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Massage Today
April, 2001, Vol. 01, Issue 04

We Get Letters & E-Mail

By Editorial Staff


Editor's note: The first two letters address Ralph Stephens' article, "Work More for Less," which appeared in the January 2001 issue of Massage Today.


"My view from here"

Dear Editor,

The following is a letter/email I forwarded to Mr.

Ralph Stephens in response to his article: "Work More for Less." I do not think his article reported fairly on several issues. Here is the letter I submitted:

Dear Mr. Stephens, I just finished reading your article, "Work More for Less," in the January, 2001 edition of Massage Today. I felt I had to write in response to your references to "sickness insurance." I would like to preface "my view from here" by letting you know that in addition to being a licensed massage therapist for five years, I have been a registered nurse for over 10 years. I presently work at both vocations part-time. As a nurse, I serve as a health educator for a large health maintenance organization (HMO), also referred to as a type of managed care organization (MCO). I will admit that there are likely some MCOs that may not be earnest in their practices. I will also agree that "managing care" has a negative connotation in many areas of health care, and that this reputation is sometimes well deserved. However, I believe these are exceptions to the overall goals and functions of MCOs overall. I admit MCOs are not the sole solution to our country's ailing healthcare system, but for now it appears to be the closest thing we have. I would like the opportunity to give you another perspective on these issues.

In your article, you cite that no third-party payers "have any interest in providing benefits to consumers." Additionally, you state, "the most sinister (insurance) is health or medical insurance, which will be more accurately referred to in this article as 'sickness insurance.'" You even go so far as to say that (MCOs) "have no inherent desire for there to be healthy people, because it makes little money for them." I read that portion of your article in disbelief. How can anyone educated in the principles of the provision of health care, who understands the definition of managed care, write such a statement? As I stated above, MCOs are not the perfect solution by any means, but I ask you, how would promoting illness be to the benefit of any health insurance company? Healthy people do not require expensive surgeries or treatments. Healthy people receive recommended preventive care and health screenings that cost little for the company in comparison to hospitalizations and treatment of chronic illnesses. As a matter of fact, managed care organizations were probably the first type of insurer to cover preventive care, including mammography, PAP smears, and physicals. MCOs saw the value of preventing illness and finding problems early.

I have seen firsthand the number of women saved by having their breast cancer diagnosed early by mammograms. Had such procedures not been covered by their "sickness insurance," they might not have received such a diagnosis until it was too late. I have seen patients diagnosed with hypertension, the "silent killer," during physical exams that they never would have received had they been required to pay for them out-of-pocket. "Sickness insurance"? Surely you must have been referring to some other type of health insurance coverage such as indemnity insurance (non-managed care). Unlike indemnity insurance, the company I work for, like most other MCOs, is held accountable for proving that their insured plan participants/members receive the care they should be. Yes, accountable. I would like to refer you to the primary MCO accrediting agency's website, http://www.ncqa.org/, for a "report card" of quality MCOs. Accredited MCOs are graded on their ability to get their participants/members to get preventive health care. Yes, that is right, the actual insurance company is responsible for educating their insured members on health care and preventive services and actually promotes care that costs the company money to provide! I balk at your comment, "The sickness industry and its banker have no inherent desire for there to be healthy people because it makes little money for them." This makes no sense. I admit, at this point in time, massage is not one of the types of care recommended or promoted by most companies. However, I think I can speak on behalf of many that certain types of "conventional medicine" have their place in our health care system.

I do not think that massage can replace health screening services such as blood pressure screenings, PAP smears, or cholesterol screenings. I believe that all readers of Massage Today know the benefits of massage and understand the integral role it can play in all levels of illness prevention, primary through tertiary, but I doubt many will refute there is a place for conventional medicine in health care today. I think that all health care providers need to try to understand one another's role in the health care system. I feel that your negativity and misunderstanding of the system as it exists today fosters dissent and serves to reinforce the views of conventional medicine practitioners that massage is not a valid form of health care. I like the reference to massage as complementary rather than alternative. My thesaurus lists such words as harmonizing, balancing and matching as synonyms for the word complementary. I think each modality or type of care has its place. Until we have a perfect world with compliant patients/clients, a world where everyone cherishes and participates in their health, eats right, exercises, practices relaxation and gets regular massages, who can argue that there is no need for "sickness insurance"? Certainly not me... can you?

In your article, you also reference the fact that, "Health is not a right, it is an individual responsibility... We should support people in taking this responsibility, not keep them in the sickness system. It is best to run away from sickness insurance..." While I agree with you whole-heartedly on the individual responsibility issue, there are always exceptions to every circumstance. I ask you, Mr. Stephens, have you seen firsthand those who have suffered catastrophic health problems through no fault of their own? Before I worked in health education for this MCO, I worked as a case manager, assisting members with their health care issues while helping them to optimally utilize their health care benefits. In this role, I assisted families with babies born with severe congenital anomalies, some so severe that immediate organ transplantation was necessary. Other cases necessitated more conventional medical intervention such as respirators, shunts, feeding tubes or dialysis. I also aided those sustaining severe trauma, from their lengthy hospitalizations, through rehabilitation and the issues of dealing with paralysis. I also assisted those who were seeking to use their health care coverage to provide palliative hospice care in their final dying days. How can you say that "sickness insurance" plays no part in these people's lives? I do not think that the alternative to conventional medicine for many of these people would be massage therapy. Perhaps massage may have been a complementary therapy in many of those instances, but massage as an alternative? As a licensed massage therapist, Mr. Stephens, I should hope you would agree that there are situations in which the therapist must know when to seek assistance in the provision of services.

I realize the focus of your article dealt with your rally for massage therapists to avoid participation in third-party reimbursement and provider networks. I think all therapists should have the right to decide whether or not they get involved with such entities, and do not deserve to be judged so harshly by you should they opt to participate. Your incorrect references to health insurance are misleading to those who are easily influenced and do not have personal experiences and knowledge to draw upon when making their choices. Your comments should have been kept more as a commentarial point-of-view, rather than printed as a scientific article. I will again point out, my comments are strictly based upon my experiences with these matters. I do not claim to be an expert on the issues - I just think it is fair that all sides are equally represented.

Respectfully,

Elizabeth Myers, RN, BSN, LMT, NCBTMB


"I would like to offer my views on insurance billing"

Dear Editor,

I read with interest the recent column by Ralph Stevens titled "Work More For Less." I agree with much he has to say - but I would like to offer my views of insurance billing for massage therapists. I advocate insurance billing, with all of its' attendant woes (getting paid in a timely manner, numerous remittance errors, the Byzantine runaround you often encounter when you call the company with questions). This is why many people already have health insurance policies that convey massage therapy benefits. Most of the people who have those benefits don't even know it, either! They are often shocked and surprised, and very pleased, to find out they have massage therapy benefits.

I encourage anyone who will listen in my community to investigate what their premiums are covering. This has brought hundreds of people to my center to try massage therapy and experience its benefits. It allows me to practice "health care" with people who might otherwise overlook massage therapies as an option. Beyond that, once they come to a holistic center for the first time and see the attentive, caring and professional way in which we work, their entire perception of alternative health care begins to change. They see us as trained and skilled therapists instead of "masseuses" - a word still widely used in the part of the country where I practice - a word that for me conjures up images of a rub-a-dub session in the back room of some casino. They also begin to take a serious interest in the various adjunct healing modalities many of us also practice, such as reflexology, craniosacral therapy, herbology, movement therapies and energy healing. This allows for an enrichment of our health care practices that might not otherwise occur.

In West Virginia alone, one insurance plan covers the highest percentage of the insured population - literally tens of thousands of people in this small rural state. Each person has $1,000 in benefits for massage therapy. They need no medical referral, for we, as licensed massage therapists, are recognized as health care providers on our own merits. Most of these people have stressful jobs in the wide network of the state's public systems, including schools and universities. Why should this secret go unused, unrealized, and undiscovered in a state with one of the lowest health profiles in the nation? I say it should not! Use those benefits, people! It's up to the individual therapist to promote a health care mentality over "sickness care." The way to get out of the sickness system is to change within, and to help others to do so. What better way than with massage therapy? I agree that there is a sickness industry. I prefer to educate and to facilitate health building and wellness - but we have a sick society to move through in order to do that. And massage therapy clearly has a place in the rehabilitation and recuperation process of many illnesses and injuries. Even if the insurance industry disappears completely - or your benefits just run out - these clients are learning how wonderful and effective massage therapy is for wellness, healing, and maintenance of health. They will return; they will refer their family and friends.

Anyone who knows me knows I am the last person to pander to the sickness industry, or to feel I must "gain credibility" from the medical profession. I already have credibility! We are moving through a time of what I hope is great change in cultural perceptions about healing, personal empowerment, illness and responsibility. Massage therapy is a much-loved modality and has been in place for decades. If insurance companies will continue to cover it, let it be a gateway to change.

Mary Finnell, ND, MH, LMT
Director, Center for the Healing Arts
Morgantown, WV


"I was pleased to find that your publication has found a good balance"

Dear Editor,

I recently received a sample copy of your publication Massage Today [January 2001] and finally had the time to read it. I was impressed with several of the articles in it: most notably, Ralph Stephens' "My View From Here" on insurance payments; Keith Eric Grant's "Ramblemuse: Beginnings and Visions"; and John Upledger's "CranialSacrally Speaking: The Magic of Intentioned Touch and Blending." I have been working in the areas of metaphysics and alternative healing for 30 years, and obtained my LMT in Ohio last June. I am currently enrolled in a course on structural therapy in Chicago, to be completed by the end of March.

I was pleased to find that your publication has found a good balance between addressing the practical issues facing massage therapists today and addressing the needs of massage therapists for information, feedback and education about what it means to be a healer in the deepest/widest sense. I have wanted to be a massage therapist for 25 years. I finally have achieved that goal. While I work with many other modalities, including shamanism and spiritual healing, and love to do so, being a massage therapist has brought me a great deal of joy. There is no substitute for the healing touch of another person, and it is needed more than ever in a society that promotes alienation and separation of the mind and body. I am glad to see that your writers address this. As massage therapists, we cannot afford to forget that the act of touching another person with healing intent is the most significant thing we can do.

Thank you,

Bekki Shining Bearheart, LMT


Editor's note: The following two letters address Cliff Korn's article, Massage and Medicine? from the February 2001 issue.


"How do we make the insurance companies understand?"

Dear Editor,

Thank you for your wonderful article (See "Massage and Medicine?" by Cliff Korn, February 2001 issue), and for bringing up some important things to think about. One of the insurance companies recently sent me an application to become a participating massage therapist in their program. I was to fill out this extensive paperwork and provide copies of my credentials, thus giving their members a 25% discount. I choose not to throw this form away and decided to give them a call. I made the call one afternoon between clients and spoke to a very young woman. I asked if she understood what this company was asking for. She answered, "Yes, by becoming a participating member it will increase your business." I proceeded to tell her that unlike physicians, chiropractors, physical therapists, etc., I can only see one person at a time during a one-hour session, and that, in a day, I'm limited physically and time-wise to a specific number of people I can see, and that by participating in this program, I would be losing 25% of my income." Her response was, "But by being in this program, you will increase the number of people you can see."

I tried again to explain it to her: "I have a very full schedule, I cannot see any more people a day than I already do." Her response was, "But in this program you will be reaching thousands of our members." I decided to try another approach. I asked, "How would you like it if your boss came up to you today and said, 'I'm reducing your salary by 25%'?" Her answer was, "I wouldn't mind if I knew I was going to make more by being in this program." Then I made a fatal mistake. I asked her this question: "A 25% cut in your income would not affect you in any way?" She then accused me of trying to discuss her personal business and hung up.

So with this said, how do we make the insurance companies understand we are limited by time and physical ability to the number of people we can see in a day? How do we make them understand that by participating in their programs, we will lose money and eventually go out of business, because of an inability to pay our bills, or because of burnout?

Linda De Gray, LMT
Enfield, Connecticut


"The solution is easy!"

Dear Editor,

I couldn't help but be moved by your last article in Massage Today! My name is Byron Hobson, and I am in the process of opening my own location as a massage therapist. I have been working under a chiropractor for the last two years, and the ability to leave this ruthless situation is upon me. However, I fear the exact dilemma you pose concerning access programs being offered by insurance companies.

As far as I can see, this is a ploy to catch the attention of new consumers at our expense. We need to stand against this. If these companies wish to offer discounts to "their" customers, so be it!! However, they should cover the % they set. We (massage therapists) have not intruded on their ground. These companies are channeling our positive energies into their "world."

We are not in this profession to spend our time battling with insurance games of cat and mouse. Look at the situation that chiropractors now face. Do we want this same fate? We set our rates where they are for a reason. If we continue on the access plan route, we will be forced onto the low rungs of some ladder we have no interest in climbing or even creating.

The solution is easy! We must establish ourselves as a separate entity, outside of this "mainstream" Western disaster we call a healthcare system... illness medicine. For this to happen we need to not give into the temptations of client referrals. Be patient, my friends... build it, and they will come.

My question is this: Is there a way to create our own system built on the true reason we have chosen our professions? The answer is a resounding "Yes"! We must stand together and not allow lower energies to drag down the inspiration and life at such a critical stage in our growth cycle.

Byron Hobson

 

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