As I mentioned last week, some insurance companies have price limits for CAM reimbursement. This means that insurers will decide in advance how much a specific treatment is worth; if a provider bills above this rate, the company will only have to pay up to this “allowed amount”. If this amount is reasonable, it isn’t cause for complaint – regulating prices can be a good idea. However, some companies have limits that are well below the normal cash rate for massage.
One of the worst perpetrators of this is American Specialty Health, more commonly known as ASH. This company is an umbrella corporation that provides CAM services to a number of other insurance carriers. Working in Oregon, I deal with ASH primarily when I work with clients who have Health Net insurance. On the rare occasions that Providence insurance provides massage coverage, it’s also through ASH.
When I say “well below the normal rate”, what exactly do I mean? Let’s put a number to this pretty heavy claim: For a 60-minute massage, the “allowed amount” by ASH is $45. I don’t know any business-owning massage therapist who regularly works for such a low price.
What’s even worse is that this amount is split up between the copay and the reimbursement. The client is responsible for a $25 copay – more than 50% of the total amount. ASH gets away with paying out $20 per massage session. Massage therapists are not allowed to seek additional funds from the client to make up the cost. $45 is what you get.
Here’s something even more mind-boggling: Since ASH is just a CAM company – an “add-on” to regular insurance – it isn’t used uniformly. For example: Health Net of Oregon uses ASH for alternative care, but Health Net of Washington uses Optum (they switched several years ago). Generally speaking, clients in Oregon will have Health Net of Oregon, but if their employer happens to be based in Washington, they will have Health Net of Washington instead.
Because the reimbursements for CAM services is through these umbrella companies, not through Health Net itself, the rates differ substantially. Including copay, I receive $45 per massage for my Health Net clients through ASH. However, I receive $64 per massage for my Health Net clients through Optum. That’s a near 40% difference for something as trivial as what state an employer is located in. And that makes a huge difference to my bottom line.
I know many providers who have decided to not take ASH clients. Too much paperwork (more on that next week), too little financial gain. I choose to take ASH because I want to be available as a health care provider to as many people as I can.
I’ve had many loyal clients with ASH coverage. As with any insurance massage, only being responsible for a small copay makes a client much more likely to return, and return regularly. Likewise, I want to stay loyal to my clients. I’ve had several clients switch over to ASH from a different insurance provider due to changes in their employment. Despite the fact that I would now be earning only half of what I had previously with these clients, I would never want to penalize them for something beyond their control. If they want to have me as their LMT, I want them to be my clients.
I don’t know if this situation will change when the Affordable Care Act rolls out next year. This irritating financial circumstance isn’t just specific to massage therapists – no CAM provider gets paid very well through ASH. If someone were to make the case that CAM providers as a whole were being discriminated against, that might affect change. But I don’t know for sure.
For those of you who plan on getting credentialed and taking insurance next year, figuring out which insurance companies you want to work with will be one of your first decisions. Ask other local providers about their experiences with certain companies – how much they reimburse, how long it usually takes for a claim to be processed, how receptive they are to questions and appeals. I plan to go over this in more detail this summer, so stay tuned!
Next up, though, is more about ASH: what they define as “medical necessity”, and how they try to stop clients from using their allowed number of CAM treatments.