The State of Billing Insurance in Washington State.
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?
April 8th, 2006 at 5:55 pm
I am researching whether to become an insurance provider. After reading several posts and website articles, the idea I was so excited about in the beginning is now waning. I don’t want to be paid less for the advanced services I offer. I am a medical massage therapist. I have spent a ton of money and time to be able to provide the highest level of care possible to my clients. I deserve what I charge my clients.
But, having said that, I have just moved to a new state where I must start over again. Georgia is not a regulated state. The sex trade has co-opted the MT profession to appear legitimate and the public perception of MT is stll in the dark ages. How do I stand out from the people who aren’t Medical MTs, who are under-trained and not licensed? I thought being an insurance provider would do that. Given the current circumstances, doesn’t it make sense to become a provider? Or am I grasping at straws?
April 8th, 2006 at 6:06 pm
You can still make money if you are billing for MVA’s and L&I. It is just when you become a provider with companies like Blue cross/blue shield that we start getting paid less.
I think it is only a matter of time before it hits the MVA claims…how long is hard to say…
If you are good people will also pay you even if you aren’t able to bill. There are other injuries besides MVA’s.
WA and FL are the only two states where you can become a provider so it doesn’t really matter how much training you have…you won’t get paid or will rarely.
Let me know if someone has other information than that.
April 21st, 2006 at 5:43 am
Nearly every week I have a client tell me that their Chiropractor has a Massage Therapist and they will bill insurance for it. However, in my state there is no insurance company that will pay a Massage Therapist for massage and there is no benefit in the policy for it. Chiropractors in my state have hired MT’s and forced them to become a Chiro Assistant and then bill the insurance company for manual therapies performed by the CA, when they are actually doing body part massage. This hurts our profession and it is unethical. The insurance company will not let you become a provider and will not discuss another provider with you. This gives the public the wrong idea about massage as well. No chiropractor wants the MT to be more effective than them for relieving the patients ailments, however massaging the body part in question will make the Chiros adjustment go better. Someone please tell me why this is being allowed to happen.
April 21st, 2006 at 8:12 am
In every state you can bill for Workmans Compensation and for Motor Vehicle accidents. With both of those you can ususally bill whatever you want and get paid which means you can make more than double or triple your regular cash fee. That’s what most chiros are doing…making a bundle on the extra amount they can get.
They may be billing under their chiro license - which may be unethical but the reason most do it is because they can. Our profession is not strong enough to stand up for itself and create definitions of medical massage and we don’t have the manpower to stand up to such chiropractors and get them to recognize massage for what it is as a profession. We will be constantly be taken advantage of until we have a stronger force. Right now we are divided into three main massage professions who are all fighting over what is right for us….doesn’t look good for being a profession who others will respect.