One of my pet peeves in the massage profession has been this whole idea that medical massage is the future of the massage profession and that the massage profession should get involved with working with doctors and insurance companies as contracted providers. I am referring to working with HMO’s and PPO’s as a regular contracted provider and also some auto insurance companies who have joined networks. Medical Massage is not being defined by the massage profession itself so the insurance companies are doing it for us. Being in WA State where we are allowed to become contracted providers with insurance companies, I have been privileged to witness the demise of insurance billing in a few short years. This is what is happening here in WA and some reasons why we need to think twice about wanting to work with insurance companies.
- The insurance companies are constantly reducing the allowable fee (what they pay you and that you accept when under contract with insurance companies.) When I first started in about 2000 accepting insurance one company paid me about $90 an hour which was a very acceptable rate. Within a few years they reduced that rate to less than $70 and it continued to be that same rate until this year when they gave us a $.40 raise – yes that is forty cents when the price of gas is sure to go over $4.00 a gallon.
- The insurance companies are also constantly reducing their benefits in their policies with people. For example – one company who used to allow 45 sessions of massage and PT combined a year now only allows 14 sessions a year.
- The insurance companies are constantly making it harder to get paid. One company in particular will ask that we prove medical necessity after 4-6 sessions of massage and then deny any further treatment no matter what it seems.
- The insurance companies set the allowable fees and usually send out a rate chart in the beginning of the year or when you first contract with them. Although it hasn’t happened to me yet as a massage therapist, I have heard from a few chiropractors and an acupuncturist that they change their mind in the middle of the year and say they are paying too much and reduce the rates and MAKE YOU PAY BACK THE DIFFERENCE – yes I am yelling- and there is nothing that can be done except to pay them back or they will take it out of future payments. I do know of one Naturopath who almost went out of business because of it.
- Out of network providers may often get paid more than in network providers- yes this is a fact too. There is one company doing just that. If you are out of network they only pay a percentage of the bill usually, but they pay contracted providers so poorly that even the percentage of the full bill which usually is about $132 (UCR) works out to be more than they pay contracted providers
- One such health network includes a list of auto insurance companies who are using provider networks and rules to pay for services rendered. This means that you have to accept a reduced rate of pay.
- Most of the companies have not increased their allowable fees since I started with them in 2000. So no raise for a contracted provider -not even to reflect a cost of living increase.
- Insurance companies are also creating educational requirements for credentialing meaning they are saying what training and education is required to become a member with them. It doesn’t matter that we are licensed by the State Board of Health. The insurance profession is defining the massage profession.
- Affinity networks are discount networks that some massage therapists unknowingly join thinking that they will get more clients not understanding that they are also taking a big cut in fees.
So does that make you still want to join a provider network and be able to bill insurance companies for your massage services?
See also the Insurance Billing Section on www.thebodyworker.com
2005 Guest editorial in Massage Magazine
Issues and Ethics in Billing Insurance Companies
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Giving up insurance companies is a fine personal choice if that’s what works best for you; the industry as a whole, however, trying to remove ourselves from the system completely is exactly what most insurance companies want: if you’re not a part of it, they don’t have to pay you anything, and they keep more of the money to themselves. What we need more of is our professional organizations addressing these issues–with PAID governmental reps, instead of volunteers like the AMTA recently put out an ad (people with the five years of experience they require are very unlikely to apply.) We also need to make sure that massage therapy is covered under the governmental plans that are proposed as the starting point for Universal Health Care.
Hi Julie,
GREAT ARTICLE! … And Yes, I am yelling, too.
Over ten years ago, I was teaching practice management seminars for massage therapists with my former partner, Linda Calandro, who was an extremely successful NMT practitioner as well as trainer for the St. John NMT Seminar System. Even back then, Linda had many TENS of THOUSANDS of dollars worth of money she could not collect from insurance companies, and she even knew the state-of-the-art techniques for collecting. But for every seminar or book on how to collect from insurance companies, there is AT LEAST one new seminar or book for the insurance companies showing them how to NOT pay you.
We were warning massage therapists back then to not get seduced by the mirage of the money train from insurance, and to maintain their professional value on a cash basis. You know your real worth when people hand over cold hard cash for your services. More than a few chiropractors suffered greatly when insurance companies periodically changed the rules on them.
Plus, being in the yoga therapy field as well as bodywork, I’m seeing that some yoga teachers inching toward the (downward???) spiral of being seduced by the same idea of insurance company riches. It is so easy to hide behind the idea that EVERYONE could afford massage or yoga if only insurance would pay for it. Well, if you understand the concept of insurance, you will know that it can only be used for severe or catastrophic illness to stay viable. When insurance is used for regular, routine and/or preventive health care, it is only a matter of time before the system becomes insolvent and self-destructs. ESPECIALLY if the government gets involved, which it is.
For those who think that nationalized health insurance will solve their problems, all I can say is Good Luck. The problems you site, multiplied by a large number, will be the result. Just look at the quality of care our veterans get at the Veterans Hospitals. The treatment (or lack of it) many of our military service men receive should tell you a lot. (Ron Paul, a physician and congressmen, explains how it should work, and how to fix it.)
Thanks for laying out how it currently works (or doesn’t work). More people need to know this information, because I think staying out of the clutches of the insurance system (whether “private” or public — but its almost all corporate now, which is a disastrous hybrid of pseudo-private and public) will help maintain the integrity of the massage profession and individual practitioners as well (and yoga too). It is amazing how human nature can be corrupted, a little bit here, a little bit there, even with the best of intentions.
Take Care,
David Scott Lynn
Medical Massage at first appears attractive as a specialty form of bodywork. There were even some massage educators that claimed “the sky is falling” if we don’t all jump on the medical massage gravy train. Well, now a few years later we are seeing the veil pulled away and the reality that it isn’t the best decision to “go medical.”
After a few years of billing insurance on my own, I gave up. More paperwork, less money, slow payment, and the worst part-not being at the head of the decision process for the client.
Many PTs and MDs in my state-California-are getting out of the insurance game. Many are not even taking Medicare. Who would want to work at a job that get harder every year and pays less? Not me, thanks.
The infighting over medical vs. relaxation massage is not uniting our profession. People selling classes to massage therapists only makes them money.
Besides, the number of people without health insurance is growing and I can’t see how this makes medical massage attractive.
my 2 cents,
Jody Hutchinson, nctmb