Can you take my insurance? Part Two

Navigating insurance can be complicated. Unfortunately, there are several reasons using your insurance might not be an option.

The most common reason I come across is that massage benefits aren’t included in a plan. Blue Cross Blue Shield plans from outside of Washington State often exclude massage completely or it is only covered if done by a medical doctor or chiropractor. Serious let down. What M.D. or chiropractor will take an hour to give you the massage you need? I’ve met a couple of chiropractors who will do quick treatment massage, but only about 15 minutes and it isn’t anything like a “regular” massage. This problem is not limited to just Blue Cross Blue Shield plans, but can affect any other insurance companies plan as well.

As a side note: I actually had a person at Blue Cross Blue Shield tell me that the company plans exclusively don’t include massage at all unless it’s written into a specific plan – and never by a massage therapist (again unless it’s written into a plan). That’s just their policy. Who knows if this is completely accurate. I’ve been misinformed by people at insurance companies before.

The most frustrating complication I’ve run into is this: a client says they have used their massage benefits many times before (usually it’s Blue Cross Blue Shield). I call to check on their insurance and I’m told what I just explained – it’s only covered if done by a chiropractor or M.D. not if performed by a licensed massage therapist/practitioner. Well, here is the super frustrating thing: this happens all over the place because within a certain office, the chiropractor or whomever decides to have the in house massage therapist perform the massage but bill it under his/her name. If this doesn’t sound legal to you, that would be correct. I’m not a lawyer but I believe that this constitutes as  fraud.

This situation is  incredibly irritating to me because I have to be the bearer of bad news to the client who swore up and down they had benefits they could use. Sorry, actually you didn’t – it wasn’t being done legally and it mislead you.

Now I will say that even though it is illegal, I understand why some healthcare practitioners do this. Health insurance companies often don’t make it easy to use preventative, holistic healthcare. So if a practitioner breaks a rule and it benefits the client/patient sometimes the harm is harder to see. I don’t condone this, but I do understand. The harm comes later when they go somewhere else expecting that things will be hunky-dory this time around.

Moral of the story? Let me call your insurance even if you are sure you have massage benefits.

~Melissa

Can I bill your insurance? Maybe, maybe not.

Obviously people want to keep their healthcare as affordable as possible. Often this includes wanting to use health insurance to cover massage therapy. I know how confusing it can be and as such I am always happy to look into it for clarification. Unfortunately, it’s a common occurrence that there is a reason someone can’t use their insurance to come to see me specifically.

One of the biggest reasons I wouldn’t be able to take your insurance is that I can’t take a couple of insurances at all.

Group Health Insurance is one example. Group Health Cooperative stopped allowing contracts for newer massage therapists several years ago, over 10 years ago I’ve heard (and I heard that 7 years ago when I was in school, so who knows). As such there are a lot of us who can’t bill that company. When an insurance decides to do this often the “reason” they give is that there are plenty contracted massage therapists already – they don’t need anymore. My clients and I disagree. The choice just ends up being limited to therapists whom might be booked months in advance or might not even be practicing much anymore (it’s a big deal to stop renewing a contract with an insurance company so many hold onto to it even though they aren’t putting it to use).

The other big insurance that I can’t take right now is Regence Blue Shield. I’ve heard of a way to get on through out-of-network billing but I’ve not figured it out yet. I’m hoping that someday I’ll be able to, as they aren’t a terrible insurance and I’ve heard they are much easier to deal with than Group Health and even Premera. For now though, I cannot bill for that insurance.

Update as of 2/26/2014: Regence now requires preauthorization for all massage therapy.

Important Note:
Even though I can’t take “regular” Group Health, I can do work through plans that offer out-of-network billing, mainly Group Health Options. This is different than regular Group Health plans and causes a lot of confusion. Please ask me if you are unclear what it is you have!

~Melissa