Insurance Billing Manual
2.
What to Charge For Your Services- The Issues and Ethics of Setting Fees
for Services
Figuring out what to charge
insurance companies for your services is a challenge. I have asked many leaders
(Vivian Madison-Mahoney, Diana Thompson and many massage therapists) in the
field about the discrepancy in fees that massage therapists charge and I get
different answers from each of them.
Most massage therapists think
that you will be able to charge more than your usual fee because it takes more
time to process the bills, do the chart notes, talk to the insurance companies
and everything else that goes along with working with injured clients and their
insurance companies. Most automobile insurance companies will pay more for
each session, but that does not mean that you can charge more necessarily.
The issue lies in setting your
fees to begin with. Charge what you need to make for each session. The
insurance company will pay you per unit of massage, which is a 15-minute
increment. So if you charge $60 per hour, your fees would be $15 per unit
(4x15=60).
There is something the insurance
industry has created called the Usual, Customary and Reasonable (UCR) fee. They
take surveys of what massage therapists are being paid by different companies
and average them out per area. As I see it, this is part of the problem. The
allowable fees are based on statistics of insurance companies paying higher
amounts because massage therapists will (and do) bill higher amounts than their
regular fees BECAUSE THE INSURANCE COMPANY WILL PAY IT! So this sets the UCR
higher than the average fee that an average massage therapist will charge!
In my opinion, this charging more
for our services is hurting the profession and adding to the problem of high
insurance rates! We are becoming part of the problem!
I have actually heard that it is
illegal to charge more than you charge your cash (no insurance) clients to
insurance companies, but no one seems to be able to agree on that. If you think
you need to be charging more for your services because you are worth more, than
I feel that you should be charging that to everyone – cash clients or insurance
companies. I think the problem lies in how we value ourselves. Massage
Therapists who charge in excess of $140 per 1 hour massage to insurance
companies who will pay it, don’t feel that they can ask that of someone paying
cash. As far as setting fees higher because of the idea that there is more to
do with each insurance case – I don’t really believe it. It takes 1 minute to
do a chart note after a session while someone is getting dressed. How much time
and money did it take you to get that cash client?
So part of the problem I see, is
that we are hesitant to charge what we need to make to be successful and make a
great living.
The way to set your fees is to
determine what you need to make each month and then looking at how many massages
you want to be doing each month and divide. So if you need to be making $5,000
a month and the average number of clients you want to see in a month is 75 (that
is about 18 a week) then your hourly fee should be around $65 per hour.
