a community of practitioners

Insurance billing in California

I would love to hear peoples comments and experiences regarding insurance billing for massage. Do you accept insurance? What type of insurance - Personal Injury Insurance, Worker's Compensation and/or Private Health Insurance?

I am starting to accept insurance clients but it's been challenging to acquire useful information that insures prompt payment. I've purchased the book "Hands Heal, Communication, Documentation and Insurnace Billing for Manual Therapists" third edition by Diana L. Thompson. I found the book to be a great resource. I also have a degree and work experience in business so I feel pretty comfortable with all the paperwork; however, I've also heard the horror stories about insurance billing in California.

I'd love to hear from you all.

Michael Spackman, NMT, CMT
www.FindingYourTruth.com

Replies to This Discussion

Permalink Reply by Charles on July 10, 2009 at 1:13pm

I've had an experience with PI cases (two) where I had to wait through a settlement via law suit. I got paid for half of the work from one case and non-payment through the other (I moved to michigan at the time). The one payment I did receive took over two years before payment.

My advise in those PI cases is payment up front for your work. Don't wait for the settlment because the lawyers will screw you. If the client does not want to pay you and asks for you to wait for the settlment don't do it. You may experience what I did.

Otherwise PI through an insurance provider with a doctor's Rx works out okay. I have a couple of colleagues that work with AAA and they get paid on time for their work. They go through a case manager (make friends and network) for their clients. Or become a preferred provider.

But no PI cases where you get paid through settlement from a law suit.

Permalink Reply by Gary on July 10, 2009 at 1:26pm

A colleague used to accept insurance clients ... but often she never collected a dime beyond the cash co-pay. And she often did a LOT of work trying unsuccessfully to collect from the insurance companies. She no longer accepts insurance clients :-(

I don't know any of the details first-hand. I'll have to invite her to join this site!

Permalink Reply by Connie Doyle on July 21, 2009 at 9:28pm

I do not accept insurance. It's very complicated, and too many therapists get stiffed.

Permalink Reply by Cheryl Shimada on August 27, 2009 at 10:20am

Hi Michael,
Back in early 2001-2003 I did WC insurance billing, I had a great success once I got the hang of it. It took 6-8 weeks to pay out, but I did get paid. Word of advice, if you are going to do WC billing, be sure to get approval from the claims adjustor prior to working on the client. I have stopped doing WC due to the lack of funding and now an adjustors unwillingness to approve it, even though I have a prescription from a MD. Not worth my time and effort in "politics".

I have also had great success in billing for personal injury. Again, be sure to confirm there is enough Med-pay money, as this is a one time "pot of gold" and once the money is used, there is no more and you will probably be competing with other medical people (i.e. chiropractors, PT, etc) when the insurance company pays out of medpay. Make it clear to your client that if you are working on them on this insurance that if you do not get paid, they will be responsible for the amount at the insurance rate if it is different than your hourly non-insurance rate.

As far as regular health insurance, I have not ventured into this area, as of yet.

Good luck to you, please let me know how your are doing with this issue.

Cheryl Shimada, BA, CMT

Permalink Reply by Michael Spackman on August 27, 2009 at 7:08pm

Thanks Cheryl for your words of wisdom! I know therapists that are billing for MV claims but you are the first therapist that I've heard from that is successful at WC and PI. I purchased the book Hands Healing by Diana L. Thompson about 7 months back. She also gave the same recommendation and gave forms to help with the billing process. I haven't ventured into the WC and PI yet but the more I feel confident about the billing industry and all it's subtle rules the more I'll accept the other insurance.

Smiles!

Permalink Reply by Jody C. Hutchinson on September 1, 2009 at 10:00am

Micheal,
Greetings. I have billed insurance for many years, I started with a few Workers Compensation and then Personal Injury cases. After buying books, asking lots of questions, buying software, and some trial and error- I found how to make it work. The state took away the Workers Comp. in 2004-2005. Done. Since then I've focused on my cash biz and have done a few PI cases. The last was a lien that took 18 months. I only take one of these per year. I've been paid 100% of all the insurance cases I've worked-even had to file Small Claims, liens, writs on salary,etc. I was a paralegal, so I can find out how to collect, being determined helps too. I don't think insurance billing is easy and it takes patience and follow-through. Not every MT can do this. I know that most Private Health insurance won't pay for massage. I am more comfortable with a cash practice, I'm a paid at the time for the work I do and the clients are more committed.
My biggest peeve with insurance is that it creates entitled clients who don't have any "skin in the game." They will no-show, not do home self-care, etc. It makes their healing difficult. Be warned.
Cheers,
jh

Permalink Reply by Crystal Dawn Suovanen on November 22, 2009 at 2:03am

At the Holistic Center I work at our insurance clients usually have a doctor's prescription, pay in full at the time of service, get a receipt from us and their insurance company reimburses them. The owner has found that it's hard to collect on insurance claims and this way of doing it we don't work directly with the insurance companies.

Permalink Reply by silvana marroche on January 4, 2010 at 9:44am

Michael!
Hi! I am a massage student-still :) but have been i the medical field since 1990! From managing a practice to doing billing and collections. I do billing NOW, for a lab and YES it is always a nightmare! :) but its a positive and great thing that MT's can bill insurances tho. Do you get the doctors referrals? is that how you bill? do you bill on your own or under a Chiropractor?
just wondering :)
thanks!
xo
Silvana

Permalink Reply by Michael Spackman on January 4, 2010 at 1:20pm

I bill the insurance companies directly. I've heard from others that working with companies directly is risky because they can decline to pay or give partial payment and some companies like to delay payment. It's also challenging to collect payments from clients especially if the bill is large - the client never added you to their budget since they pay insurance.

My advice is to contact the insurance company before seeing the client. Determine if their insurance covers massage. You will also need a prescription from a doctor.

I would also submit the invoice upon the client's first appointment. If you are going to experience problems with the insurance company, it's better to find out sooner than later.

silvana marroche said:

Michael!
Hi! I am a massage student-still :) but have been i the medical field since 1990! From managing a practice to doing billing and collections. I do billing NOW, for a lab and YES it is always a nightmare! :) but its a positive and great thing that MT's can bill insurances tho. Do you get the doctors referrals? is that how you bill? do you bill on your own or under a Chiropractor?
just wondering :)
thanks!
xo
Silvana