Massage Insurance Billing : WA State Information
Billing Insurance Companies in WA State...
Being able to bill insurance companies for massage therapy services is a dual
edged sword. You will get more client but you will often be paid less than
you charge as is the case with many companies here in WA State.
We are able to become contracted providers with major medical carriers
such as Blue Cross and Blue Shield. We are required to go through a credentialling process and sign contracts accepting the rules that the insurance
companies make. While AMTA has a representative reading the contracts,
they only share this information with their members.
There is a major Third Party Network called American Whole Health which I
think just changed their name to
Axia who manages
3 of the major medical insurance companies and a group of auto insurance
companies called Corvel.
When I first signed up with them, I had no idea who they were nor was any
information sent on the details of their company. It turns out they manage
a group of auto insurance companies (which I have yet to get a list of) which
means when you participate in this group you have to accept a discounted rate of
reimbursements from the auto insurance companies. This means that my $132
UCR for Seattle doesn't mean anything and the allowable fee is usually $30-$60
less. I really think that it is only a matter of time before the rest of
the states and auto insurers catch on to this. While you don't have to be
part of this group to bill for a MVA, if you become a provider with Axia you
will automatically be a provider unless you opt out. What happened is that
most massage therapists had no clue who they were and all of a sudden were
getting paid a substantial amount less for mva's.
So as a provider with these groups and networks, they determine what the
allowable fee is. When I first started in 2000 (I think it was), I was
paid about $99 per massage from one company. That amount has decreased
every year to about $58-68 per 4 units. While this year (2007) stayed the
same, there was no increase for cost of living.
The other insurance companies pay between $59 - $69 per hour which is less
than my cash rate for clients. Basically my cash clients are subsidizing
my insurance work as I have to keep increasing my fees for cash clients.
The other things that are happening:
- benefits are constantly being reduced. One company used to allow
45 sessions a year and have cut that back to 16 per year.
- one company requires that I prove medical necessity for treatments given
by requesting chart notes. It does not matter what the referring
physician says in their prescription. No matter what I say in the notes,
most clients benefits are cut off and no more massages can be given for that
icd-9 code unless extensive proof is shown that it is a new condition.
I have talked with the insurance company to try to figure out what
conditions this applies to and what they are really looking for and I do not
have an answer. They just read me the medical necessity section of the
policy which is a general clause.
- insurance doesn't pay for pain conditions and assume that people have to
live with a certain amount of pain
- insurance does not cover maintenance or wellness (preventative massage)
although most clients try to use it for this and because only one of the
insurance companies check on this, there are many getting away with it.
- I have been told by one insurance company to just write down a diagnosis
code without having a prescription. They tell their patients that none
is needed yet I do need one to be able to get a diagnosis. It is very
confusing.
Basically, taking insurance has probably helped stabilize my income, but I
have to work more hours for the same amount of income. People also tend to
become less responsible for their health when they come in under insurance
policies. This is not to say that all are doing this. It has indeed
helped people who were seriously hurt or with chronic conditions etc.
Axia represents Group Health Co-op here and they are creating a "medical
massage credentialing".
Some Insurance companies will only let us bill the CPT code 97124 while
others allow 97140 and 97112. There is a great discrepancy in allowable
fees.
In general, since the Every Category Law was passed making it mandatory for
insurance companies to allow us to become providers, the insurance companies are
constantly finding new ways to not pay us. Some have closed their list
permanently meaning no one else can join. You also cannot sell your
business to anyone other than someone who is already a provider.
We can bill Labor & Industries for 12 session of massage ( a joke really if
someone has a serious injury - which they usually do)
We can also bill automobile insurance companies, but there are a few
companies who are joining the third party networks which means we have to accept
discounted fees!!
Every category Law
WA State Insurance Commissioners office
