Massage Insurance Reimbursement

With the prospect of a troubled economy, some massage therapists may feel more compelled to explore the path of billing insurance companies for massage therapy services.   Massage Insurance Reimbursement is a very controversial topic and a very difficult path but having clients coming in regularly with an injury or condition and having someone else (the insurance companies) pay for their massage session can seem very appealing.  Done correctly, billing insurance companies can be very lucrative.

Some of the things that you have to know about working with insurance clients is that insurance does not cover palliative (unnecessary) treatments or preventative treatments.  Massage will be covered by most auto insurance policies in some way when there is a motor vehicle accident.  Massage may also be covered by most states labor and industries or workman’s compensation policies for people who are hurt on the job.  In WA and FL massage is actually a part of the major medical insurance companies.  In WA massage therapists are able to become contracted providers with companies like Premera Blue Cross and Regence Blue Shield to name a few.  WA is one of the first states to accept massage therapists so there is much to be learned from the WA State if you are looking for your state to become part of the medical system.   When it first started in about 2000 I think it was, insurance companies paid fairly well and paid without question for the most part.  Each year clients benefits gets reduced meaning we get paid less per session and clients are allowed fewer sessions.  A few companies have increased their allowable fees through the years but some companies haven’t.  With free electronic billing nowadays with companies like officeally.com, the time between billing and getting the payments have been reduced to a few weeks compared to 4-6 weeks.

If you are thinking that you want to explore the aspects of billing insurance companies for massage therapy services you need to be able to set clear boundaries around your sessions.  People who are coming in on insurance tend to be the first one’s to not show up or cancel at the last minute because they think that they won’t have to pay for it.  I inform my clients on their first session that they will be responsible for a full fee if canceling in less than 24 hours.  Clients who use insurance for massage also tend to want to get massage long after their pain is gone or they may try to use it in preventative ways.  They also try to use it just for everyday aches and pains caused by sitting at the desk too long or working in the yard or climbing a mountain.  If the pain is debilitating and causes a loss in function, massage will cover the session.  With car accidents and injured workers you also may see  more people who are coming in to make their cases seem worse than they really are thinking that they will get a larger settlement from the insurance company.  While I am making these statements more as a generalization and all clients of course are not like that, it is something that you should be aware of when working with clients and insurance.   Creating clear boundaries around your sessions can help you create a more successful massage insurance billing business.

There are also more insurance companies who are allowing massage therapists to bill for their services without being contracted providers.  You will have to find out what each company allows and what each policy allows so it makes billing more challenging.

Some other things you need to know about are included on my website in the Massage Insurance Billing Manual

Some other things to be aware of:

  • Setting your fees higher for insurance companies than your cash clients no matter how you want to rationalize could be illegal.  You can only charge the amount that you would pay a person to bill insurance.  You can’t charge more because it takes longer to get paid or it takes more time to do chart notes.  Those are considered part of doing business so your prices should reflect that -ie if you take insurance you may want to raise your cash rates too to compensate for the additional time it takes to bill, write notes and managing the cases and doing all the work it takes to actually get paid.
  • Set guidelines for creating treatment plans that have a clear beginning and end.  What improvements in the clients condition will let you know when the client is done with their sessions?
  • Learn how to write chart notes that include functional outcomes
  • Have clients monitor their claims and payments for you and ask them to call when you are not getting paid

What state do you live in and are you able to bill for mva’s, PPO’s, HMO’s, Workman’s compensation?

Comments

  1. We choose to work with our clients to make our services affordable. While in a perfect world, insurance would cover massage…in reality, the insurance system seems to be broke in regards to complimentary medicine.

  2. I live in California. About four to five years ago I was able to bill for Workman’s Compensation and have about 40% of my practice as insurance, also a couple of MVA’s. In 2004 the California legislature changed the rules and severely cut back the number of visits and threw most of the injured workers out of the system.
    Now in 2008, I’ve done only a couple of MVA’s and it was a pain to collect the $, one client was a complete flake. The amount of time I spent on the phone and waiting 60 days for payment was absurd.
    I have been much happier having an all cash practice. I get calls every week from people wanting to know if I take Medicare or can bill their insurance. Most of them can’t or won’t afford to pay for massage.
    In an ideal world, insurance would pay for part or all of massage therapy. However, in our world, the insurance company wants to keep as much of the premiums as possible and pay out a token claim.
    After investing the time and resources to learn how to bill insurance and follow up the claims- I don’t think it’s worth it for a one-person practice. I have decided to offer clients a HCFA form and let them deal with it. I can only imagine how stressful it is to be a DC, MD, or PT and have to deal with non-healthcare people directing your treatment plans and delaying payments.

    Jody Hutchinson

  3. Susan N Powers says:

    I have been teaching Insurance Billing for Medical Massage for 9 years now – specifically in NYS. NYS must pay for doctor-prescribed therapeutic massage for auto accidents (NYS is a No Fault State) … and MAY pay – very dependent on the particular workman’s comp insurance carrier – for doctor-prescribed therapeutic massage for on-the-job injury.
    I recommend always getting pre-authorization to treat for all worker’s comp clients/patients.

    Learning how to bill successfully in just these two kinds of scenarios is one important way to create a steady stream of income … and help recession-proof your practice. When economic times are tough — the nos. of private pay clients can decrease significantly and the shift can happen relatively quicly — INSURANCE BILLING – when you really understand the process – is a wonderful addition to anyone’s massage practice — Most of us spend a LOT of our own money for training in advanced techniques – why not use these skills on individuals who need them most ??????

    AND if you do not want to take on the responsibility of billing cos.yourself – you can ask the client to pay you directly, provide a superbill – or statement of what you did in your session – and they can submit it to their insurance cos for reimbursement (this applies to No Fault ONLY – at least in NYS)

    NYS No Fault fee structure does allow us to bill in a way that can often pay more than private pays — you just have to understand the process. I cannot comment on other states …

    One national expert I follow is David Luther of The Medical Massage Office — he has done more extensive research than most other folks I know … Vivian Mahoney as well.

    So I vote YES for LMTs billing insurance companies … my experience is that it is TOTALLY worth it — in all respects.

    Susan N Powers
    sphands@aol.com

  4. Hi

    Can someone help me with billing workmen’s comp. My client is in Connecticut. Do I need to bill in the 15 min increments and if so what would the CPT code be? Any advise would be greatly appreciated. It was approved to.

  5. Julie Onofrio says:

    You have to ask the CT workmens comp division to get the specifics for what you are allowed to bill and proper billing procedures that you need to do to get paid by them. Most have a manual of some sort or a provider rep to help you.

    The main codes are listed on my main website
    http://www.thebodyworker.com/ins-billing-contents.htm

    but you have to decide what type of massage you do and what code it fits under and then see if they will pay for that code.

  6. If I work with a chiropractor and am doing massage on his clients do I bill under my name, his name or the practice?

  7. Julie Onofrio says:

    You will have to ask your attorney. Each situation is different. It depends if you are an employee or subcontractor.

    Julie

  8. I don’t have an attorney. Do I need one? I am an employee getting paid by the hour

  9. My partner is an LMT contracting with a chiropractor in Oregon. He heard from an other LMT that he has to be a Chiropractic Assistant to be payed by insurance companies to for doing work under the chiropractor. Is this true?

  10. Deb Riggs says:

    What’s the average number of visits that insurance will typically cover per incident?

  11. There is no average. There may be limits in their policy like a dollar amount but even if their benefits run out there may be a court case later that would get more money that you would get paid out of. Talk to the lawyer and insurance company and the client to find out more.

    Julie

  12. Jennifer says:

    Julie, you are a massage therapist are you not? I don’t see how you can be against letting insurance cover part of the cost of a patient’s massage. Most insurance plans would not cover the whole thing, there would be a co-pay, as there is with almost all types of doctor’s appointments, so there is still an incentive for the patient not only get the massage if it is truly needed and/or truly providing benefits (since they are in part paying for the cost). And, regarding this comment: “Clients who use insurance for massage also tend to want to get massage long after their pain is gone or they may try to use it in preventative ways. They also try to use it just for everyday aches and pains caused by sitting at the desk too long or working in the yard or climbing a mountain.” What? Using massage in a preventative way and using it to get rid of neck aches and/or pains from physical activity ARE some of the reasons that massage is valuable! To say otherwise is to discredit your own profession. If you don’t think that massage can provide great benefits to people without super serious conditions, I don’t understand your perspective on massage, and it is utterly different than any massage therapist’s I have ever encountered. That being said, it would surprise me that anyone in the massage therapy industry be against patients be able to pay for massage in part with their insurance. If insurance companies disallow it, I feel it is a statement that massage is not a serious established treatment and not “worth it” for people to receive it.

  13. Yes massage does help with preventative things but insurance does not cover maintenance or preventative massage. They only cover massage for the purpose of rehabilitation from an injury or condition in which massage can resolve the problem. Insurance doesn’t usually cover massage just because you want to get massage. That is the problem. I only just a few weeks ago got a someone with a wellness plan that would cover that.

    I am not against people using insurance benefits for their massage. It is what has kept me in business for so long. What I do have trouble with is the insurance companies are constantly lowering what they pay us meaning I lose money taking a client with insurance benefits now except for car accidents. I can’t stay in business when I lose money with every client so I have to stop taking some of the insurances.

    Only FL and WA will allow people to have benefits for massage sessions and most states will pay for injuries due to car accidents or accidents at work. You need to know the laws and coverage. It is a long way from being covered for maintenance massage or for preventative uses.

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