to spend so much just to keep a patient. It is happenind for Physical therapists and others too
• Personally, I do not want to be a part of such a system and hope to be instrumental in teaching massage therapists about what they are getting into when they want to accept insurance.

So for these reasons, I am making the insurance billing manual available so everyone can learn how to bill and experience it first hand so they can decide for themselves.
personally feel that the cost of playing with these insurance companies far outweighs the cost of getting new cash clients and teaching clients how to accept more responsibility for their health.

Here in WA state we have something called the Every Category Law which tells insurance companies that they have to allow massage therapists, naturopaths and acupuncturists to be contracted providers for HMO’s and PPO’s.

As contracted providers we are very limited in having any say in such issues as what we get paid. All of the insurance companies except one in particular pays less than my going rate of $75.00 for cash clients and doesn’t even come close to my medical massage rates of $100.

This is the law.

This is some info from the insurance commissioners office.

And an article from massage today

The every category law is constantly challenged and each year we have to defend our right to be contracted providers and I am not sure it is worth it to be able to bill insurance companies who don’t pay us and respect us. They are actually in the process of creating a definition of a medical massage therapist for us because we don’t have anything defined as a profession.