Comments on: Working for a Chiropractor

By: annie noonan

annie noonan — Tue, 24 Jun 2008 16:43:03 +0000

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)

By: Julie Onofrio

Julie Onofrio — Tue, 24 Jun 2008 03:05:59 +0000

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

By: Kelly

Kelly — Mon, 23 Jun 2008 20:34:13 +0000

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

By: Jenny Bannon

Jenny Bannon — Tue, 25 Mar 2008 17:44:32 +0000

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.

By: D. Tsakiridis

D. Tsakiridis — Mon, 24 Mar 2008 19:58:19 +0000

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!!

By: Barry Smith

Barry Smith — Sat, 22 Mar 2008 21:48:35 +0000

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.

By: ***

*** — Fri, 21 Mar 2008 20:39:55 +0000

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.”

By: julie

julie — Sat, 01 Mar 2008 19:14:22 +0000

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.

By: Julie Onofrio

Julie Onofrio — Fri, 29 Feb 2008 02:02:42 +0000

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.

By: Sean Slovik

Sean Slovik — Thu, 28 Feb 2008 23:45:19 +0000

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