Feb 08
27

Working for a Chiropractor

One common issue that I always get emails about or see comments on my Yahoo Group or other groups is about massage therapists working for chiropractors. I actually have already started to address this issue in another post but another thing keeps popping up – that of billing insurance companies and what the massage therapist gets paid by the chiropractor.

When a chiropractor (or even a massage therapist) bills an insurance company for massage services, one of the common practices you will see is one of overbilling the insurance company – the person coming in and paying cash will be charged something like $60 and if the insurance company will be charged $220 or something above and beyond the charges for the person paying cash. The thing about this is there is some concern over whether it is actually legal or not to do that and it may vary state to state but as far as I know after attending a workshop put on by two attorneys for AMTA- WA last year, it is illegal to charge more for your services when you bill an insurance company. You can bill a fee that would be equal to what you have to pay a billing person to actually do the paperwork and collections which I would think a normal fee would not be much more than $20 and that is guess high. The thing is that insurance companies will and do pay the higher fees and also do not really have a system for catching such discrepancies.

Here in WA there was actually a law passed awhile ago that limited the amount a chiropractor could charge to the insurance companies. ( I think this is it but am not 100% sure so let me know.)

So then you have a chiropractor charging high rates to clients like $200 or more for a massage and the client is left paying a high copay if it based on a percentage of the fee and the massage therapist is usually paid between $25-$50 an hour. Where does all the money go? To billing? I don’t think so. The chiropractors are getting rich off of the massage therapists work.

On the other hand you also have to take into consideration that the chiropractor is probably doing all of the marketing and work to get that client. That is worth something I think – but is it worth $150 a session or more?

The other thing that seems to be going on is that chiropractors think that they need to be the boss and tell the massage therapist what to do and how to do it. Well that is fine if they are an employee – you can tell an employee what to do but it is different if that person is a sub-contractor. Chiropractors also are only trained in chiropractic methods and some are not informed of what massage can do. They also can seem to be overly protective of clients and not refer freely to massage for various reasons -like I had a client who had so much inflammation going on the chiropractor thought it would be best to wait when massage is one of the best things to deal with inflammation.

The thing is that there are chiropractors out there who are mainly interested in their patients health and will hire a massage therapist to participate in that healing process.

Part of the problem is also that massage therapists are not informed when they take a position with a chiropractor and end up complaining about something that they unknowingly agreed to.

Some things to ask a chiropractor when interviewing for a job at a chiropractors office are:

How much do you bill the insurance company for the massage I will be doing?
How long are the sessions I will be doing with a client?
Will I have time between sessions for self care and client follow up?
Is it OK to tell clients to stretch and so other self care things?
Is it OK to tell clients about other therapies that might work better?
Do you give clients the option of paying cash and receiving a receipt so that they can bill their insurance company later and be reimbursed?
What is your philosophy on healing and chiropractic?
How do you see massage fitting into your practice?

So often massage therapists are so excited about the possibility of getting a job at a chiropractors office they forget to stop and figure out what it is that they really want and find out if the chiropractor is somewhere where they can fulfill their dreams. The best way to actually know about a chiropractor is to get treated by them first as a client. If you wouldn’t go to that chiropractor or send your mother to them why would you want to work for them?

When you make an uniformed decision you often end up complaining and blaming the chiropractor. If you get stuck working in one of these offices, while you can try to voice your needs and work with that chiropractor if they are open for it. If not just learn more about what you do want and learn to focus on what you do want rather than focusing on what you don’t want by staying in a bad situation.
While it is always easier said than done – better now than later.

It is possible to find a good job that pays you well and has a respectable chiropractor as the owner who is willing to work for you.

And what about someday having massage clinics that hire chiropractors???

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This entry was posted on February 27, 2008 at 8:47 pm. You can follow any responses to this entry through the RSS 2.0 feed. You can skip to the end and leave a response. Pinging is currently not allowed.

Posted in Find a Massage Job The Wealthy Massage Therapist by Julie Onofrio 22 Comments

Julie Houff says:

May 4, 2010 at 11:50 pm

Actually it’s $75/hour for cash clients. And the other clinic up the street bills at the same rates.

Alison Chiropractic says:

May 27, 2010 at 10:59 pm
It is frustrating to read that MT can complain about when a chiro bills for massage work that in done in the office. MT who want to complain about chiros, obviously don’t know much about the billing in regards to what chiropractic offices have to deal with or for that matter running a business. For example, if we bill $100 for 30 minutes of massage, that is the BILLED amount not what is PAID. We have insurance companies that will be pay $28 for that same 30 minute massage, hello not the entire billed amount!! Also sometime payments come 30 working days later or are delayed for some other reason such as losing our bills, the doctors need to provide more reports supporting future care etc!!! How would you guys like it, if your clients paid you 30 days later??? I didn’t think so.. With increasing red tape (denials) with insurance companies, it is not as easy as MT think, you just don’t send a bill to the insurance company and PRESTO a check for 100% of the billed amount show ups…
- Julie Onofrio says:
  
  May 27, 2010 at 11:39 pm
  No it isn’t easy but there are many chiros who are billing $100+ and getting $100+ for that session and only paying the massage therapist a very small portion of that. If you are having to wait to get paid, then you can usually start planning on that and create a revolving cash flow system – last month billing pay this months expenses. It is just part of doing business.
  And now it isn’t easy to bill and it is getting more difficult to get paid every day.
  
  I am talking about the chiros who are scamming mt which is quite common although I would guess less so these days with mt and clients becoming more wiser.
  - Alison Chiropractic says:
    
    May 28, 2010 at 12:30 pm
    Are you serious??? I guess you are NOT too involved in the billing process. The massage therapists get paid during their payroll dates from the chiro and then the chiro have to wait for payments from the insurance companies…
    
    The doctor offices in many instances pay for supplies (such as lotions, massage sheets, towels etc), a front desk person who schedules their appointments, electricity to play the music or to keep the massage room warm/cold, plus marketing that might have brought in that massage client, any paperwork, reports that substantiate the necessity for the massage. You must think insurance companies pay on time and pay 100% of the billed amount. That definitely isn’t true with indemnity insurances… some personal injury cases I can see pay 100% of billed amount but that is few and far between too these day.
    
    One of our therapists used to bill her own clients with their insurance and had to stop doing that because the money wasn’t 100% guaranteed to be paid to her in a timely manner… She experienced the delays, red tape etc. At times she didn’t know how to overcome their denials etc.
    
    You are definitely misguiding MT out there regarding how chiro are scamming MT out of money they deserve from the insurance payment. WOW, unbelievable…
    
    MT overhead is nothing compared to a chiropractic/medical office. For instance, the going rate in our neighbor for retail space is $4 per square foot and we have 2,000 sq ft office ummmm…. That’s $8,000 for the space not including all other expenses staff, supplies, insurances, electricity… MT usually are mobile and can from home, go to a client’s house, bring their table etc.
    
    MT should be glad that chiro offices out there give MT the stability of work, insurance benefits (in some cases), etc.
    - Julie Onofrio says:
      
      May 28, 2010 at 3:05 pm
      
      Actually I do all of my own billing and wait for the money for a week or two. Using electronic billing has changed the time dramatically. I have learned to screen out clients who have cases that will not pay or will be tricky to get paid. I just don’t have time for it. I work only with ins. companies that I know will pay. You can do that too if you would like.
      
      I am just trying to make MT aware of the possibilities that are out there and that they deserve to make more than $15 an hour…
      
      Thanks
      Julie

May 4, 2010 at 11:48 pm

I’m scheduled to have an interview with a chiro this week. I am not yet with any insurance since, but have gone through the 1000hr Cortiva/Brenneke program and worked from home for a few months. He has already told me he pays $20/hr and bills $70 for cash clients and $130 for insurance clients. The chiro up the street pays $25/hr. I would think that more like 30/hr would be much more reasonable. Am I out of line with this assumption? Should I shoot for this since this really is what I would need to come anywhere close to making a living?

Julie Onofrio says:

May 5, 2010 at 8:49 am
The thing with these job interviews is that you have to go in an prove to them how much you will increase their business and how you will work to get new and repeat clients! Don’t just go in agreeing to their terms! Go in and interview them to see if you even want to work there. If they aren’t offering you fair pay you need to really drill them to find out if they are good chiropractors – Would you send your mother to them? or go yourself? This is what I talk about in my Ebook “The Massage Job Guide”

It is about finding and/or creating your ideal job. Anything less you will end up feeling drained and burned out in a few years or less which is no good to anyone!

Julie
http://www.thebodyworker.com
http://www.massage-career-guides.com

Sandy Chiropractic says:

April 17, 2009 at 9:53 pm

They should not engage in dysfunctional behavior by blaming the chiros.
Caveat Emptor. Buyer Beware. That is the MT’s need to know what the market is: Primarily a medical-insurance industry out to suck what they can out of it. Been going on 100 years.
Are the MT’s so stupid they don’t know what’s going on-and that includes anyone who participates. Why do you continue to pick on the roach in the melee YEAHHH-of course the chiros who do insurance, have MT’s working for them,etc. etc. are a part of that paradigm.

Nick says:

March 7, 2009 at 8:29 pm

To say that chiropractors are only trained in chiropractic methods is an inaccurate statement. Most DCs are trained in soft tissue manipulation to include MFR, instrument assisted soft tissue mobilization and lymphatic drainage techniques. Additionally, they are Physicians… if you plan to work in an office with a doctor, expect to be given direction on what to do with certain patients.

Usually, the cost that is billed goes to paying: the office upkeep and fees, insurance, the full time office person who has to chase down insurance companies… etc. Most insurance companies will not reimburse at NEAR the level that is billed. For example, I know that in my office, the chiropractor will take vitals, adjust the spine, teach exercises, do soft tissue work, adjunctive therapies and evaluate care. The bill for that 45 minute visit comes to about $280… insurance companies will reimburse about 130…approximately 40% of that goes to office overhead.

Matthew says:

October 30, 2008 at 1:42 am

Nice informative article. Your fees are your fees and they should be standard whether you bill an insurance company or not. The only legal way around this is if your patient is having legit financial difficulties. You can then proceed to a signed hardship agreement by both parties and reduce the cost that way.

As far as chiropractors billing in excess of $200 / visit goes, physical therapy is no different. I strongly feel it’s ok to charge a good price for your services if you provide a fortune in value in return. Getting someone out of debilitating pain is worth much more than a few hundred dollars. I think many professions tend to undervalue themselves too much.

annie noonan says:

June 24, 2008 at 9:43 pm

Many of these comments and presentations seem to originate from a bit of ignorance, expectations, unmet fantasies.
The massage therapists who have their own practices/businesses seem to know what the costs of doing business are, and what is covered by insurance and what can/not be charged by insurance. If they don’t, their education has been compromised. Simple. They should not engage in dysfunctional behavior by blaming the chiros.
Caveat Emptor. Buyer Beware. That is the MT’s need to know what the market is: Primarily a medical-insurance industry out to suck what they can out of it. Been going on 100 years.
Are the MT’s so stupid they don’t know what’s going on-and that includes anyone who participates. Why do you continue to pick on the roach in the melee YEAHHH-of course the chiros who do insurance, have MT’s working for them,etc. etc. are a part of that paradigm. Hello- do you live here??? Don’t you know that the chiros just stopped being jailed for practicing without a license?? So don’t blame them, that is the 20% of them who are bottom feeders for
doing what our society holds up as legitimate. Remember now–this is what our culture has established as good.
Massage therapists never had the hutzpah to present themselves politically as an organization against mainstream
medicine like the chiros did. And why not?????
Maybe if the chiros had someone else in their non-traditional medicine camp: like MT’s, acupuncturists, energetic healers – that there would have been a large enough block of politically motivated consumers to pose a real threat to the insurance industry that would have changed the status quo. Perhaps alternative health professionals would then have been able to advocate for themselves and get paid with fees that would be more justifiable. But of course that could never be!!!!
Thanks for listening. Annie (just interested in alternative healing for 30 years)

Julie Onofrio says:

June 24, 2008 at 8:05 am

It would depend on what they provide? Clients? table, sheets,laundry, billing, appointment setting? mentoring?

If you are renting space and getting your own clients and doing all of the work etc just find out what the ave. rent is for office space in the area.

If they are providing everything and telling you when you should be showing up you probably should be an employee on an hourly wage.

The question is more – what do you want/need to make an hour to meet your needs for living and having a good life – vacations, retirement, savings, etc.

Julie

Kelly says:

June 24, 2008 at 1:34 am

What is the average amount a chiropractor should get cut if he allows a MT to work out of his office.

Jenny Bannon says:

March 25, 2008 at 9:44 am

Well, I have been a MT for a bit over a year- i’m a baby in the profession. i graduated from the Cortiva MTI in Boston- i live in Maine. I have to admit- i am one of those incredibly underpaid MT’s. i work at 2 prominant spas in Kennebunkport and a chiropractor’s office. at both, i make an embarrassingly small amount compared to what is being charged and shamefully i admit, i took all three jobs out of necessity- there aren’t a lot of opportunities to find decent pay in my area and i don’t have a network or the financial security to take the risk to open my own practice somewhere. at the spas- i look at it as brainless work- i go in, do my job and the details are all taken care of. at the chiro- i’m an employee with a w2. he’s a great guy- very oldschool, he’s his own receptionist pretty much. compared to the 2 chiro mills on either side of him pushing 80 clients a day, he has maybe 80 clients a week seeing each one for a minimum of 20 minutes. not the quick in and out like i am used to seeing. however- during my interview process- it was a quick whirlwind, and looking back on it now, i was a bit sweet-talked into my compensation. not so much on his part, but on my own. i asked him about his billing and i knew some of the answers from others familiar with the process. He told me he bills 2 codes for mt per 1/2 hour, which is legal. ( some other offices that have been shut down here had been charging 3-4 codes per 1/2 hour thus charging hundreds of dollars for 30 minutes.) in maine each code is worth about $35 making a rough max of $70/ half hour. the way he explained the billing to me was as honest i think at the time as he could be since i am his first employee mt that he was going to be charging insurance with- an expiriment for both of us. so he couldn’t tell me what the ins.co were really going to give him. i was okay with that answer knowing myself that insurance companies won’t always pay. i over shot for $60/hour, he offered me $30/hr a sad $15/client. and all of a sudden there was no other discussion, i was hired. i didn’t really think about it at the time. but i don’t have my own room- i share a room with a mt who subcontracts, i have to lug my sheets and oils etc ( not the table ) back and forth, do my own laundry at home etc… $30/hour wouldn’t be so bad if it weren’t $10 below my minimum at the spa, and i had my own space to make it a little less complicated to get to and from work. i 100% appreciate his practice, his ethic, the hard work he does for me to market to his clients etc. he does all that hard work for me… when i was reading these posts i was all ready and fired up to join the bitch fest. but as i reflect and have read Barry’s post, he’s got a good point. my chiro has been in business for 5 years so he’s still working off his overhead. he has an intense amount of education behind him, i learn a lot from him, and he treats me a part of the team. Yes, i would like to be paid a bit better, but all chiro’s aren’t out to screw the world of MT. if anything, i think if these two sides would stop there squabbling, joining forces on an ethical and honest, would be awesome. i think there needs to be an incredible overhaul on both sides when it comes to standardizing fee’s and payments through insurance. whoever is the employer should appreciate the schooling and experience of the employee. i myself went to a 900 hour clinical program. only 500 is necessary in maine and the technique varies from fluff and buff to just taking the national and skipping school altogether.

so yes- i’m going to ask for a raise- only to say to myself and to him, that i am worth it and i will work that much harder to earn it. my personal ethic sets me apart, as well as my education and passion for the work. but i wanted to give a shout out to all the Good Chiro’s out there that unfortunately are getting mixed up in the mess. there are just as many illegitimate MT’s out there that over charge and get all messy with practice too. MT is far from a perfect field.

i apologize to anyone this may offend and i appreciate the opportunity to voice my thoughts. thank you.

D. Tsakiridis says:

March 24, 2008 at 11:58 am

Thank you soooo much for presenting this info.
I’m not computer savvy enough to forward this thread, but I would love to have you forward it to my former chiro, omitting my entry, of course!!!
I am so glad this is being exposed. It is sad for many reasons. The chiros are cheats. Usually the MTs are cheated along with the patients, ins. companies, & the even the honest taxpayers eventually.
Re: the vaccination issue. I am skeptical about wholesale vaccines, too. There may be the additives or the fact that they give so many types of vaccines at once to the kids. Even if they were safe, how safe is mixing so many toxins at once into a small child’s system? How about the size of the dosage vs. the size of the child? I think of this now as my almost 32-yr. old was a tiny person. But that is not the issue here.
Thank you for exposing the chiro scandal. Keep it up!!

Barry Smith says:

March 22, 2008 at 1:48 pm

About your comment ..Chiros will charge that cap, but they often have to write off what the insurance/PIP/workman’s comp, etc., really pays, which they get to write off on their taxes. How can you write off something that you don’ make? Reduced payment is not income and can not be a write off. After reading all your moaning, why don’t you just work for yourselves? If you did work for a Chiropractor , don’t you understand that he or she has overhead to pay? I live in PA and MT’s are not licensed. One comment was to have Chiropractors work for MT’s. Why would a Chiropractor who has a minium of 6 years of college work for someone with little or no training. What is the required training in WA for MT’s? Another comment..Chiros often cannot make much off of cash patients unless they’re running specials all the time with significant and more than customary (up to 20-25%) discounts. What a stupid thing to say. Almost every insurance company cuts the rate that is paid to the chiropractor and many times that rate has not been increased for 5-7 years. In most cases the “Cash” patient is the better patient. No billing and no cut in fees. Would you think that a vaccination was good if your child developed Autism as a result of the vaccination? A recent suit has been settled which indicated that this was the case. Not to say that every injection (the case mentioned was a mercury based injection) will cause Autism..wan to take a chance? Check out the the increase in autism . I am a Chiropractor, and have a sister who has been a MT for 15 years. We work in separate offices referring freely to each other.

*** says:

March 21, 2008 at 12:39 pm

Most states and insurances set a customary fee cap, Julie, so they can’t charge so much. Chiros will charge that cap, but they often have to write off what the insurance/PIP/workman’s comp, etc., really pays, which they get to write off on their taxes. Chiros often cannot make much off of cash patients unless they’re running specials all the time with significant and more than customary (up to 20-25%) discounts.
The problem I worry about is the “rabid” chiropractors. I’m sure there are plenty of good ones out there, but so far I’ve run into the ones that believe vaccinations are bad for you and the general populace and won’t give informed consent to their clients because the fact there’s risk for strokes and neurological injury is “too scary.”

julie says:

March 1, 2008 at 11:14 am

Rob Graves | | hartfordmassageinfo.com |

Julie, nice job. Taking on an industry like this takes a lot of courage. Let’s all keep in mind working in this setting also raises the bar on liability issues for the MT, the rate they are paid in billing is an issue I hadn’t even thought of. $200.00 per session? Wow ! Yes, I could see how some MT’s might not do their best work carrying $140.00 worth of resentment per hour.

I have always worked on my own, done my own marketing, and paid rent, and it’s so much easier.

Personally, I’ve never really hit it off with the chiropractors I have encountered. Some of it is possibly just a personality conflict, other times it’s program related, where I feel rushed, and my concerns go ignored, so I have to follow my instincts.

A few years ago, I just wanted to simply rent a room in a chiro office and bring in my own clientele, but it turned out he tried to spring a whole marketing/refferral program on me, which, of course, also involved me doing free chair
massage at events, etc. even though I was to be a sub-contractor.

In the “interview”, he bashed his previous MT for moving out to a bigger, better space across the street. Apparently that MT “stole” his clients, so then, of course, we had to go into the whole “non-compete” contract thing,
which wouldn’t apply in my case, as I would be bringing in my own clients anyway.

Naturally, I was required to recommend chiro work to my massage clients. It was just too much. This whole thing lasted about a week. Best move I ever made.

I think it’s important to interview with them when they are not at work. I’ve had two “interviews” while the owner was “in session”, looking over the clients’ shoulder.

How unprofessional can you get? So take them out for coffee or lunch instead. And yes, ask those questions in your map, good idea. I think things can get frustrating when things move too fast. I try my best to be a tortoise, not a hare.

February 28, 2008 at 6:02 pm

I guess I am not sure what you mean as the reason I want massage therapists to ask how much will the chiropractor be making (which would be a better way of asking since what they do charge is sometimes now what is paid but it depends on what type of insurance is being billed. Since most states don’t allow MT to bill for PPO’s and HMO, I am assuming that most of the work done out of a chiro’s office is with an MVA in which case they do usually pay what is billed. So Many massage therapists often are shocked to find out how much they are billing compared to how much they are actually making. And you would be surprised at how many massage therapists do different work when they feel resentful about the rate they are being paid. I worked with a massage therapist last year who spoke of wanting to hurt a client physically because they were so mad at the chiro and I even will cut a session short when an ins. company is only paying me $60 compared to the $110 I get from another.

The bottom line is to be clear about what you want to make and what you need to make to not feel resentful.

I also worked with an ins. company last year as an advisor panelist and saw MT charging from $30- $300 for the same cpt code. The ins. company paid both but was starting to get a little curious as to why there was such a discrepancy.

Sean Slovik says:

February 28, 2008 at 3:45 pm

While I’ve agreed with many of your positions, Julie, one I’ve never seen eye to eye on is the concept of the first question you pose:

“How much do you bill the insurance company for the massage I will be doing? ”

We need to teach our young our services have a quantifiable amount of worth in dollars. Too many MT’s accept this notion of a percentage. What good is a 60% split if the price of the massage is discounted, comp’d or of a promotional nature.

If we are working for 60% of a $40 dollar massage fee, do we put less effort into our work, as compared to a situation where the charged fee is $180 and we get 60% of that? I think not. We have an obligation to provide consistent service regardless of the amount charged to the client or insurance carrier.

The amount we are compensated for our services should be set (or negotiated by us). Our worth is a figure which we are best determined as a price in which we are willing to accept, working in unison with a price the chiropractor is willing to pay. That final value of our services should have no bearing upon what is paid by the client or charged to the insurance company.

Finally, as a side note, you already know from your own insurance experiences, the amounts of fees charged to insurance companies don’t mean much. What they end up paying is usually reduced, sometimes significantly (i.e. 50% reduction).

Charging these high fees is often done for a reason, even knowing that they will never be reimbursed at that rate. High charges are done to set up data bases with insurance companies as to what are ‘reasonable and customary charges’. In this day and age, few people have traditional indemnity insurance plans. Most have some form of managed care insurance. Those plans are formulated with the concept the doctor will accept a certain percentage off of the standard reasonable and customary fee for a geographic area. Usually 30%-50% discounted!

The doctors’ business plan has taken this into account for survival, and can accept this rate, however, had he set his standard charges at this rate, this may turn into the new reasonably and customary charge for a geographic area, and he might ultimately be stuck with 30%-50% off of that.

Sean

Jody Hutchinson says:

February 28, 2008 at 7:59 am

I worked for an office with a DC and MD for 14 years. The billing was done in and out of the office and it was very hard to figure out how much beyond was being charged the $40.00/hour I was paid. One day I saw a bill for an injured worker I had been treating. The charge was $100.00 for 30 minutes!. The office was charging a visit with the provider who only said “hi” to the patient.
This was one of the tipping points that made me resign. I also wasn’t paid when the patients missed their appointments.
While I did learn a lot working in the office and saw many patients that I don’t see in private practice, Julie’s advice of going into a job with one’s eyes open is very wise.
I wish there were more educators telling MTs how to deal with the hiring and payment practices of chiros. At the massage school that I attended, there are chiro teaching “Massage and Chiropractic” classes. Neither of these DC have massage in their office and one openly disparages the lack of skills of most MTs.
Massage in a doctor’s office is a profit center. The stats show that as well as it makes the patients happier and heal faster. However, there are chiro practice consultants who show DCs how to “work” an MT for more revenue. How sad.

Respectfully,
jh

Alexander Kohl says:

February 27, 2008 at 11:56 pm

Interesting. Here is the Australian perspective:
All private health funds cap how much they pay for a certain service. If anyone charges more (whether Chiropractor or Massage Therapist) the patient pays the difference.
Actually, usually the patient has to pay all and then claim a part back from their health fund.
Only a few modalities are integrated into a system where the practitioner can charge the health funds directly.
So, there is no way to overcharge insurances in the way you describe.

Working for a Chiropractor

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