I know I am always talking about massage insurance billing and how it is one of the things that has allowed me to stay in business now since 1989, but there is the other side of billing insurance: The headaches with insurance companies, healthcare changes, working with doctors/lawyers and things like how clients deal with their health issues. I do talk about them in my book Insurance Billing 101 for Massage Therapists, but I want to expand on that info here now.
It has always been a mixed blessing for me as you can see from this editorial Massage Insurance Billing (PDF) I wrote on it in 2005 for Massage Magazine.
The first challenges are really all of the hoops you need to jump through when working with insurance companies. You are really subject to their rules and regulations along with the benefits of each plan. You have to always be on top of what you need to be doing. They change their plans/rules as often as they wish and you are often left trying to figure it out on your own. Things in healthcare are constantly changing with HIPAA laws, billing forms and knowing what you need to do to get paid.
As a provider for health insurance companies here in WA, the insurance companies are constantly lowering their allowable fees (cutting our pay!) and reducing benefits in their plans. They are also doing things like requiring pre-authorization for massage services according to what they have found to be medically necessary but they haven’t really told us how they determine this. In the beginning of billing health insurance which was around 2000 or so, the insurance companies paid between $60 an hour (4 units of massage) to $120 or more for an hour session. It is now between $57 and $67 an hour. That is much less than what I charge my cash clients. I also have had to raise my fees for cash clients in order to still make the same amount without having to work more per hour.
Some massage therapists often envision that getting into insurance billing is like getting into bed with the devil. The insurance companies are seen as evil parts of society. Insurance companies are about profit, greed and money and are not about HEALTH, healing or being healthy.
I also have been seeing more people who won’t come in for massage unless their insurance is paying. People have become almost dependent on insurance paying. It has become more of a right here in WA. People who use their insurance also have a tendency to take it for granted. They are often the first people to cancel in the last minute or not show because they know that the insurance company is supposed to pay and they don’t know that a massage therapist can not bill the insurance company for a missed appointment. You can set cancellation policies around this too and have the client pay for the missed appointment.
People will come in saying I have 16 visits a year and I just want to get massage but often don’t realize that it has to be medically necessary. It has to be prescribed by a physician and the sessions have to show improvement. If massage isn’t working, I send them back to their doctors. Many would just prefer to keep getting massage.
It is also a mixed blessing taking insurance when clients begin to count on their insurance to pay because it somehow makes a massage session more around fixing the client. While we are taught to fix and know how to fix things that have gone haywire in the musculo-skeletal system, often there is a deeper part of healing that goes beyond fixing that massage can address. Often the real work is in being present for the client and following the ‘path’ of their illness/disorder (Pathology). But the insurance companies/doctors/lawyers only want to know if the client is ‘fixed’. It ties us deeper into that part of us that Loves to fix and Loves to feel powerful when we can fix. Clients will often be seen wanting us to ‘fix’ them, when in reality they are the only one who can fix themselves.
Insurance companies are also closing their provider lists here meaning even if you wanted to bill, you can’t unless you are already a provider. They are saying that there are too many massage therapists for the number of patients that they have. Some of the lists have been closed for years even though many massage therapists have left their networks and/or gone out of business.
With the new HIPAA laws and the many changes occurring in healthcare, there is a larger movement towards being an “evidence based profession”. The insurance companies definitely want that – it helps them to be more profitable as well as get people better faster hopefully. (But I still don’t really understand massage research and all of that, although I have tried!)
So why do I persist in all of this insurance billing crapola?
Yes it has allowed me to stay in business for over 25 years but I have also gotten to work with many injuries and conditions that I would have never seen really because people who are seriously hurt or sick may not have the funds to get the help they do need.
What I keep hanging onto is the idea that massage could be mainstream medicine. Could it be the first line of treatment in most diseases/conditions like:
- Headaches – removing the need for heavy drugs
- Carpal Tunnel syndrome – reducing the need for surgery
- Fibromyalgia – reducing the need for drugs, loss of work etc.
- Depression/Anxiety – reduce or eliminate the need for drugs and help people really have better lives
- Back/Neck Pain – reduce drugs and surgery
What keeps me hanging on is hearing things from major players in the world of massage insurance billing:
Deborah Senn, has told me in person, that the ACA should help us here in WA although I have yet to see how. Deborah Senn was instrumental in getting massage accepted here by the insurance companies back in 1996 with the creation of the Every Category Law that now reads really closely to the 2706 section of the ACA.
I also heard John Weeks of the Academic Consortium for Complementary & Alternative Health Care (ACCAH) speak at a conference with the Alliance for Massage Education in 2012 and the one thing that he said I found most interesting: “There is Power in Numbers” meaning that there are over 300,000 MT’s in the US and then you can also count on their clients who love massage. Could it truly work that way? Could massage therapists have an impact on the level of care patients get? Could massage ever be the way to put the HEALTH back into Healthcare?
I may just be delusional also! It may not ever happen in my lifetime….But….until then, you might want to just start learning the ropes on how to bill insurance and that is exactly why I have written this book ” Insurance Billing 101 for Massage Therapists”