Is Primary Spine Care the Answer for Chiropractic?
Recently, we sat down with Mark Studin, DC, FASBE(C), DAAPM, DAAMLP, to discuss the state of chiropractic and why primary spine care may hold the key to chiropractic's future. Read what he had to share in this exclusive interview.
Dropping Insurance: 4 Steps
My office manager just got off the phone with the secretary of a long-standing patient. I have treated this woman and 10 members of her family for more than a decade. She has, as have all of my patients, paid my fee at the time of service since I dropped insurance in 1997.
Better With Chiropractic
While chiropractic care is receiving high levels of exposure these days, most pain patients who consult with a health provider still do so with their primary-care MD. And of course, that means in most cases, they're receiving standard medical care, not chiropractic.
Spring Allergies & The Spleen: Looking at Pattern Differentiation
As the season of Spring fades away and we shift into the warm summer months, many patients suffer from chronic allergies. This is by far one of the most common issues I see in the clinic as well as often mistreated and misdiagnosed.
Regenerative Medicine: How to Do It by the Books
The "lay of the land" for regenerative therapies, including but certainly not limited to adult stem-cell treatments, seems to change almost daily.
Missed Causes of LBP: It's the Syndrome, Not the Subluxation
When I read the chart notes of other chiropractors, I am usually disappointed. They list what vertebrae are fixated or misaligned. They may describe the involved fascia and muscles.
Old Trend, New Risks: Heavy Weight Training
With more opportunities to exercise than ever, a greater selection of exercise options, and the subsequent opinions supporting and challenging their merits, it's easy to be confused as to which approach is best.
State by State: Chiropractic Leads Changes in Health Care
Monumental legislative bills in support of the chiropractic profession were passed recently in Washington, West Virginia and Oregon. Here is a review of this important legislation, state by state...
New Opportunities for DCs
For decades, the model chiropractic practice has been the single-doctor practice. Recent surveys have found that approximately two-thirds of U.S. doctors of chiropractic still practice this way, with another 20 percent practicing in multiple-chiropractor practices.
Transforming Exam Delivery
The NBCE Board of Directors has never wavered on its promise to deliver an excellent, on-campus computerized testing experience to students. Likewise, there has never been a compromise to the delivery of fair, valid and legally defensible exams.
Cyber Threat Checklist: Defend Your Business With These 10 Steps
Living in an internet connected society brings many conveniences and benefits. The power of the internet to connect us with customers, store data, and find information has opened the door for many small business owners to grow and flourish.
Diagnosing & Treating Aggressive Energy
Recently, there has been an article, and subsequent discussion, about the subject of Aggressive Energy (AKA "AE"), including ways to detect its presence and an alternative method of treating it.
First World Spine Care Graduate: Hildah Molate
Hildah Molate, the first World Spine Care (WSC) scholarship student, graduated from Palmer College of Chiropractic earlier this year and is now working at the WSC community spine clinic in Shoshong, Botswana.
Practice Pearls: There's More to ROM Than Meets the Eye
As part of my neuromusculoskeletal examination, I perform range-of-motion (ROM) evaluations. I can "eyeball" the range and measure, I can use a goniometer and measure, I can use my phone app and measure, or I can use various other instruments to help determine degrees of motion.
News in Brief
Parker University Launches New Open-Access Research Journal for Chiropractic; Western States, Cleveland-KC Name New Deans of Chiropractic Colleges; Sherman College Goes Tobacco-Free; Life University Wins 11 Awards.
Paving the Way to Integrative Health & Wellness
Jared Polis (D-Colorado) and Mike Coffman (R-Colorado) launched the integrative health and wellness (IHW) caucus in October, 2018.
Bastyr University: On the Front Lines of the Pain Epidemic
At University of Washington's Harborview Medical Center, the Seattle region's only Level I Trauma and Burn Center, the demands for in-patient care are dramatically different from a private clinic environment.
Chiropractic's Next Frontier: Adjusting the Microbiome
Restoring a healthy microbiome to help treat disease may be the next frontier in chiropractic offices around the country.
Prompting Memory: How to Stimulate Cognition
Recently I gave a talk titled, The Art of Memoir – Tapping the Past to Sharpen the Present at a senior lunch event in Austin, Texas.
Official NCCAOM Practice Tests
The National Certification Commission for Acupuncture and Oriental Medicine (NCCAOM) is excited to announce the launch of the new NCCAOM Exam Preparation Center.
The Acupuncturist and the Opioid Crisis: Conquering Pain & Addiction in the U.S.
The current opioid epidemic dominates the discussion among national health leaders, recovery advocates and families nationwide. Opioids include heroin as well as prescription pain relievers such as oxycodone, hydrocodone, codeine, morphine, fentanyl, and others.
Acupuncture's Standard of Care
Both a concern and critique of acupuncture, frequently espoused by the bio-medical community is, "there is no standard of care in acupuncture." The following is why I believe this statement is disingenuous at best.
Multi-Dimensional Acupuncture: 3D, 4D & 5D
Maggie is an intuitive healer and workshop leader who I met on a recent hike. While we were talking she told me how she had to take it easy because of her knees. She said that her doctor told her that she has the early signs of arthritis.
NBCE to Reinstitute Computer-Based Exams
The National Board of Chiropractic Examiners (NBCE) has announced it will reinstate computer-based testing in January 2019 courtesy of a partnership with testing and assessment solutions provider Prometric.
A Novel Way to Prevent Elderly Falls: Toe Strength
In any given year, nearly 40 percent of senior citizens ages 70 and older will fall at least once. Each fall significantly increases the risk of not only sprains, strains and contusions, but also fractures.
Catch the Workplace Wellness Wave
Do you offer workplace wellness services to local businesses? If not, you might want to consider this lucrative channel for expanding your practice. Workplace wellness programs and wellness-related benefits have grown in popularity over the past several decades.
Prevention: Stop Recurrent Urinary Tract Infections
The recurrent urinary tract infection (UTI) is one of those nuisance conditions that can play havoc with quality of life, and this particular infection is much more common than most people realize.
TCM Codes for the World
I just received an email concerning the ICD-TM11 codes. The World Health Organization (WHO) will be presenting the new ICD-11 codes to World Health Assembly very soon.
Reducing Allostatic Load & Stress Through Heightened Awareness
Your contemporary mental health and psychotherapy colleagues may often approach the treatment of allostatic load as a mental health condition and use prescription psycho-pharmaceutical medicine to affect general and specific central nervous system (CNS) pathways and brain neuro-chemistry medicine to alleviate the associated symptoms.
It's Time for a Functional Approach to Chronic Illness
It seems one of the more modern buzzwords is chronic, referring to diseases – that is to say, "ongoing and incurable." However, we can take a different perspective and recognize that, although the body may have been traumatized and injured, healing should always be viewed in the realm of possibility.
Poll Results for the following Question:
What percentage of your practice consists of cash-paying patients not covered by insurance?
Total Respondents: 550
Note: These comments are reproduced as written by visitors
to this Web site.
More than 75% I do not know what fees for what services can be charged. Can someone help me?
More than 75% As I'm in the UK all my patients are cash paying. Massage therapy is not covered by the insurance companies
More than 75% HERE IN ALABAMA, NOT ALL MASSAGE THERAPISTS ARE NEGATIVE INDIVIDUALS. LIKE THERAPISTS IN THE REST OF THE COUNTRY WE ARE TRYING TO DO THE BEST WORK WE CAN. OUR STATE BOARD LIKE ALOT OF OTHERS IS VERY POLITICAL AND IS DOMINATED BY THE AMTA. INSURANCE COVERAGE FOR MASSAGE WILL BECOME MORE COMMON IN THE FUTURE, FOR NOW WE NEED TO BE PATIENT AND DO THE BEST WORK WE CAN SO PEOPLE WILL DEMAND THAT THEIR INSURANCE WILL COVER IT.
More than 75% In Alabama a stand alone massage therapy establishment is for the most part not recognized by the major insurance providers. Workers Comp and auto insurance companies will pay with pre-authorization provided the physician has required massage as part of the overall treatment program. The MD's need to make sure they list 1. Why massage is being prescribed 2. How many treatments and how often 3. Duration of treatment (1 hour) etc. It is also better if the Patient actualy submits the claim themself; they are much more likely to receive full compensation; insurance providers often try to discount a therapists services. Of interest is that in Alabama massage therapist are not providing "treatment", because "treating" is outside of their scope of practise. Sigh.
More than 75% NON-LISCENSED STATE OF INDIANA
More than 75% after a low back and spine injury and then blood clots i am permanently disabled.compensation wont pay for anything for me.Not even the doctors bill.I lost my insurance i paid for through my employer 9 months into injry.So when i get sick i have to suffer more because i dont have the income to pay for it .
More than 75% I'm 100% cash now, but that is only after doing insurance for several years. Being an insurance provider was great for me because I got to work on tons of people and form some very strong relationships with other healthcare practitioners. Fortunately, it got to point where I no longer had to do insurance work and I am now able to devote more time to patient care.
More than 75% Actually 100% of my practice. Who in there right minds wants to deal with Insurance. Dentist were smart to not embrace the Insurance Cartel. Look what insurance companies, HMO's and PPO's did to Doctors and Physical Therapist. They make a fraction of what they did 10 to 20 years ago.
More than 75% I am licensed in the state of RI moving to arizona in the next two years....was trying to find out what the licensure laws were so that I could apply and was surprised to see that arizona does not license massage therapists I have been a massage therapist for 6 years I have taken one pre-authorized workerscomp which payed very well and in a short time and I accepted two accident cases..one person filed bankruptcy so I lost 2,500 and two years worth a work a good lesson learned I am much happier having my servies payed at the time that I render them...I have been approached by many insurances companies and I prefer not to join....my husband is a doc and I see what insurances have done to him in 20 years its called burn out
More than 75% I am licensed in the state of RI moving to arizona in the next two years....was trying to find out what the licensure laws were so that I could apply and was surprised to see that arizona does not license massage therapists
11-20% I accept insurance from PIP auto only. I am a provider with Sloans Lake and Corvel. I have been very happy with the results, however, the papaerwork is a nightmare. Had to hire a billing service to keep up with it. I charge more for doing rehab type services and Rx'ed Tx. If person is paying out of pocket I give a hefty cash discount. If person wants to save their insurance Co. a few bucks, then I give them the cash discount and a super bill and they pay me at time of service. This keeps the none insured an opportunity to seek therapy and I still get reimbursed well for putting up with the inefficient insurance systems. I also charge about 15% less than the maximum allowed by the current pricing structure of our geopgraphic area set by the insurance companies. If I were to go 100% cash pay, then I'd have to raise my cash price by about $10- $15 in order to cover overhead, but then I could eliminate alot of stress, a billing service and the 5% royalty I pay to SLMC. However, It is a good way to get established because I get many referrals from Doctors I haven't even met, just because I am "in-network" and I can get people in quickly.
Don't really think I want to continue the insurance game forever, especially with new changes proposed here in Colorado, but I am grateful for the linig and opportunity it provides. People who would not otherwise pay for massage themselves can get help from chronic pain and even avoid surgeries, in some cases.
I did personal injury auto claims for about four years with few problems but got out of it because insurance is a racket and is rife with dishonesty and corruption on both sides, in my view. My current fee policy is open donation and I do well.
Michael Wolff, Minneapolis, Minnesota.
0-10% I strongly believe if more clients had access to insurance which covered massage, my practice would be much larger than it is. Many find the cost of massage prohibitive, therefore do not seek the benefits until they are already in a crisis state. If insurance carriers paid even a percentage of the cost for wellness care, clients would more likely seek out preventative services.
More than 75% Ralph Stephens has correctly stated the problem in aligning with the health insurance industry. I will gladly provide a statement of services rendered, but the patient will always pay me upfront. This provides me with full control of what I do and how much I receive for my work.
More than 75% You should also conduct a poll about therapists
providing affordable massage in other ways, i.e.
donations, sliding scale, barter, etc.
More than 75% When will HMOs start covering massage therapy? The benefits can be measured pre and post; the tetimonials alone from patients that can and have avoided more costly surgery should be persuasive to even the most stubborn board of directors.
More than 75% In my fifteen-year career, I accepted ONE auto-accident client for whom I agreed to accept payment from her insurance company.
Under the rules of this insurance company, I agreed to NOT bill the client for any amount unpaid by the insurance company. I lost twenty percent of my income.
My mortgage company would not take 80% of my mortgage payment that month, nor would my car leasing company accept 80% of my car payment that month. Suffice it to say, neither would the electric or gas companies take 80% of the amount due either of them.
I give 100% of my talent to help people for which I expect 100% compensation. I cannot afford to not run my business any other way.
I now require my clients to pay me in full as they receive treatment. At predetermined intervals I fill out the form their insurance company requires, and then the client submits it for re-imbursement.
Everyone is happy!
Do any of the proponents for licensure in the commonwealth of pa understand this simple concept: just because the client's insurance company will accept a massage therapist's invoice for services performed, it doesnt ensure we'll be collecting 100% of that invoice.
Massage therapists can now join the ranks of those few medical professionals who CHEAT on their insurance claim cases by over billing or simply bill for services not performed!
I have not, nor will I, run my business this way!
More than 75% From 1991-1998, 50-60% of my practice involved insurance covered cases. Due to delayed payments, the additional paperwork and litigation complications, I changed my practice to direct payment from clientele. In medically referred cases, I process only those which have been verified by an insurance representative.
31-50% While cash will always be considered the easiest, I have found I enjoy working with Insurance companies. Many of my patients are Personal Injury / Auto Accident cases. The best part of this is that I get to see them once or twice a week for 6 months. This gives me plenty of time to treat, evaluate, and modify customized treatments for them. This constant therapy also helps to alleviate chronic conditions the patient has suffered from for years. Sure, sometimes an insurance company will try to play hard ball and sometimes they win at my expense. However at $100 - $120 per hour for treatments on patients who consistently return week after week on prescriptions that can be 6 months long, I can afford a few losses. These patients really get the chance to enjoy the true nature of what it is that we do, something that is not always understood by a patient who gets in for a couple treatments a year. Plus these patients continue on after the insurance case is closed. They pay cash, refer friends and family, and buy gift certificates. Best of all, it allows me to interact with those who normally might not be able to afford regular treatments. Single mothers, the elderly, and kids... People who sometimes need help they can not afford. Insurance work is not for everyone, but it can be extremely rewarding on so many different levels.
More than 75% It is just too difficult dealing with the insurance hastle. I will provide a recipt to clients if they care to try to submit it to their ins. co. Most insurance companies won't cover massage anyway.
21-30% Unfortunately, many patients/clients simply do not have any Massage Therapy coverage in their benefit plans. Even clients who have been covered in the past, are sometimes subject to benefit revisions that exlude Massage Therapy. For those who do have benefits, it is to our advantage as business owners to have the client pay initially, and subsequently be reimbursed by their insurance company. Often this results in a faster payout to the client, and to the business owner/therapist depending on the type of practice.
Kerri Olds, B.Kin, RMT
Hamilton, Ontario Canada
51-75% Cash is best! Since I work only part time cash is nice although checks are always registered for tax purpose.
I do not do insurance!
21-30% Having worked in Fl under licence and was able to bill with correct doc. we moved to an unlicenced state back then no licencure or certification necessary, working in a dr's office 90% of clients were ins referals, there was a lot of humming and hawing about payment.. some paid, some did not, cases were lost in court no payments, a lot of karma there universal payment gimme cash ...
More than 75% unlike physical therapist who work by doctors prescription for soft tissue mobilization,( massage therapy) we perform overall evaluations and tissue work. most of the highly trained MT's have additional knowledge, inabling them to perform added tasks on the job, giivng th emost therpeutic massage.
These highly trinied individuals should be compnesated from insurance billing for their normal regularly costs plus paperwork involved, n ot by the 1/4 hr as in physical therapy.
Barbara Hernandez PhD
More than 75% Obviously, this is the way to go...no forms to fill out, etc. Some of my clients require a receipt which they turn in to their employers for reimbursement through a Federal Cafeteria Plan.
More than 75% Until we as a group stand fast and demand to be respected as health care professionals, the insurance companies are not going to take us seriously. ACCESS PROGRAMS are degrading to our profession by expecting us to work at a discounted rate. This is really a great deal for the insurance company because it does not cost them anything.
It would be really good if insurance companies would realize that they could save alot of money by paying for massage therapy.
More than 75% When clients have inquired about the possibility of massage being covered by insurance - I pass along my own humble observation - massage promotes wellness and insurance promotes illness. Although some companies do actually advertise that they cover a % of a massage, the response to my inquiries has been that there is actually no reimbursement at all - the therapist simply provides the insurers specified discount - so basically using the profession of massage as a "hook" to attract new business & the therapist takes a loss or raises the rate of their massage to accommodate for the loss - I have actually had clients randomly and without solicitation call to inform me that my prices were less than they would pay for the balance of their insured visit. I have been a massage therapist for almost 20 years and have developed a massage that has blessed me with a healthy practice - at one time personally treating 10-15 clients a day 6-7 days a week, with a month's waiting list. After many years of this rigorous schedule, I began to hire and train other therapists to help me service my clients, who through experiencing successful results of their treatments realized the great benefits of this simple and powerful alternative (or is it the original?) touch. Thank you for this opportunity to express my thoughts and observations, based on facts and years of intense experience. Geri Costanza, Owner and President, the Ivy Tree Massage in Marblehead, Massachusetts. www.ivytree.com
More than 75% My practice is marketed to a sophisticated client who appreciates unique, superior skills massage therapy. Insurance is not necessary nor is it accepted for payment thus eliminating paperwork.
51-75% I generally find that people coming into me under their insurance, generally don't take their treatments as serious as my cash paying clients. They tend to be the first ones to be late, cancel etc. If they are getting treatment due to a MVA, they usually exaggerate their symptoms in hope of getting a big settlement.
I am a provider with Regence Blue Shield and Premera Blue Cross. Although I have more clients due to this, I am also being paid less than my customary fee of $70 per hour. Regence just reduced their allowable fees. I believe that this will be the case - working more and getting paid less. I am also subject to the rules and regulations of the provider organizations. They dictate which codes I can use, what I can treat (if they have a shoulder injury, I have to work only their shoulder -which we all know is not the only problem),how long I can work on a person, how many times I can see a person, etc.
I believe massage therapy as a profession should take healing to the next level and forget about trying to be accepted by the medical profession and insurance companies. Focus should be on the client as a whole - not just is their shoulder "fixed".
More than 75% At the time in my state massage establishments can't bill out insurance, only PI. If you worked in a medical office and the doctor office did the billing and the doctor paid you, this is the only way. So I got tired of chasing the doctor for what he owes me. Doctors greed!!!
51-75% I love doing insurance work, especially with clients who have been in auto accidents. The cases are more demanding, they require more technical skill and empathy on my part, and they are more fulfilling for me as a professional. They also pay me what I feel my work is worth, as opposed to what clients can pay from their disposable income as in relaxation massage.
I have read articles in Massage Today and elsewhere claiming that we should keep our charges low to convince the insurance companies to pay us. I believe that tactic is unwise. It may be a form of "credential envy." Keeping our fees artificially low just encourages insurance companies to treat us as patsies. If we as a profession are to be respected as health care providers, we should be paid as such. The insurance companies should pay us because our treatments are effective, not because we're willing to give them a great deal. I have helped plenty of clients who were not helped (or even injured) by previous PT, chiropractic, or acupuncture treatments. I deserve to be paid well by insurance, and I am.
I have also read that we should not use the Medicare RVU's to determine our fees. I have to ask, why not? If a doctor bills for a service I perform in his/her office, why should the company pay more than if I performed it in my office? It is exactly the same treatment with exactly the same effects. Why should I charge less for a hot pack than my chiropractor does? The equipment and energy costs are identical! When PT's and DC's charge for services that I also perform (e.g. 97140 - Manual Therapy) they base their billing rates on Medicare RVU's. Why shouldn't I? If you say that they have more education, that's not always true. I have more education than a newly minted BSPT, for example, to say nothing of *far more* experience. But the Medicare RVU's do not take education or experience into account. *Everyone who has a specific code within their scope of practice is entitled to bill at the same rate.*
Only a few CPT codes are within my scope of practice as an MT. Other professions use different, more expensive codes. If you know of an MD using the 97124 - Massage Therapy code for treatments they do themselves, I'd like to hear about it! A doctor just can't make it on $35 for a 15 minute treatment. The billing rate is so low that they can't afford to use that code. Besides, doctors don't typically do massage. If they did, they'd almost certainly use a 99xxx office visit code, which pays much more than the 97xxx physical medicine codes we use. Using Medicare RVU's with a reasonable multiplier (145% to 165% is typical, or so I've heard) is not overcharging in my opinion. It's appropriately charging! Just make sure that the specific CPT codes you use are appropriate. If you just graduated from a 500 hour program, you might want to consider whether you actually have the skills and experience necessary to help someone who has a serious medical condition. It might be more appropriate to refer the client to someone who does have those skills.
Billing insurance for an MT is like gambling. You never know when, if, or how much you're going to be paid. It's also a hell of a lot more work than a relaxation massage, even if you do know how to play the game. Sometimes insurance companies irrationally and arbitrarily change your codes or lower your billing rates. Sometimes Med-Pay coverage runs out in the middle of treatment. Sometimes plaintiffs in PI cases lose, and pay you nothing! We don't always get all the money we bill. Therefore, it makes sense to accept the rates the insurance companies are willing to pay.
Donald F. Schiff, BS, LMT.
More than 75% I do some insurance work but the majority of my clients are self-paying. I like doing insurance work. The satifaction of seeing someone get well under my hands is overwhelming sometimes.
More than 75% We have adopted a policy not to accept insurance. Our clients do not seem to object. If they feel that their insurance will cover their massage session we will give them S.O.A.P notes and a receipt to submit to their insurance company for reimbursement.
More than 75% I tried the insurance game and was not happy. Surviving as a sole proprietor is hard enough without having to put time in pursuing insurance folk for payment. The $ value of my sessions was reduced considerably by time lost in dealing with the companies and I am not willing to pay a third party to handle collections.
It is very rare that anyone asks about insurance. If they do, I tell them I will give them a receipt but do not file insurance as most insurance companies do not cover massage therapy. In almost 8 years I have dealt with insurance only twice.
More than 75% My private parctice (Spazultimate, Inc.) is located in the center of East-side Manhattan. Most of my clients are business people who mostly have time for lunch time and afterwork treatment. Since most of their insurances do not cover Alternative Care Medicine, my business tends to get a little shaky at times. Most times I have to turn to "discounts". It does get a little frustrated. They usually want to come in for treatment. Due to the unstable economy, they are not.
31-50% I do more insurance because I work in a chiropractic office which he bills out directly.
More than 75% I specialize in working with pregnant women -- most are referred to me by their Ob/Gyn and given a prescription for treatment -- a few will file with their insurance company and get paid -- but, I guess the rest just don't want to hassel with the insurance company... so they pay cash....
Patti Heimlich, RMT, CLA, CD
More than 75% I would have to get a lawyer to read the fine print upon setting it up. I learned a lesson by taking credit cards which I feel was a bad mistake cause so far this year, as of Nov. 2002, I had only 43 transactions. And the fees and uncalled for.
More than 75% My practice includes patients in the hospital. I do patients who have just had knee or hip surgery 1 day post op, just shoulder/neck arms and hands, also patients who have had bypass surgery, usually the day before they are discharged. The hospital pays me not insurance....yet.
Kate Pfeffer RT CMT