Legal Business
I just went to a presentation of John Conniff and John Pieck who are attorney’s who have been hired by the AMTA Washington to look into the legalities of doing business with 3rd party payers - insurance companies.
Here in WA we are allowed to become contracted providers with insurance companies such as Blue Shield and Blue Cross and others.
With that I feel compelled to inform others about what is happening here in WA State because so often I hear that massage therapists around the country want to be able to be contracted or at least get paid by insurance companies. But most do not understand the risks of doing such business and there isn’t enough information and support as a profession to be able to work with these insurance companies.
The biggest things I learned are:
- There is a fine line over the issue of whether or not it is illegal to be charging cash clients one thing and insurance companies another. It borders on insurance fraud. Many massage therapists try to explain it by making medical massage different from relaxation massage which can be debated from both sides. The bottom line is that you have to be able to prove that medical massage is different from relaxation massage and be prepared to pay an attorney to help you defend yourself if you ever have to.
(I for one think the whole medical massage thing is questionable. What would you charge a cash client who comes in with a stiff neck? When you do a relaxation massage and find a tight muscle do you ignore it?) You can read about it more in their article “The Business of Caring“ - When you work for a chiropractor or other business and they pay you a percentage of the fee of the massage, you have to do this as an employee. You cannot do this as a independent contractor or subcontractor. If you rent a space and pay a percentage and you pay the chiropractor a percentage of your income it is a kickback and it is illegal. If you rent space by the hour and pay only for the time you take each day it is also a kickback. A kickback is anything that is influenced by patient volume. I am not sure if this kickback thing is only in WA or is a Federal thing and am looking into it more.
Basically, we can only complain to the insurance companies about the low rates of pay, delays in payments or any other problems. It is illegal to talk about problems and you can’t say to another massage therapist that you would not recommend signing a contract or you can’t discuss fees or it would be a conspiracy. The only way you can work with insurance companies is through a formal association of massage therapists who talk to the insurance companies. Our massage profession does not have enough manpower or money to stand up to these insurance companies.
There were some other things that are pertinent only to WA State massage therapists such as because we are licensed as a health care provider, you are required to write chart notes for everyone. I will be writing more on this in the next few days as I make more sense of it all. What I do want to say is that every massage therapist needs to understand all of this if they want to get into billing insurance companies. It is not all cake and ice cream.
March 18th, 2007 at 11:08 am
Dear Julie,
Your sites are looking great! . . . Keep up the great work and content.
My firend David Shue, the blind neuromuscular therapist in Sarasota, Florida, works with 8 to 9 people per day. 50 minute sessions. (He only recently cut back on Wednesday and Fridays to mornings only.) He charges CASH, Check, or Credit Card ONLY, NO insurance. He does a combination of St. John style NMT plus what he learned from me in a 3 day workshop 12 years ago. . . . AND he charges 145 dolars per hour, no discounts. . . . He is booked up a MINIMUM of 5 weeks in advance. He has one receptionist. . . . Do the arithmetic. . . . Bottom Line, even if he was only charging HALF the amount, he would be doing very well.
It is quality of work, not sneaky payment arrangements that make one prosperous. This is why more and more doctors are going for strict Fee for Service, no insurance of any kind.
I suggest people stop looking for ways to access and manipulate the 3rd party payment structures and get awesomely better at what they do in the treatment room. AND, as you, Julie, are demonstrating, learn the most important part: MARKETING. Which means EVERYTHING you say, write or do that in anyway produces an impression on potential or existing Clients.
Anyway, I have always said, Insurance destroys everything it touches.
But that is not exactly true. It is any insurance that the State regulates that is the problem. Add to that any State Regulation that pretends to protect the public through force or set some kind of standards that the regulated are supposed to conform to. Or pretend they can really determine who is worthy of practicing or not.
Truly private insurance can work. What we have now — State regulated Standards and Insurance — is a disater waiting to happen.
If a chiropractor and a therapist and a Client/Patient have an agreement that works for them, who are we or anyone else to say it is wrong?
That is Authoritarianism — the very thing the Founding Fathers tried to prevent.
Oh Gosh, you know I could go on for pages. So I’ll stop.
Here’s a toast to your great examples of how all therapists/coaches should be thinking.
Take Care,
David Scott Lynn
March 19th, 2007 at 5:21 am
Some very good points, as usual, about insurance, but there are certainly going to be some who disagree.
I’ve done some insurance myself in the past. It’s a system that will suck the “health” of therapy right out of any therapist in a heartbeat!
Regards
Sean
March 19th, 2007 at 6:38 am
While some may disagree with the idea that you can’t bill insurance companies more for your services than you charge your cash clients, it does not matter. The fact is that it is insurance fraud no matter how you want to explain it and you will be required to prove it and defend yourself if you are ever challenged and you are taking a great risk with your practice. The cost to hire a lawyer and defend yourself plus the risk of being charged with a Class C felonly - punishable by imprisonment and a $5000 fine per count. The risk seems to high to me. It is only a matter of time before the insurance companies start investingating this because they are all about making money and not about client care.
April 5th, 2007 at 12:25 pm
Hi Julie,
Great site…very informative.
Where are the lawyers on the idea of offering a “time of service discount” on one’s “set fee”? I was under the impression this was acceptable.