The Affordable Care Act (yes it is the same thing as Obamacare) is starting to come into effect. Oct 1, 2013, was the opening of the States insurance exchange market which is where low income people can find insurance plans to fit their needs and budgets. The massage profession should have been working on getting massage into these plans and all plans for that matter as the ACA has sections that make it so. 2706 is the law now. How and if it is implemented is another story.
The Integrative Healthcare Policy Consortium (IHPC) has hired Deborah Senn (WA States past insurance commissioner who brought WA MT the Every Category Law which allows MT, ND’s and Acupuncturists to bill insurance) to work on the implementation in each state. The IHPC has invited many groups to assist in the process. The American Massage Therapy Association is listed as one of the groups involved in the process.
In my opinion, AMTA is the most likely group to help get this implemented in each state if possible. Some of the state chapters already have lobbyists and Government Relations Committees that might already have some sort of relationship with the Office of the Insurance Commissioner or other politicians. They have the ability to connect with local members in many ways to get the word out and to work together to help each other through the many challenges of working with insurance companies.
The thing really is do we as a profession want to get into healthcare on a whole.
The Down Side of Billing Insurance
Being in WA State, I have been a contracted provider with health insurance companies since about 2000. In the beginning, the pay was more than fair (above $95 per hour) and billing was fairly straight forward. Using www.officeally.com has made the billing process really easy. It is a free electronic billing service. The bills are paid usually within a few weeks at most for a clean claim. Credentialing is done through www.onehealthport.com Provider Source which was a big nightmare for me when I actually lost my credentialing with one insurance company due to many errors in the process. I was not even warned that I was losing my credentialing. A client told me! The biggest problem is that now the provider lists are closed and also the fees have been reduced significantly for most of the major companies meaning I have to do more massage to make the same money and that is something I wasn’t planning on in this stage of my career. (25 years – My plan was to start slowing down and work less, Play more!)
So with that in mind, why do I still support MT being able to bill insurance companies which also means working with doctors. I still have this obscure dream that massage could be the first response for many conditions – headaches, fibromyalgia, carpal tunnel syndrome, herniated discs, back/neck pain etc. Could massage replace the high priced drugs and become the main treatment protocol for things like these? What would it take to make that happen?
What it would take would be having a more organized and supportive organization that could stand up for us in the face of low reimbursement fees and closed lists. What it would take is having a strong network of Massage therapists that will help each other stay up on billing procedures and the many challenges of being a provider. What it would take is having a unified profession.
There is Power in Numbers
The one thing that gave me some hope was something that I heard last year (2012 AFMTE Conference) was John Weeks ( from www.theintegratorblog.com who is very instrumental in the changes in healthcare for complementary therapies) said : “There is Power in Numbers” . Could all 300,000 or so massage therapists AND their many clients make a difference in getting massage covered by healthcare?
Then there is also this stat from AMTA:
The people want coverage!
Would clients come more often when they have pain issues? Would massage therapists have more clients and not be struggling so much as they are now in general? Could we ever get insurance companies to pay us what we are worth (at least pay what we charge our cash clients)?
Insurance will only cover things that are medically necessary meaning you will need a prescription from a doctor. It will only usually cover a certain number of sessions. In WA on average it is about 16 -20 sessions. You will not be forced into taking insurance. Not everyone uses their insurance all the time. Insurance plans do not cover maintenance massage meaning people can not just come in because they want a massage. It is only for pain and medical conditions in which massage can help improve the condition! (That is the way it works in WA now anyways! Who knows really what other insurance companies will do.)
So get the Facts before you react.
FAQ’s from IHPC
FAQ’s on 2706 (PDF) from IHPC
Implementation FAQ’s from CMS.gov
Watch this from Deborah Senn