Taking clients with medical insurance and filing medical insurance claims with the company for payment can be great for your practice if you would like to increase the number of clients you see.

More and more policies are now covering medical massage therapy. Always call the health insurance company prior to treatment to see if the policy covers this and what the criteria for payment are.

Before beginning treatment, make sure that you ask your client if this was an accidental injury. If so, it may be covered by auto insurance, Worker's Compensation, or a miscellaneous accident policy. If this is the case, the client's health insurance may not be responsible for any of the payment.

Physicians are starting to refer patients to massage therapists for lengthy medical massage treatments as this frees busy physicians to see more patients. A lot of medical insurance policies provide coverage for medical massage if the client was referred by a physician.

Chiropractors and physical therapists are hiring massage therapists to work in their offices. Usually, they will bill or file medical insurance for the massage therapist in these cases. This will cut down on your paperwork as a massage therapist since you won't be filing medical insurance claims for your clients.

Be sure that you are documenting the client charts as your records can be
subpoenaed by attorneys if there is a court case is involved.

Never release records to anyone without obtaining a signed release form from the client. Do not send original documents from client charts. Send photocopies.

When getting ready to send claims in, the address to send the claims to should be on the insurance card. If not, ask the insurance representative while you are on the phone getting coverage information.

Again, to see if medical insurance covers your services, call the insurance company and check the plan involved. The insurance company will also let you know if there is a deductible or copay. They will state to you that what they tell you is not a guarantee of benefits. Always mention this to the client so the client will understand that he/she is responsible for payment not covered by the health insurance.

One other important note about filing medical insurance claims, if you are a network provider, realize that you will not be reimbursed for your entire fee. You will be paid the network reimbursement amount and you cannot charge the balance to the client as part of the agreement when you sign up to be a part of the network. If you are a non-network provider, then you can bill the balance to the client.

Massage insurance billing is not as lucrative as you may think. Most insurance companies cut the fee you bill as a massage therapist either to a UCR (Usual and Customary Rate) for the area in which you bill, or they pay you a rate established by a PPO (Preferred Provider Organization) or an HMO (Health Maintenance Organization.)

Most insurance companies offer PPO or HMO coverage so you are going to earn a lot less money than if you have cash clients.

I started in the health insurance industry back in 1981 as a clerk. I pulled paper files each time a medical claim came in for a client. I took the file to the insurance processor who paid the claim and then I put the file back on the shelf.

After eight months of doing this, my supervisor promoted me to become a medical claims processor. After two months of training, I began to pay medical claims. I learned all sorts of tips and tricks. I learned that my main job was to save the health insurance company money. Those who found billing errors, suspicious looking claims that could be fraudulent, and ways to make payouts smaller got rewarded.

I paid claims for four years and then was promoted to a Cost Savings Department within my company where I was taught to cut surgical and other fees even more. Processors would refer claims to me that they thought were too expensive and I would look up UCR data and tell the processors how much to allow for a particular claim.

Fast forward 20 years. Now with the PPO and HMO companies, most insurance companies just apply the fees given by the particular PPO or HMO to which the client belongs. It is usually built in to the computer system so the computer automatically cuts the fee and sends the provider of services a tiny check.

EXAMPLE: Let's say that you submit a medical massage claim for $100 for one hour of medical massage for an injured back. This particular client belongs to XYZ PPO through ABC insurance company. ABC receives your claim, enters it into their computer system, hits the enter key, and XYZ says the rate for the CPT code you used on the massage insurance billing is $15. The computer cuts the fee to $15, which they send to you. The other $85 cannot be billed to the client per the contract you signed with XYZ PPO when you became one of their covered providers.

So, you took time to make a copy of the client's health insurance card, called the customer service number listed on the card, waited for 10 minutes on hold for a customer service rep to answer the phone so you could ask if the client has coverage, performed one hour of medical massage on your client's back, documented the client file, chose the appropriate CPT code for the service you performed, typed out all of the blanks on the HCFA 1500 which is the massage insurance billing form, mailed it in to the insurance company, and waited for about four to six weeks just to receive a check for $15.

That is a lot of time and energy for $15, don't you agree? This is why so many massage therapists prefer cash from clients instead of trying to collect fees from insurance companies.

I would like to say that the above payment of $15 is just an example and your payment may be more than $15 depending on the services you performed, the networks you belong to, and the geographical location where your office is.

Some insurance plans allow you to collect a small copay from your client at the time of service in addition to the massage insurance billing compensation that they send you. This is usually between $10 and $25 so you are still not getting the amount of money you need to successfully run your practice.

Think long and hard before you agree to accept medical insurance. Read the contracts in full before you sign.

In some policies of health insurance massage therapy may not be a covered benefit. Some policies consider any type of bodywork to be for relaxation and not medically necessary and, therefore, not a covered benefit.

Some policies will allow coverage under certain conditions such as medical massage for an injury or pain. There must be a valid medical diagnosis (ICD-9) code and a valid CPT (current procedural terminology) code on the bill.

Many plans will also require a referral from a physician. HMO's require a referral from the patient's PCP (primary care physician). Some require that the therapist be a part of their network of covered providers.

Still other plans will not cover a massage therapist unless the therapist works in the same office as and under the supervision of a covered physician. Other plans do not recognize massage therapists as a covered provider of service no matter where they practice.

Some plans will want a copy of a prescription from a medical doctor stating the diagnosis, the specific types of treatment to be done, the frequency of treatments, and the length of time for the treatments or there is no coverage.

Explore each type of insurance policy--both your clients' and your own to see if coverage is available.

I know a great deal about health insurance coverage as I have been in the health insurance business, dealing with the processing of medical claims since 1981. I have worked for six different insurance companies over the years and they all work in much the same way.

As a massage therapist, you must become a covered network insurance provider under some medical policies, such as PPO or HMO plans, in order to be reimbursed by a client's medical plan. Some plans do not recognize massage therapists as covered healthcare providers but others do.

To do this, you will need to contact each health insurance company as new clients who are part of these networks come to you for treatment.  Apply to join the various networks in your area.  If you live in the city, there could be many different networks. 

Since each health insurance company has many policies with many different clients, it is important for you to check on each client's coverage and whether or not you will be considered as a covered network provider.  This is time consuming and can be quite confusing, but it is good to know prior to starting treatment on a new client.

If you are not considered covered, some plans will pay a lesser amount and some plans will not pay anything to a non-network provider.  Always call the insurance company and get the benefits.  Remember that your call does not constitute guarantee of payment.  The insurance company will tell you this during your call.

Be sure and let the client know what the insurance company tells you.  If you are a non-network provider, tell the client that he or she is responsible for payment to you since you are not covered by the insurance company. 

You may decide that it is not worth your time for the money you will be paid by the insurance company.  A network provider must accept a discounted amount for services rendered and the provider cannot bill the client for the balance due.  It must be written off.