a community of practitioners
If you would like to help me in my cause to stop insurer discrimination against massage therapists for direct reimbursement please let me know.
For the record.
Automobile and Workers' Compensation (Labor and Industry in some states) and other liability cases such as slip and fall including homeowners and business injuries do reimburse massage therapists in every state. (With proper coding and billing procedures).
With that said, just recently a couple of insurance companies have court ordered denials for payment on auto cases to PA massage practitioners. However this will be in their favor when licensing is in hand. The orders basically stated that the claims would not be paid due to the State of PA not having licensure for massage therapists. So as soon as licensing is in hand (and should be soon as their Governor signed the bill) these court orders will be in their favor.
The problem is this:
Most health insurance companies WILL reimburse for massage and/or manual therapy techniques. However, they do not reimburse a licensed or certified massage practitioner. They will only reimburse those who do not do the work, such as a PT, MD or DC.
These providers do not do the work, do not have time to, nor do they want to do the work to say nothing of the fact that they are not trained in the procedures as most massage therapists are. Therefore, insurance companies are paying these providers, to in turn pay a massage therapist.
Does this make sense? They pay higher rates, the patient has to pay higher co-pays on the higher rates and worst of all because of the discrimination, not reimbursing or allowing massage therapists to be "in network providers" these policyholders have to pay higher deductibles, upwards of $2,000, to see out of network providers if the insurance will cover them at all as some do in FL.
Any good fortune in FL is due to the Law enacted by legislators in October 1992, due to strong efforts of the FL State Massage Therapy Association, it's legal counsel and lobbyist. I am very proud to have had a significant part in the introduction and passage of this bill as the Insurance Committee Chair for the Association.
While Washington State therapists can join networks due to their efforts to create positive legislation through, their then Insurance Commissioner Debra Senn, and others, they still cannot be reimbursed by some insurance company policies under Federal Guidelines, which like in FL, supercedes state laws. If these two states with extenuating legislation cannot be reimbursed by some health care plans, how do we expect that therapists in states without any special legislation is going to?
In addition, because their original law was an "Every Category Provider" law, when they won and insurers were required to allow WA therapists to be in, or join, the networks, there was nothing to say how many providers of each category they were required to accept. Therefore it is my understanding from many WA therapists I have spoken to, that most of the networks are closed to new therapists.
We need to tackle it in a different way. I have ideas that I will be sharing in the near future to hopefully make efforts to begin to move us forward. It may take us nowhere but I am a firm believer that if we don't try there is no chance of success. If you might be interested just write me a note to: firstname.lastname@example.org
In the meantime, accept the type of cases that will pay and be sure to do it right, be sure you know the rules, guidelines, laws, coding, paperwork, filing time and other requirements such as legal documentation etc. This is a very rewarding business, both in helping those who need it and could otherwise not afford it, and from the extra income standpoint. I am speaking from having been there, and from 20 years of helping other massage therapists reach their goals.
I know because they write or call and tell me so or tell it in my seminars they take to continue to keep up on all the latest changes and to stay refreshed.
May your future be bright and those you help be even brighter!!!
Vivian, I appreciate your valued work about this situation. I have been affected from this kind of discrimination and has been very frustrating. I live in Florida and it still very complicated to get reimbursed by insurance companies, they just want to pay directly to PT's, Chiro's and doctors.
I would love to know your ideas and anything I can help with just let me know, it would be my pleasure to be part of this great cause.
Great article Vivian. I personally do not handle insurance work as I am already quite busy. But I do know those that do and want to and I am so glad you are standing up for them. You are such a credit to this profession. Thank you for what you do for all of us!
Thank you Vivian for sharing all this excellant information, and your willingness to help us all.
Wow, it is encouraging to get emails like this, also frustrating to hear that so many in WA have had the same complaints
I think maybe it would behoove a lot of WA LMP's get together or with your State Association if you have one or AMTA WA and make an appointment with someone at the Dept of Insurance and all file the complaint at the same time. Maybe their Consumer Division if possible. I would approach it from the policyholder's view (get prospective patient's on the bandwagon from the stand point that they are unable to receive medically necessary treatment when prescribed by their physicians.
Will this work? I am not sure, but one thing I have always been sure of, if it is not tried, one will never know and nothing gets done. IF it does not work, at least you all would have some input of what may be your necessary next step. But it has to be done in numbers or at least with a leader in that assoc that KNOWS enough about insurance to help make a difference, like Diana Thompson.
I would like to see some in roads with that because it is my guess, IF the non discrimination portion of the health care reform is not destroyed, eliminated etc, the insurance companies, while not discriminating, will do what they have been doing in WA and other states with many providers. Saying,ok, we don't discriminate, we let you all in, but only a few and then close the gates.
Thanks so much for writing!! Please provide me with your name as all I see here is your company name. Thanks!