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Some issues I am not sure how to handle with a client

I recently started seeing a client, she actually seeked me out from a friend that referred me because I went to her house to do a massage. I am not a mobile massage therapist, I am really not comfortable going into other people's homes, so it is not a regular practice of mine. I decided to do this for her because she needs massage due to a rotator cuff surgery and the therapist she was working with previously couldn't accomodate her schedule. She likes to be scheduled early morning on weekends and late evening during the week. ( I know late evenings during the week is normal because of people's work schedules)Since my finacee and I have had financial problems I went back to a full time job that is 9-6 so I figued that these times would be acceptable, I had no idea the taxing on my family it would take though. That being said I have 2 issues I am unsure how to handle, professionally and personally.

Professionally: She has been ordered by her dr to have another round of 12 sessions. Her insurance/workmans comp is paying for the sessions. In the month I have been working with her (2 times a week) I feel I have made very little progress and this is due to her not letting me do what needs to be done. I try to work within her pain threshold, however the slightest touch sends her jumping so she then askes for a "light" massage. I have explined that what the dr is asking for,may be a little uncomfotable to start off but in due time that will ease off, so we have compromised at working 40 minutes deep tissue and then 20 minutes swedish so she can have the relaxing effect as well. I am torn though because I am not being paid by workmens comp to do relaxing I am being paid to provide a therapeutic service. I am also wondering if it would be out of line to contact her previous therapist to find out what she was doing to help her and if she was able to achive release in any of the affected areas. I feel like everything I have done is not helping and am wondering if I need to insist on the full hour to do therapeutic.I feel like I am rushing the warming of the muscles to work deeper faster and even the warming of the muslces is difficult because the slightest amount of pain she asks me to back off.

Personally: I had to reschedule a session with her because my youngest was sick with the flu, we wereup all night and this was one of the early morning sessions. She asked me if I ever needed to get in touch with her to use her cell number and calling or texting was fine, since my daughter was laying right next to me and had finally fallen asleep I opted to text. I finally fell asleep as we were not up and down anymore to then I awaken to her texting me asking why I wasn't there yet. She apparently did not get my text and proceeded to get after me through texting back and forth. Now I understand the frustration, I should have just picked up the phone and called. I feel that she has no regard for the fact that I had a family issue that I needed to tend to, because she demanded that I come the following day right after I get off work. She also talks on the phone while on the table and I am trying to massage, I feel like she is crossing my personal boundries

I really do not know how to handle either situation, please feel free to give me some advice and be as honest as possible. I need constrctive critizism at this point. This is the first time I am dealing with a workmans comp type thing, so I am not even sure that the proper things have been done in that aspect. I wonder if I should be in touch with the Dr, or if I should release her as a client since I feel we have not made any progress. I am stressing about it to the point that I am dreading her sessions, and I know that is not healthy.

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Permalink Reply by Jimswife on January 15, 2013 at 3:37pm

I agree with what others have said and I am glad to hear that you are requesting more info from her. As far as the script, usually the dr will say what he wants as far as increasing ROM, decreasing pain or something along those lines. But I wonder if W/C will approve massage in the first place especially if she was released from PT. And i dont know about home therapy for someone who can get around by their own power?

And not just that but its a pain in the rear end for someone to get paid from W/C in the first place. It's a waiting game. And what if its denied? Do you have a contract with her to pay you? And what if she gets a check and doesn't sign it over to you? Maybe have her pay you for the sessions and let HER wait for re-embursement from the settlement. I mean right now you are donating your time and energy. And let's not forget $ for gas and supplies (lotion, sheets and laundry). And now more time and energy with phone calls and so on. It's draining!

I gotta say you are a better person than I. I wouldn't have said yes in the first place unless I was getting paid up front for each session. And with all that you have said about your experience so far I would have said see ya!!!

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Permalink Reply by Lavinna V. Rendon on January 15, 2013 at 4:44pm

Oh gosh! You have no idea!! I have been in contact with gentelman from Workers Comp with Colorado Dept of Labor and Employment, because I was so overwhelmed with what I need to do as far as paperwork, where to get it, how to fill it out, units, codes etc... I forgot to even ask if they would approve of me going to the Ct's house. I am tempted to just invoice her asking for payment and letting her wait for reimbursment. My whole work day ( a completely different job) has gone to reasearching and phone calls on this situation.

I am now awaiting a phone call from the Dr's office to speak with a lady from billing to find out that proper procedure and then so I can get paid for the sessions we have had and I am going to refer her to someone who has more experience in W/C and Insurance billing... Not that I wouldn't like to work with Insuance clients, just not right now, THAT is a full time job in itself,lol

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Permalink Reply by Jody C. Hutchinson on January 16, 2013 at 8:51am

Lavinna,

I am glad you see how much is involved in W/C cases. You spend one hour in "face time," with the client. Then you spend thirty minutes in "chase time," trying to get paid. I re read your posts and think it is very unclear to invoice the client and wait for a lawyer to pay. You should contact the attorney and get a lien to guarantee your payment. In California is is illegal for the client to pay or be responsible for payment for sessions and missed appointments can't be billed.

Yes, the insurance system is challenging and if you can be patient, persistent and cross all the t's, it may work.

Cheers,

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Permalink Reply by Char Huber on January 21, 2013 at 8:17pm

Hi Lavinna,

I just read through the posts, sorry to hear of such a stressful situation. Wondering what the present status is.

I'm in Colorado and have some experience with these matters. Here are the guidelines I use for all injury cases involving third party payees. First, I instruct the client when scheduling their first visit, to bring a written referral, and all insurance information. Then I allow extra time for paperwork at the first appointment. I have them sign a form that authorizes me to release information to their insurance and instructs them to pay me directly; or the attorney to pay me directly in case of settlement (whether they have an attorney or not). I also have them sign the HCFA billing form authorizing the same. If I need to speak with the referring dr. I have them sign an authorization for that as well. I inform them that my job is to follow the guidelines set by the referring source, and/or to help their bodies return to a pre-injury state (this should also establish that that is their intention also). I also let them know that their job is to be compliant with the instructions of the referral or me. This sounds kind of cold, but it is all done with a caring attitude towards the client.

Hopefully this will help avoid another of these situations in the future, don't let it discourage you.

Best of luck,

Char

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Permalink Reply by Jimswife on January 30, 2013 at 4:18pm

Just checking in because I am curious about how things are going for you Lavinna.

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Permalink Reply by Janae Klindt on January 30, 2013 at 8:49pm

It is my opinion that you should call her previous therapist. My instinct is that he/she gave your client the scheduling issue as an excuse because he/she may have been having the same issues. First and foremost your family comes first. If that is not something a client can understand then I personally do not want that client in my practice. If there is ill feelings toward my client, my intentions on aiding in their process of healing will not manifest through and it then becomes a waste of both of our time. Also I worked as a dental assistant for 12 years before I became a RMT and one of the most valuable lessons I learned was that you control your schedule and the boundaries in your practice not the client. You are the professional and it is your responsibility to make sure that those boundaries are understood and maintained. Now there is a way to get it across in a personal yet professional way, but it clearly sounds like she has no consideration for you and that you are trying to help her. It is also my opinion that she is not wanting the help for the rotator cuff issues. That she simply sees this as an opportunity to receive free massages on someone else dime. That is why she is only wanting a relaxation massage and makes a fuss every time you try to work on her shoulder. I would also consider letting her physician in on what you are experiencing with her. After all, the may be looking at you and how much you are able to help her and if he likes your work, may send you referrals. If he however sees that there is not progress being made, it could reflect unjustly on your work.

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Permalink Reply by Janae Klindt on January 30, 2013 at 8:55pm

I have read others posts and I must also add that there becomes a point when the time and energy is more valuable than what you are getting paid. To me this is all reading RED FLAGS! RUN!

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Permalink Reply by Gordon J. Wallis on January 30, 2013 at 11:59pm

uhm,, I didnt even read you entire statement . My opinion only. Based on my experience... If I cant help some one dramatically or in a very noticable way within four sessions.. I cant help them. I dont see them any more unless they insist on it.. And whatever you call it. Relaxation theraputic or what. Everything you do is in the hopes or goal to make her better. And just because of the dama about the texting or whatever. Id let her find a new therapist. You have many years of massage work a head of you. Just move on. My opinion only.

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Permalink Reply by Lavinna V. Rendon on January 31, 2013 at 10:13am

I wish I would have reasearched all I needed to do. The client is insisting that I just need to send her an invoice to which she forwards to her lawyer and Workers Comp adjuster and they pay me from there. It led me to wonder if I am being paid out of an HSA account, that would make more sense if reciepts or invoices are being turned in. After speaking with a gentelman with the Co. Dept of Labor and Emp. he explained the process with forms, codes etc... after explaining this to her, she proceeded to tell me " I have never had any massage therapist have to fill out any types of specific forms"

I am beginning to feel she is isulting my intelligence & crossing many boundries. I finally found the correct form but have no idea how to fiil it out because I don't think I have the proper info. I have the dr referral but I am not sure it contains all the info I need and I really dont have a place to turn for assistance. So now I feel inadequate and discouraged.

Char Huber said:

Hi Lavinna,

I just read through the posts, sorry to hear of such a stressful situation. Wondering what the present status is.

I'm in Colorado and have some experience with these matters. Here are the guidelines I use for all injury cases involving third party payees. First, I instruct the client when scheduling their first visit, to bring a written referral, and all insurance information. Then I allow extra time for paperwork at the first appointment. I have them sign a form that authorizes me to release information to their insurance and instructs them to pay me directly; or the attorney to pay me directly in case of settlement (whether they have an attorney or not). I also have them sign the HCFA billing form authorizing the same. If I need to speak with the referring dr. I have them sign an authorization for that as well. I inform them that my job is to follow the guidelines set by the referring source, and/or to help their bodies return to a pre-injury state (this should also establish that that is their intention also). I also let them know that their job is to be compliant with the instructions of the referral or me. This sounds kind of cold, but it is all done with a caring attitude towards the client.

Hopefully this will help avoid another of these situations in the future, don't let it discourage you.

Best of luck,

Char

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Permalink Reply by Lavinna V. Rendon on January 31, 2013 at 10:24am

Yes, that is one of the things I did, because that was also my first thought... the scheduling and because she did mention that "she worked on whatever she wanted" I went in with the intenetion and tried to make it clear to her, that I was there to assist bringing her back to her pre-injury state, that there will be discomfort and that I would work within her pain threshold but once I started working I found out very quickly it wasn't going to be that easy. I did get in touch with the therapist, but she wasn't very open to talking about the client, so the only answers I recieved from her was that yes she did have to use specific forms, but she hands that over to her bookeeper so she doesn't know the process.

I agree whole hearteadly, about my feelings toward her and that would disrupt my intent to do my work properly, since then I have not worked on her, that and because the referral I finally recieved stated that she was to recieve massage through January 14th and on the 15th is when this all really came to head. she insists that the dr has extended it, I asked her for documention that shows an extended date, she says it wasn't necessary

Needless to say, I am ready to move on from this sitautaion. I want to do insurance billing, but after I have a bit more experience and more time to learn the process to do it correctly and without fear of something going wrong.

Janae Klindt said:

It is my opinion that you should call her previous therapist. My instinct is that he/she gave your client the scheduling issue as an excuse because he/she may have been having the same issues. First and foremost your family comes first. If that is not something a client can understand then I personally do not want that client in my practice. If there is ill feelings toward my client, my intentions on aiding in their process of healing will not manifest through and it then becomes a waste of both of our time. Also I worked as a dental assistant for 12 years before I became a RMT and one of the most valuable lessons I learned was that you control your schedule and the boundaries in your practice not the client. You are the professional and it is your responsibility to make sure that those boundaries are understood and maintained. Now there is a way to get it across in a personal yet professional way, but it clearly sounds like she has no consideration for you and that you are trying to help her. It is also my opinion that she is not wanting the help for the rotator cuff issues. That she simply sees this as an opportunity to receive free massages on someone else dime. That is why she is only wanting a relaxation massage and makes a fuss every time you try to work on her shoulder. I would also consider letting her physician in on what you are experiencing with her. After all, the may be looking at you and how much you are able to help her and if he likes your work, may send you referrals. If he however sees that there is not progress being made, it could reflect unjustly on your work.

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Permalink Reply by Lavinna V. Rendon on January 31, 2013 at 10:33am

Thank you all for the input, I have said it before but I must say it again.... having this as a tool for advice is a huge relief for me!

All in all, going back and looking at the dates I worked on her, it was actually only a 9 day time frame, so 4 sessions in 9 days and no progress. I am certain that she is in need of another modality. She also voiced that "in her 2 years of doing this she has never had a problem" if she has been getting massage for 2 years, then it is more than apparent it is not working and for many reasons I assume.

I want to massage to help people, but they also have to accept the help and I honestly believe that she doesn't. I sent her an invoice, so I will see if I do get paid that way, if I do great! but I am still going to release her, for personal and professional reasons. I have accepted that if I don't get paid, that it will be a drawn out process to do so... but ready to head that road if need be. I have all my documentaion that I need if I ever do need it. I have done my best to be as thourough as possible :)

Thank you all again for the time and input you have put forth, your experience has taught me and I am greatful!

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Permalink Reply by Sheryl Matters on January 31, 2013 at 11:46am

This product may help (in a good therapist-client relationship). If someone needs help relaxing before receiving deep work: