I just wanted to let everyone know that I one of the reasons I am so passionate about the insurance billing issues going on is because they have directly affected my private practice that I have had for 18 years.
The issues I talk about are quite controversial and things are happening here in WA State that will influence other states. In WA we can become contracted providers with HMO’s and PPO’s which is quite different from just doing mva’s or L&I. It requires that you become credentialed with the insurance companies and sign a contract in which they do take control of you and your work. They determine what they are going to pay and what codes you can use. You will also have to deal with proving medical necessity which isn’t anything unusual, but the thing is they don’t provide any treatment guidelines or rules as to what they do and don’t allow.
When I first became a contracted provider and started billing HMO’s and PPO’s in about 2000, the insurance companies were paying $90 or so 1 hour session (4 units). The benefits were gracious. Clients could get unlimited sessions or a decent number of sessions for their health concerns. It was easy to get paid, clients could find you easily through the networks and life was easier.
Each year they have reduced our allowable fees, restricted the number of sessions, have asked us to prove medical necessity (which should be up to the doctors since we can’t prescribe), have made it harder to get paid. I have had to raise my rates for my cash clients to subsidize my insurance work. I have to work more hours and get paid less, meaning I have to see more patients and do more paperwork just to get paid the same as before all of this insurance stuff started.
For awhile I sold an Ebook called “The Massage Therapy Insurance Billing Manual” and recently made it available for free online (but with the presence of ads). My intention is to hopefully teach as many massage therapists how to bill insurance companies so they can begin to see first hand the issues involved in doing so. Then we will be able to define ‘Medical Massage’ for our profession and respond to what the insurance companies are doing rather than reacting. Right now we do not have the cohesiveness of a group to stand up to the insurance companies to ask for what we want and to be paid a fair wage.
For more on the insurance billing issues:
Issues and Ethics of Billing Insurance Compaines
What is the future of billing insurance companies? Do we even want to be able to bill insurance companies -Guest editorial 2005 – Massage Magazine
Insurance Billing section on www.thebodyworker.com
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This subject is of great interest to me since I am a certified massage therapist and concentrate in the area of medical massage. Where I practice, the techniques, and course I choose are all related to the medical profession. I am currently working out of a medical clinic and the clients I have are wonderful. I thought that insurance billing would be a good idea for my clients and questioned why the clinic wanted no part in working with billing insurance. Now I’m finding out for my self that it’s a great concept but is not worth the time or expense.
I would definitely like to be part of making the effort to make a change. I can see such a benefit as a massage therapist to be part of the medical community.