The Long & Short of Insurance Coverage
One of the most common questions I get is “do you take insurance?” The answer is “yes to PIP, or auto insurance” and “no to private insurance.”
However, many clients submit their visits to their insurance company themselves. Insurance typically reimburse on some level. I know at least one client who was reimbursed in full. I email the clients a statement of their visits, with treatment codes and information that insurance companies require for processing. Reimbursement will fall under the “out of network provider” category, since I am not credentialed with private insurance companies.
Regardless of the value an insurance company reimburses for a visit, the cost does go toward lowering your deductible. And I do take HSA Cards (Health Savings Account).
In Washington State, the average private insurance company reimbursement for a massage therapist is about $60. That includes any co-pay on your part. I’ve been practicing 23 years and that reimbursement rate hasn’t changed much in that time. That means for a 60-minute massage, I get reimbursed 60% if I charge $100 for a massage session. That does not include the administrative costs.
As a practitioner, if I do take insurance, first I take a copy of your insurance information. Next I call your insurance company to ensure you have massage therapy benefits. As we all know, this can take many minutes, up to an hour. And since COVID, waiting longer for most services is becoming the standard. Next I fill out a CMS-1500 form with all the pertinent information. If I have all the information, this can take 20 - 30 minutes. Once submitted, I will need to follow-up to see that this went through correctly and if yes, payment will arrive on average, four weeks following the actual session. If not, then I will need to put in more time.
In a nutshell, if I receive 60% reimbursement for an hour of massage service, minus an additional hour of administrative time, well, you do the math. Suddenly it’s challenging to make a living.
I would love to be apart of the health care system in Washington State. I believe that everyone should have access to massage therapy. Many physicians are beginning to recognize that massage therapy is an essential piece of managed health care. I look forward to being part of a larger team, but that will take some essential changes in our current health care system and insurance reimbursement.
Most recently: there is current legislation requiring health carriers to provide annual cost of living adjustments. HB 1655* passed out of the House Health Care and Wellness Committee on 1/31/24. The bill must also pass out of the Appropriations Committee by Monday 2/5/24 in order to keep the bill alive.