Changes in insurances

Billing insurance is a continual learning process. I have been lucky in that I haven’t had to deal with too many issues. However, there are some things to keep in mind if you are pursuing using your insurance for massage. As always it fully depends on your insurance company.

  • Regence requires preauthorization for massage (and other physical medicine therapies). This extra step is making me reconsider whether or not I’ll even do out-of-network billing.
  • UnitedHealthcare may require preauthorization – it depends on each situation, plan, etc.
  • Cigna has subsections of insurance plans – those that were always Cigna and those that used to be Great West. There are different provider contact numbers and different types of member numbers. This change may have occurred last year, but it’s this year that I noticed/experienced it.

If you have questions about your insurance please let me know and I’ll help you figure it out!

 

Melissa

Insurance Billing – Part 3 – Insurances Rates

In Part 1 of insurance billing I mentioned a scenario where fictitious LMP, Sally, billed $120 per massage and the insurance only allowed $58 to be paid out by them and the patient. Why is there a discrepancy?

Every insurance company decides what they are going to pay out for each covered service. They set rates for massages, doctors visits, vaccinations, women’s well visits. You name it, they set a rate. Healthcare providers can either contract with them and accept that rate (if they can in fact get on contract) or not accept it. In that case the cost falls to the patient.

It makes sense to protect the patient from super high charges from a healthcare provider or facility that might seek  to take advantage of a situation. However, the unfortunate side is that often the insurance rate doesn’t match even a slightly less expensive cash rate.

So if you are looking at your explanation of benefits and see numbers that don’t match the total charge, it’s because they set a rate and I must abide by it. As always feel free to call or email me and ask me to explain what something means.

Thank you!

 

Massage Gift Certificates for 2013

Per the usual, I have gift certificates available for purchase, in person or online, for this holiday season.

You have until the Friday before Christmas to take a few moments to pick one up if you would like. I will be closed the entire week of Christmas so please plan ahead!

Other than that, have the more awesome holiday season!

Insurance Pages

In the next couple of weeks I’m going to be creating insurance pages specific to the insurances I can bill. On there you will be able to find up to date information about what your insurance will probably, or definitely does, require in order for you to use your massage benefits. As is the typical, things can change at any time, sometimes without me receiving notice. Please make an effort to fully understand your benefits.

Stay tuned!

 

~Melissa

Massage Laws Series

I like to be thorough, very thorough. It makes sense to take extra care when following laws, especially if you have a license you need to keep. Going through massage school we were taught most of the laws that applied directly to massage. The usual stuff, you have to be licensed, call yourself these things specifically, follow local laws, etc. There were a few things that weren’t covered and things change a little every year.

I’m going to create a post series (or page series) talking about the laws that pertain to massage therapists and all healthcare professionals. They will include links to the WACs or RCWs, how I implemented it if it applies to anything I do, and what to look for as a person looking to get a massage.

If you are feeling industrious feel free to read through the Department of Health page for massage therapists. It’s boring and extensive for sure. Until then check here on the blog and look for devoted pages on the website as well.

Thanks!

 

 

Yoga in Bellingham – The Search Begins

I am a huge fan of yoga, I’ve been practicing at home for years. This summer however, I decided that I needed to go to an actual class, in part so I can better know where to send my clients and also for feedback on how I’m doing.

Yup, the couple of classes I’ve tried so far were just as awesome as I had hoped. I’ll be continuing to working my way through the yoga studios in Bellingham in order to have a good idea as to what is out there.

If you have been to a studio in town that you love please leave a comment and let me know so I can try them out! I’m specifically looking for a studio or instructor that is good at adapting to people with physical issues such as old injuries, poor balance and that is pregnancy friendly.

Enjoy the rest of your summer!

Insurance Billing – Part 2 – What the law says

Here comes the boring and confusing part of insurance billing – the law. If you missed my first post read it here. It’s long, but I wanted to be thorough.

In that post I used a story to describe why massage therapists and others often  appear to have different prices for billing insurance versus cash paying clients.

It’s been justified to me in a couple of different ways.

Scenario One – What I learned in school:

If you bill insurance, since it does take more time on the admin side to get things done you can charge for that extra time. So if it takes you 30 minutes for each billing then you can add that price to your massage rate. In my previous post, Sally billed $120 for the massage plus all the admin work.

You can create a pay-at-time-of-service discount or rate for people who pay cash because it doesn’t cost you that extra time to bill or pay someone to bill for you. You have to phrase it correctly though, or it’s illegal. So don’t say different rate, say discount or something similar.

Oh yeah, so when someone calls and asks for your price you have to ask if they are using insurance or not. Then you have to  carefully say that pay-at-time-of service is $65 or whatever your charge is. Also, be careful not to say “cash rate” because that won’t protect your license.

Scenario Two – What I’ve heard since school:

Whatever you do, don’t say you give discounts. There are no discounts, but a slightly less expensive rate for those who pay out of pocket, or ride their bikes, or are seniors, or students(or people with red hair, ha kidding). It should be close enough to the price of your massage that it doesn’t raise eyebrows, but not so cheap as to not reflect what it costs you to bill insurance.

Show a difference in price for medically necessary massage and regular maintenance or general wellness massage(I disagree with this stance). There is a difference in what you do, sometimes anyway.

Don’t post your prices online.

Be very careful what you say to your clients and their insurance companies.

BE CAREFUL! SAY THE PERFECT THING!!

We all try to balance on a tightrope, scared to death that a client will ask their insurance company why there’s a difference, or that an insurance company will find our prices online. It’s stressful and very frustrating.

In an effort to gain some clarity and protect my livelihood more thoroughly, I went to the source – the law. It was clear, kind of, well… Decide for yourself if it’s clear. I’ve made the mistake of thinking things were perfectly  clear and then heard another argument that made perfect sense but had a completely different meaning than what I thought.

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WAC 246-812-390

(2) Submitting to any third-party payor a claim for a service or treatment at a greater or an inflated fee or charge other than the usual fee the licensee charges for that service or treatment when rendered without third-party reimbursement.

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Hmm, so that appears to mean that one can’t charge more. It doesn’t address the claim that charging more because it costs more in time and money is okay. It just says that we can’t charge a “greater or an inflated fee or charge other than the usual”. What is the usual? The cash rate that we can’t call a cash rate? Also, where does it say we can’t offer discounts, call things “cash rates” etc? At the moment all I have are more questions. I’m working my way through laws that apply to massage therapists and I’ll address what I find, what’s clear, what’s not. Perhaps it’s set up to be unclear so that a good lawyer can argue it any which way. If only I built doll houses, I feel like laws would be simpler – though maybe not.

~ Melissa

Insurance Billing Game – Part 1

The Insurance Game:

I know there is a lot of confusion around insurance. Can you can use your benefits? Are there discounts for paying at time of service, sliding scale, etc? This post is actually a lead up to a change I’m making – don’t worry I will still bill insurance, but I want to share with you many of the intricacies of insurance billing, why I was doing it this other way and why I’m changing things now.

Let me be frank. I don’t like billing insurance. I do it so I can work with a wider variety of people, but if I had the choice I would probably drop it all. Work life would be so much more simple. However, at this time in my practice the negatives don’t wholly out weigh the positives.

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Many of us healthcare providers supposedly charge more for insurance. Well that’s not exactly the case. It’s more complicated than that. We bill what it costs us – usually. (Of course there are exceptions.)

The following is an example of the “game” that we healthcare providers all play if we bill on behalf of our clients:

 

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Sally Whoever LMP works with insurance clients and non-insured clients. You may not know it but she charges $120 for a massage. Posted in her office are the cash-based-fees only.  In fact, you only become aware of  the differences when it showed up on your insurance explanation of benefits. The weird thing is the  service is broken down in several ways and doesn’t add up to $120 paid out. Insurance pays a portion and you pay a portion via copay for a total of $58.  However, that leaves unpaid and unexplained $62. You wonder why in the world she charges $120 for an hour massage when they only allow $58 to be paid out. Also why would she charge $120 if the cash service fee is only $65?

It all has to do with what you don’t see:

Insurance Billing Scenario

When you first called to ask about using insurance for massage, Sally confirmed your insurance benefits and then put you on her  schedule. She does this to protect both herself and you the client. That took 10 minutes, including a short hold time.

You come in for your massage which includes about 10 minutes of intake so she can take proper notes and figure out how best to treat you, followed by 60 minutes of table time. You pay your copay($30), reschedule, leave and go home to ice. “Check out time” takes about five minutes.

Later when she has time, Sally sits down to bill for your treatment. She first puts you into her billing system. She’s a sole proprietor and prefers to keep her overhead low so she uses a free clearing house. A clearing house is a company that allows access to online software for billing electronically. They can offer it for free because they get kick-backs from the insurance company. The insurance company gives out those kick-backs because it saves them money since they don’t have to pay someone to do the laboriously job of reading through hand-written HCFAs(bills).

It takes Sally 30 minutes to input you into her system. She has to follow specific protocol for how to input patients to save her time later.  Depending on the insurance company she can submit it electronically or she may have to print it off and mail it. Then she waits…

The next time you come she gets to skip some of the work because you are already in her system. She simply has to  create a visit, then a bill, and sends it off however it needs to go. Usually it’s quicker but it’s common for things to arise to eat up that “extra” time saved.

Two weeks to two months later she gets paid by the insurance company. She gets a $28  check. Your copay covered the other $30 allowed by the insurance company.

Sally spent the following time just on your first appointment and everything she had to do to get paid for that:

  • 10 minutes on the phone with insurance company
  • 75 minutes with you between intake and table time
  • 30 minutes for imput and first billing

Total time: 115 minutes(one hour and 50 minutes)

Total paid: $58

Non-Insurance  Scenario

Then consider the possibility that you are a non-insurance client.

Sally schedules you. You come in, fill out paperwork, have about 10 minutes of intake, 60 minutes table time and five minutes check out time. She charges you $65 for 75 minutes of time with you. No billing, no phone calls to insurance, no inputting of insurance info. No worries.

Total time: 75 minutes

Total paid: $65

The comparison:

Off each massage hourly she makes the following:

Insurance: $30.26/hr

Non-insurance: $52/hr

If you are confused you aren’t alone. The rules are that we are allowed to charge for how much is “costs” us hourly for the massage and other admin time(billing etc), whether or not we are paying ourselves or a billing and/or front desk person. In Sally’s case her time is worth $120 for almost two hours of work (some of that includes taxes). The thing  that gets forgotten by the client is the extra time spent behind the scenes. When I was a patient at a doctor’s office I didn’t understand it either. As health care consumers it’s never explained to us how much more work it actually takes to bill insurances.

Let me break it down a different way.

Sallie allows for $65 per massage. So for the 70-75 minutes spent with you she charges just under a dollar a minute. Fairly standard in the massage world – we are specialists and don’t exist on a normal 8 hour a day work day. Our bodies would fall apart much faster if we tried to do 8 hours of massage in a day.

Sally allots $55 for 45 minutes for billing and the other paperwork that comes with it. While this might sound like a lot you have to consider everything else that might happen:

  • The insurance benefits much be confirmed even if the client decides not to come in
  • Hold times happen – sometimes the billing person or self-employed therapist has to sit on hold which can draw out the time spent on a specific claim/date of service
  • Sometimes they have to check online (which is fine) but sometimes you have to call anyway because massage isn’t written into the plans basic documents.

Insurance is rarely easy to deal with and doesn’t pay well. Soooo, lots of massage therapists don’t take it.

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Let me get back to the whole point of this post. I’m changing the way I do things to better protect myself because of the complications of the law. I’ll be covering that in another post, this one is just too long already. What you need to know is that across the board I will have one charge: $65 for massage that isn’t a specialty service  such as aromatherapy massage. It does not reflect all the work I do for my insurance clients. More transparency in healthcare is beneficial perhaps imperative, so I’m telling you guys what’s going on. Also, I’m just tired of playing a game that’s really just set up to fail me anyway. At the moment, this is the only way I can think of to do business that finally sets my mind at ease. I’ve always known that I don’t get paid for all the work billing insurance requires. Now you guys know. That’s all.

~Melissa

Heat Wave

♪ We’re having a heat wave, a tropical heat wave, the temperature’s rising, it isn’t surprising, I might be dying ♪… kidding!

Hopefully, if it isn’t too late I’ll be getting a window A/C unit soon so we don’t all melt while getting/giving a massage (or I’ll at least get 27 fans to help with air flow). If you don’t mind the heat consider this prime time for hot hydro!

Remember, be heat smart! Drink lots of water, stay out of the mid-day sun, don’t leave your pets in the car and wait to walk the dog until it’s cooled down a bit.

 

 

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