LMT Interviews – K.P.

Name: K.P.

Name of your practice: Beaumont Health Care Clinic

Location: Portland, OR

Number of LMTs working there: 2

How long have you been massaging? 1.5 years

What type(s) of massage do you do? Myofascial release, Deep tissue, Thai

How long have you taken insurance? 6 months

What types of insurance cases do you accept? MVA. Medical coming soon

Do you do your own insurance billing? Yes.

What’s your favorite part about taking insurance? Increases accessibility to preventative health care.

What’s your least favorite part about taking insurance? Hoop jumping differently with each company.

What do you hope the new ACA laws will accomplish? Increase access to preventative health care!

What would you say to an LMT who is interested in taking insurance? Once you get a system organized it gets much more smooth.

Are you also an LMT who takes insurance? Fill out your own survey here!

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LMT Interviews – A.R.

Name: A.R.

Name of your practice: Andrine de la Rocha Massage Therapy

Location: United States

Number of LMTs working there: 2

How long have you been massaging? 16 years

What type(s) of massage do you do? Swedish, Myofascial Release, CranioSacral Therapy, Pregnancy.

How long have you taken insurance? 14 years

What types of insurance cases do you accept? MVA, PIP

Do you do your own insurance billing? Yes.

What’s your favorite part about taking insurance? Being able to offer a service to help a person recover from an injury without them having to worry about the expense coming out of their pocket.

What’s your least favorite part about taking insurance? Trying to explain or “justify” the treatment that I’m providing to insurance people whose job it is to pay me as little as they can get away with. Also waiting for up to 2 months to even have claims processed and then sometimes having to re-submit them because of an error on the part of the ins. co. and having to wait another 2 months.

What do you hope the new ACA laws will accomplish? I hope the ACA will allow more people to get the medical treatment that they need when they need it, rather than waiting until they are too incapacitated to function.

What would you say to an LMT who is interested in taking insurance? Beware. Insurance panels will pay you the minimum amount they can get away with, while requiring you to put in hours of paperwork and wait weeks to get your 30%. PIP ins can pay well, but they will sometimes cut you off without telling you they are doing so, leaving you and/or the client with a huge unpaid bill for up to a year or more.

Are you also an LMT who takes insurance? Fill out your own survey here!

Insurance Billing in Oregon

Today I want to talk about how health insurance billing works in Oregon.

Similar to Washington, LMTs in Oregon typically have to be credentialed with insurance companies in order to get reimbursed. To get credentialed, we fill out paperwork to establish that we’re fully trained and licensed in the state and send it off to whichever companies we want to work with. Insurance companies don’t have to allow everyone who applies to join: some have certain criteria that must be met first (eg, one company only allows therapists who have been in practice for two years already), and others are closed completely to new applicants.

Even without being credentialed, though, a few companies may allow LMTs to bills as out-of-network providers for a reduced rate. However, being an out-of-network provider excludes you from one of the biggest benefits of working with insurance – having your name and practice listed on the insurance company’s website. When customers want to find a provider who takes their insurance, they typically consult this page to make their decision.

Once a client finds a therapist who takes her insurance, she can schedule a massage – no doctor’s referral required (for the majority of plans, at least). Insurance policies that cover alternative care work in one of two ways: Either the policy has a specified amount of money per year that goes towards these services, or there’s no set maximum amount but the client must meet his or her deductible first. From there, policies either have a copay (set dollar amount) or coinsurance (percentage of appointment charge) that the client owes for each session, and the insurance company picks up the rest of the tab.

This tab can be preestablished (eg, insurance saying that any 60-minute massage will only be reimbursed up to $64) or it can be based on what the therapist charges (eg, insurance covering 80% of the bill, leaving clients to pay a 20% coinsurance). If a therapist chooses to increase the cost of a massage for insurance billing, either to make up for paperwork hassles or to give a “time of service” discount to cash clients, the rates must still be reasonable.

I like that my heath insurance clients don’t need referrals. Sure, some of them will see a doctor first anyway to check on their issues, but others know that they just need a massage without anyone having to tell them. Not everyone wants to go to a doctor for every minor ache they have, and I’m certain that I would lose a good portion of my clientele if they all needed to get referrals first.

And honestly, I don’t know that every doctor would think to refer their clients to massage. Plenty of clients come to me saying, “well, my doctor says I need surgery, but I wanted to explore other options…”

As a side note, clients are still required to have a doctor’s referral when it comes to PIP insurance. This makes sense – PIP deals exclusively with injuries and trauma. Especially when it comes to car accidents, it’s best for the client to rule out anything serious before getting a massage.

Unlike Washington and Florida, Oregon doesn’t have any mandate that requires insurance to cover massage. That means that massage coverage is rather unevenly distributed, usually offered to those who can afford to add an alternative care rider to their policy. Some insurance companies consider massage an even more frivolous benefit than the rest of CAM, though, and make people (or, most typically, the companies that these people work for) pay for an extra rider on top of the alternative care rider (which includes chiropractic, acupuncture, naturopathic) in order to have massage coverage.

I’ve come across some policies that allow massage only when it’s performed by someone other than a massage therapist (eg, a chiropractor or doctor). Where’s the logic in that?

Personally, I think there are good and bad parts to both the Oregon and Washington approaches. I don’t think that health insurance should require a doctor’s referral for massage. I am a health care professional; I should be able to treat someone without the need for a doctor’s approval. At the same time, though, I wish massage coverage was available to everyone, not just those on ritzy insurance plans. I hope the Affordable Care Act can make my services accessible to anyone who needs them.

LMT Interview: Helen

Name: Helen

Name of your practice: Helen Ciampi, LMT

Location: Floral City, FL

Number of LMTs working there: 2

How long have you been massaging? 12 years

What type(s) of massage do you do? Medical, craniosacral, myofascial, lymph, hot stone, ETPS, kinesiology.

How long have you taken insurance? 12 years

What types of insurance cases do you accept? All medical insurance that covers massage therapy.

Do you do your own insurance billing? Yes.

What’s your favorite part about taking insurance? The ability to help someone who might not be able to afford massage therapy.

What’s your least favorite part about taking insurance? Being out of network and often waiting too long for payment

What do you hope the new ACA laws will accomplish? More people being able to have health care, including preventive care.

What would you say to an LMT who is interested in taking insurance? Never count on timely payments. You may have to resubmit. You also must be willing to make phone calls to the insurance company and be placed on hold. It often requires patience and tenacity.

Are you also an LMT who takes insurance? Fill out your own survey here!

LMT Interview: Carolyn

Name: Carolyn

Name of your practice: Body Tuning Massage & Neuromuscular Therapy

Location: Portland, ME

Number of LMTs working there: 1

How long have you been massaging? 8 years

What type(s) of massage do you do? Neuromuscular therapy, sports, relaxation, oncology

How long have you taken insurance? 7 years

What types of insurance cases do you accept? Health (when it covers), auto, workers compensation.

Do you do your own insurance billing? Yes.

What’s your favorite part about taking insurance? Increases client basis, increased income.

What’s your least favorite part about taking insurance? Frustration when claims are denied, wasted time on telephone tracking down these errors (insurance company has always been at fault and eventually pays).

What do you hope the new ACA laws will accomplish? Increased accessibility to more people for preventive health.

What would you say to an LMT who is interested in taking insurance? Just be patient and willing to learn; learn how to translate S.O.A.P notes into an acceptable documents; buy a program that allows you to type and update the HCFA; study neuromuscular therapy (as CE, do not rely on initial training) in order to deal with people who have specific pain issues; continue to study, read, etc.

Are you also an LMT who takes insurance? Fill out your own survey here!

State by State

One of the biggest obstacles we’re facing is that every state has different laws in place regarding massage therapy.

Not every state requires licensing. Some states have optional licensing or certifications that vary by city or county. Even among states that have mandatory licensing, the amount of initial training and the required number of hours for continuing education vary. States all have comparable definitions of massage therapy and similar scopes of practice, but some of the details don’t always match. For example, South Carolina disallows “electro-therapeutic devices” to be used for massage, while Texas allows them. LMTs in Ohio can only treat TMJ disorder with a doctor’s referral. California, which does not have state licensing, only “voluntary certification”, does not have a set scope of practice for its massage providers at all.

Not every state allows therapists to bill health insurance. Actually, most don’t. Washington does, as you read about earlier. Oregon does as well, although not every health plan includes massage coverage, and insurance companies vary widely on their reimbursement schedule.

Florida has legislature similar to Washington, in that it mandates insurance companies to cover massages as long as a doctor has deemed it medically necessary and has specified the number of treatments. Unlike Washington (and Oregon), however, Florida LMTs cannot be credentialed with insurance companies, so they can only bill as out-of-network providers. The rest of the states have even tighter restrictions, and some don’t allow massage therapists to bill health insurance at all.

In short, this is a complete mess. How can the ACA benefit massage therapists if we are this disorganized?

There are a ton of details we should find out about Section 2706, but I’ll save most of that for a different blog post. We need to know how, exactly, this section of the ACA will be put into place. Will it mandate that insurance allow LMTs into their provider network, like in WA and OR? Or will it just mandate that insurance pay for doctor-referred massages without the benefits (and drawbacks) of being an in-network provider?

And, perhaps most importantly for therapists living in Minnesota, California, and other non-licensure states: How will the ACA law affect states that don’t have mandatory licensing? Will some sort of massage certification be a requirement for billing insurance?

My goal for March is to find out the answers to all of these questions. As soon as I do, I’ll let you know. And from there, I can direct my efforts to make this blog the most useful resource for the most amount of people.

LMT Interview – C. Brusket

Name: Cheryl Brusket

Name of your practice: Cheryl Brusket, LMT

Location: Salem, MA

Number of LMTs working there: 1

How long have you been massaging? 6 years

What type(s) of massage do you do? Deep tissue, swedish, hot stone

How long have you taken insurance? 4 years

What types of insurance cases do you accept? PIP

Do you do your own insurance billing? Yes

What’s your favorite part about taking insurance? Getting paid.

What’s your least favorite part about taking insurance? The hassle it has been to get paid. Time waiting to get paid. The battles I have had to fight. Time wasted on writing rebuttals and spent in court… the list goes on and on.

What do you hope the new ACA laws will accomplish? I do not accept health insurance at this time, so I do not feel qualified to answer. BUT, I would like to see more health insurance companies offering massage as a covered benefit to their insureds…

What would you say to an LMT who is interested in taking insurance? Be prepared! Learn what to expect!

Are you also an LMT who takes insurance? Fill out your own survey here!