Category Archives: Insurance Reimbursement

Insurance Reimbursement

Don’t let this happen to you

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I’ve learned a lot about health insurance these last few months as I battle it out with my health insurance company.

As many massage therapists also have to take care of their own health insurance and that of their families, I feel compelled to pass on what I have learned, so that what happened to me does not happen to you too.

Prior to my husband Francis’s surgeries to fix a torn meniscus and repair a bilateral hernia that happened as a result of an accident, I called my insurance company to find out what they would cover. I was told they would cover 100% of what was usual and customary (U&C).

I questioned them pretty extensively about how they came up with these U&C amounts, but they assured me that we had nothing to worry about. They also told me that we had a great policy because we were not limited to any network and Francis could go to any doctors he wanted.

So I felt pretty confident that after our $2500 deductible our bills would be paid and so Francis went ahead with the surgeries.

A few weeks later the bills stared pouring in. Here is what happened.

1. Even although the surgeries were the result of one accident we were charged three deductibles totaling $7500 (one for his knee and one for his hip and one for the hernia (even although the hip pain was the result of the inguinal hernia). Our deductible is per occurrence and not annually and it is up to us to prove to them that the injuries are related to the same accident (even although all the doctor’s notes support this!)

2. The U&C rates that they actually paid out were in most cases 1/3 or less of each bill (after our deductible of course).

3. Even although they told us before hand that he could have all the surgeries done at the same time (which cost them only one hospital bill and not three) after the fact they said it was not usual and customary to have them done on the same day and disallowed most of the charges.

4. Because our policy is not part of any network we have ZERO protection and the doctors and hospital offer ZERO discount on the bills so we are responsible for 100% of what the insurance doesn’t pay. Which is about $20,000.

So here is what I have learned:

1. When you are part of a network, even although you are limited to which doctors you can see (often ones employed by the health insurance company) at least you have some protection from escalating bills.

2. Watch these U&C rates! Unfortunately the amounts that your insurance company actually pays out for each service is developed by a proprietary formula unique to each company and they are NOT required to disclose how they come up with the formula.

So you may think you have a great policy because it pays out at 100%. But in fact a policy that pays out at 80% may actually have more realistic U&C rates and therefore be a better policy.

3. Watch these “per occurrence” deductibles. You are better of with a clear cut annual deductible.

4. Keep great notes of every conversation you have with your insurance company. (In fact I started recording mine – with permission of course) including who you spoke to, when, and what they said. This will become invaluable if you run into problems.

I do intent on fighting this and will keep you posted. Meanwhile does anyone have a great health insurance policy out there? I’m looking for a new one!

Sicko for Sure

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I know that a lot of massage therapists, myself included have had our share of challenges (and some pleasant surprises) in dealing with our client’s health insurance companies.

I have also been dealing with my own personal insurance nightmare the past few months.

Like many of you my husband Francis and I are self-employed therapists and have private health insurance which we pay for dearly ($914 a month for the two of us for a policy with a $2500 deductible). In over 10 years we have never needed to use our major medical (thank goodness!) until Francis had an accident and needed surgery last December.

Despite having a policy that is supposed to pay 100% after the deductible has been met we are now stuck with about $20,000 in medical bills (which is growing each month because of interest fees). Now that is Sicko!

So I am particularly interested in Michael Moore’s new movie dealing with the subject.

As I am currently traveling across the country from Bellingham, Washington to Annapolis, Maryland I have not had a chance to see it yet.

Have you?

Free Massage Insurance Billing Information

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Julie of www.thebodyworker.com recently commented on a previous post on insurance billing for massage therapy. She has some free resources on her website that I wanted to share with you. You have to click around a bit to find the free manual, and be wiling to sort through a bunch of ads. If you want to bypass the ads you can make a donation and get the ad-free version.

Here’s what Julie has to say about insurance reimbursement.

The medical massage profession is in a big state of confusion. Here in WA State we are able to become contracted providers with companies such as Regence Blue Shield. But that is a mixed blessing. While we want to be a part of the medical profession, the insurance companies here are raking us through the coals and taking advantage of the fact that massage therapists are willing to work at such low rates. ($59 for one such company.)

They are also making it harder to collect money and are limiting benefits. Do we as a profession really want to be a part of such an organization?

My personal passion is teaching people how to bill insurance companies for massage services so that they can then see how it does not serve our profession.

I also have most of the information that one needs to know to bill insurances available online for free at
http://www.thebodyworker.com

Thanks Julie!

Establishing a 9 to 5 Massage Practice

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In response to a previous post about getting massage clients during day-time hours, Tamara Felix, PhD, LMT of The Right Touch had this to say…

Massage therapists are MEDICAL providers. If you are trying to establish a 9 to 5 practice (as I have successfully done for the last 12 years), the next time you have a client ask if you for an appointment in the evening after work or on weekends, ask the client how they handled their last medical appointment. Most employers provide 2-3 hours during a work day for medical appointments, which is what you are offering. The only difference is yours feels a whole lot better, and provides more health benefit than they realize!!!

Then ask the client if their employer offers a FLEX plan (caffeteria plan, etc.). FLEX plans cover medical services not covered by their health insurance. Massage therapy is not typically covered by health insurance without a prescription, and is a serious business requiring tons of documentation; but with a FLEX plan, they don’t need a prescription, and you don’t have to deal with their insurance. All the client has to do is simply supply a copy of your receipt to their human resources manager and they get REIMBURSED from their employer for your services!

So, then, not only will their employer provide the time for them to get a massage from you during your normall 9-5 day, but will also PAY FOR IT!

Happy massaging!

Thank you so much Tamara. We appreciate you sharing your expertise.

Sicko for Sure

Published by:

sicko badge
I know that a lot of massage therapists, myself included have had our share of challenges (and some pleasant surprises) in dealing with our client’s health insurance companies.

I have also been dealing with my own personal insurance nightmare the past few months.

Like many of you my husband Francis and I are self-employed therapists and have private health insurance which we pay for dearly ($914 a month for the two of us for a policy with a $2500 deductible). In over 10 years we have never needed to use our major medical (thank goodness!) until Francis had an accident and needed surgery last December.

Despite having a policy that is supposed to pay 100% after the deductible has been met we are now stuck with about $20,000 in medical bills (which is growing each month because of interest fees). Now that is Sicko!

So I am particularly interested in Michael Moore’s new movie dealing with the subject.

As I am currently traveling across the country from Bellingham, Washington to Annapolis, Maryland I have not had a chance to see it yet.

Have you?