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