To take insurance or not to take insurance?

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Permalink Reply by Stuart R Dole on October 9, 2009 at 12:26pm

Hi Bianca:

My wife and I took over a one-man practice, and he was taking insurance. So we did too, for a while. Lately no one has asked about it, so it's "moot".

The bottom line is whether you like filling out paperwork - it took me about an hour average to fill in the paperwork for an hour massage, but it gets easier and quicker with time because you just copy it from last week. Then you wait a month or two or three to get paid.

You need to have a doctor's prescription WITH DIAGNOSTIC CODES first. Your client needs to bring that in. Then you NEED TO CALL the insurance company with the CLAIM NUMBER and ask them if massage is covered, and how many treatments. Then you need to look up the TREATMENT CODES (I forget the name for these now - it's a number) and use those in the forms. You can get pads of the standard forms at good stationery stores on online - find out which forms the particular insurance company requires. Usually it's one that's all in red, and you have to fill it out in black ink. Then you're good to go.

It helps if you're in the habit of taking extensive notes about each treatment and client - either the old SOAP notes or something equivalent. Then be prepared to have your notes and records subpoenaed if the case goes to trial - and for the legal process server to knock LOUDLY on your door at ANY TIME to serve the subpoena - or even barge right in. Signs that say "Do Not Disturb - Massage in Progress" don't slow them down! This has happened...

If your schedule it pretty full already, I'd say it's not worth it except as a favor to someone. If you have time, then it's a way to get some income and give someone who really needs it, and could not otherwise afford it, some relief.

Insurance clients do not tend to become regular non-insurance clients, but a few have.

Find a friend or acquaintance who already does insurance billing for massage and have them guide you through the first two or three - it will save tons of grief. It's not obvious from the forms what to leave blank and what to fill in! And if it's wrong, you have to resubmit and start the wait all over again. Insurance companies are in business to hang onto people's money as long as they can.

Hope this helps!

Happy trails...

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Permalink Reply by Lina Petridis on October 9, 2009 at 6:12pm

I had one insurance client for a few years. and it was a very good for me.Once I understood how to fill in the claim. I saw him several times a week..and repeated the process each time.. the payment came after two weeks..Since I had only him on insurance I kind of enjoyed filling in the paperwork..It was like therapy for me. Pretty easy.
He was a regular client I already had previously that was injured in a car accident..I really don't see why I wouldn't want to accept more insurance clients.
I think taking a course on insurance might help because when my client changed his insurance the other company was so different and more complicated that it did cause confusion.
Best Wishes

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Permalink Reply by Rachael Lynn Ostrander on October 9, 2009 at 8:59pm

Thanks so much for posting this discussion!! I have had my own practice for a year now, I don't take insurance at the moment. I am juggling with the idea as well. I have heard from several people that its more trouble then its worth. I will definitely be checking this to see what everyone else thinks. Im sure a lot of people will find this useful info. : )

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Permalink Reply by Kathy Jo King on October 10, 2009 at 5:51am

Most insurance companies do not cover massage. Massage is normally covered for worker's compensation and personal injury (auto accident) cases. Many people think that if they get a prescription then thier insurance will cover it. Not true. There are some insurance companies that offer a "rider" for "alternative" therapies. These allow the person to get a discount on massage. That means I get to charge 20% less for a massage and NOT get reimbursed from the insurance company. They have basically negotiated a price or a discount percent. I can see these clients, and for the privilege of being on the provider list, I get to charge less for my services. I do take these clients at the moment because I only have a handful.

I do also take the worker's compensation and personal injury clients. I bill the insurance company and wait for weeks to get paid. At the moment, I only have one client in this category. I suggest you buy one of the manuals being offered that explain how to do this. It's worth the price and will save you some headache. Fortuantely I have not had to testify, but did have to wait for many months while a client's lawyer fought w/insurance to pay bills. Good luck w/it.

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Permalink Reply by Rhonda MacFadzen on October 11, 2009 at 9:37am

Hi Bianca,
I had accepted a work comp case last year and the adjuster was kind enough to help me through the process. It really wasn't that difficult and of course a big learning curve. I really love working on medically necessary cases..so I decided to pursue the insurance billing. What I have found after taking a course in insurance billing, purchasing a all in one printer/fax/copier machine, locking file cabinet, connecting phone service( land line) into my office ( I used my cell phone for business), making packets to contact others in the medical field specifically orthopedists and chiropractors so far, taking out advertising, and then crossing my fingers....no cases. I am not sure if the medical community is on board with the thought of allowing their patients to go outside of their offices for any treatments or if I am just too impatient. Or maybe the right physician hasn't come along..although I got very good response from a couple of the dr. offices. I even have included over 50 free gift certificates in the packets I have sent out. No one has even used them. As I see it...all I can do is put it out to the universe, be prepared, and breathe.

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Permalink Reply by Julie Onofrio on October 11, 2009 at 12:18pm

There is a basic accounting formula that you can go through to see if taking insurance will actually increase your profits.

http://thebodyworker.com/costperclient.html

There are two sides to taking insurance. You can charge more and make more but it comes at the cost of putting more time into billing and getting paid. I would recommend that you take some classes in it so that it will make it easier to get paid when you know what you are doing.

Here in WA we are contracted providers and can bill HMO's and PPO's. I have been doing massage for 20 years. I have always billed a few MVA and Land I cases each year but never built a practice around it totally. Most pay reasonably well but you also get into the charging clients different amounts which gets sticky both ethically and legally.

It can help in building a practice to be able to take these clients. You can also do ins. cases exclusively if you want to get into charting, billing and progress reports and even the occaisional court case (which you get paid to appear sometimes.)

I also have some info on billing
http://thebodyworker.com/ins-billing-contents.htm

Julie
www.thebodyworker.com

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Permalink Reply by Patricia D. Moore on October 19, 2009 at 4:11pm

Hi Patty here,

I have billed insurance for massage, and for the regular people that want it, and have the coverage, be careful! The insurance company will say "yes" we cover it; however, who has to do the massage? Most answers from insurance will be a chiropractor, or a physical therapist. I am telling you the truth. That is how they get around not paying. Most chiropractors are not going to do it and neither are the physical therapists. I have talked to both, and they don't want our job. It seems to me, the insurance companies are offering the therapy with strings attached. Sometimes it's cover, or most times under 97124, the physical therapy portion of their medical coverage. Just be sure it's covered by a massage therapist. Just remember to ask that question, who has to do the massage. Other prescriptions I have are all fine, it's these ones, so always verify coverage prior to treatment. Taking a good insurance billing course is great, just remember, they don't teach to ask that question. I learned the hard way.
Patty in PA

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Permalink Reply by Gerry Bunnell on October 20, 2009 at 4:56am

Auto accident cases are not always a sure thing either. Case in point from last year, about $2,000.00 worth of Chiropractic and Massage care done on one case over a year ago. I am very glad we were able to resolve the Patient's issues and is now recovered. However we are still working on receiving payment and may end up writing it off. The insurance company of the other driver is stalling payment and we have no control over it. It is in the hands of our patient's lawyer.

Patty is absolutely right, you must clarify all the details. It does matter who performs the massage and how you code the massage. Many insurance companies will flat out tell you they do not cover massage, but when given specific billing codes they will tell you they consider 97124 (code for massage). That is an important word "consider". Even if the insurance company tells you they will consider a charge, they will not necessarily pay for it.

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Permalink Reply by Gregory Oed on October 21, 2009 at 6:40pm

In consideration of the time that goes into preparing insurance forms, following up on bills due, slower cash flow, deductibles, co-insurance... I would not accept insurance assignment. If I did I would have to at least literally double my fees. These are some of the reasons doctors and chiropractors charge so much even though they spend as little as a few minutes with their clients. Ever see a doctor or chiropractor do his own billing or does he/she have a staff often of more than one to do all this for him. Remember you can bill whatever you want. But what you get paid is at their discretion. Insurance companies build profiles of what you and others in your community bill clients. So this years profile is based on last years bills. You are always behind unless you bill this year what you think you are worth next year. Also you are expected to bill insurance companies the the same as uninsured clients. You can't bill the difference to your client. But you may have to bill them for the deductible if not met or the co-insurance. A lot to keep track of. So the uninsured get nailed... Guess what! You are now in the insurance billing business and if you have time you can practice your massage craft.

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Permalink Reply by Bianca Berrios on October 21, 2009 at 8:49pm

I just want to thank everyone for your informative reply's this has been a great help! Thank you guys!

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Permalink Reply by Heidi Krenzke on October 21, 2009 at 10:32pm

I agree again with Stuart, I've done medical billing for years, and still am. One thing to keeep in mind in Michigan (Check your state laws) a Dr. or PT needs to be on the premises, and do billing thru them. Most health insurance companies do not acknowledge Massage Therapists, however they do acknowledge Dr.'s and PT's. So unfair! In Michigan we are allowed to bill for workman's comp. and auto claims, that is all I do! The forms to use are HICFA, you can order them through Medical arts press, pretty inexpensive! Do your SOAP notes and yes keep them all!

Stuart R Dole said:

Hi Bianca:

My wife and I took over a one-man practice, and he was taking insurance. So we did too, for a while. Lately no one has asked about it, so it's "moot".

The bottom line is whether you like filling out paperwork - it took me about an hour average to fill in the paperwork for an hour massage, but it gets easier and quicker with time because you just copy it from last week. Then you wait a month or two or three to get paid.

You need to have a doctor's prescription WITH DIAGNOSTIC CODES first. Your client needs to bring that in. Then you NEED TO CALL the insurance company with the CLAIM NUMBER and ask them if massage is covered, and how many treatments. Then you need to look up the TREATMENT CODES (I forget the name for these now - it's a number) and use those in the forms. You can get pads of the standard forms at good stationery stores on online - find out which forms the particular insurance company requires. Usually it's one that's all in red, and you have to fill it out in black ink. Then you're good to go.

It helps if you're in the habit of taking extensive notes about each treatment and client - either the old SOAP notes or something equivalent. Then be prepared to have your notes and records subpoenaed if the case goes to trial - and for the legal process server to knock LOUDLY on your door at ANY TIME to serve the subpoena - or even barge right in. Signs that say "Do Not Disturb - Massage in Progress" don't slow them down! This has happened...

If your schedule it pretty full already, I'd say it's not worth it except as a favor to someone. If you have time, then it's a way to get some income and give someone who really needs it, and could not otherwise afford it, some relief.

Insurance clients do not tend to become regular non-insurance clients, but a few have.

Find a friend or acquaintance who already does insurance billing for massage and have them guide you through the first two or three - it will save tons of grief. It's not obvious from the forms what to leave blank and what to fill in! And if it's wrong, you have to resubmit and start the wait all over again. Insurance companies are in business to hang onto people's money as long as they can.

Hope this helps!

Happy trails...

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