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Massage Today
June, 2001, Vol. 01, Issue 06

We Get Letters & E-Mail

By Editorial Staff

Editor's note: The first two letters reference "When Massage Meets Managed Care," from the February 2001 issue of MT. The article can also be viewed on line at

"I don't agree with pushing these managed care plans"

Dear Editor:

I really enjoyed your article in the February issue of Massage Today regarding massage therapy and insurance/managed care.

I am a licensed massage therapist and have been practicing for 10 years. I have always been in a clinical environment, and I think it is a huge mistake for massage therapists to join these insurance plans.

Insurance is very destructive in a lot of cases. The insurance companies control the provider and the insured. They dictate the type of care people can receive and also dictate how much the provider receives for providing these services.

I think managed care will devalue the massage profession. If people truly understand the benefits of massage therapy, they will pay for it. Those who will only come if their insurance will pay are usually not interested in getting better or overcoming any type of problem, and they will drain you in numerous ways.

Why are we pushing this so strongly? I truly do not understand the mentality of the therapist who would want to join managed care. I have a very strong practice - completely booked with standing appointments (seeing 30 people per week); a waiting list; and all cash-paying clients.

I know there may be differences in the type of practice and type of clients other massage therapists have, but I still think we shouldn't be pushing these managed care plans. We should be able to have thriving practices simply by educating people and putting the appropriate value on the work we provide.

Lisa E. Kirk, LMT
Morristown, Tennessee

"It's the game we should be preparing to play"

Dear Editor:

I received your February issue, and I have to say that your article on health insurance plans is right on track. What you have failed to mention is how the insurance game is typically played today by those already accepted into the "system." Inflated prices are commonplace in medicine, directly because of (in my opinion) these "modest discounts." And at one point I'm sure that they were just that: modest discounts. Doctors charged a fair price for their services, and people paid the doctor directly. Then came the third-party payor system and the progression of policy to what we see today. According to their tables (which are based on inflated prices), a 25% discount is modest. It is their world with their own benchmarks and standards. Doctors are forced to increase their rates disproportionately to get the insurance company to eventually pay a little more. We can see the evidence of this in the inflation rate of health care costs which are growing at 200% that of inflation (according to my memory from past news spots). It is commonplace for doctors to bill $300 and get paid $50 by insurance, while those paying cash get stuck with the whole bill.

It is clear that medical costs in general have become grossly distorted. However, we as massage therapists have not yet played the game of insurance long enough to become equally inflated. However, we have played the game of what the competitive market will bear, in which there is no room for grossly inflated prices. In order to survive financially and play their game, we too will have to become inflated in price to absorb the cost of discounting services. If we do play, we will become dependent upon the system, because no one outside of our contracts with the insurance company will be able to afford us. Moreover, the discretion of the therapist to appropriately treat the client will automatically be limited to what the prescribing physician orders and the insurance approves. For example, a physician writes a script for "massage" therapy for a patient's low back pain, and insurance approves the treatment for x # of sessions. Those who know little or nothing about holistic therapies will limit your ability to treat beyond the region specified (L1-L5). If you do treat beyond what was prescribed, your services will not be reimbursable if they "catch you committing fraud," and you will also have to contend with the potential legal consequences. It's precisely the same string that doctors complain of regarding HMO's -- the practitioner with the knowledge and skill isn't allowed to decide what is best for the patient.

There is another option, one that is becoming a major trend among many physicians: cash-based practices. Medical practices are firing billing departments, (on average it takes two full-time staff to handle insurance billing for every physician) cutting prices to fair/competitive levels, and going to cash payment for services rendered. In turn, the doctor provides patients (now customers) with a form detailing their diagnosis code, treatment codes, necessary physician information, and the amount paid by the patient. If patients desire to be reimbursed by insurance, they submit their claims to their insurance carrier and the carrier reimburses them directly. This is the type of game we can play where everyone wins, and it's the game we should be preparing to play as an industry.

Peter C. Kassner, ND, LMT
Tuscaloosa, Alabama

"I don't ever want to take insurance payments..."

Dear Editor:

I am a certified massage therapist in Virginia and just read the second issue of Massage Today. I agree with your article about "Massage and Medicine." (See the front page of the February issue, or access the article on line at I had the option to participate in the networking program (access) and decided not to participate.

I am having trouble understanding why any massage therapist would participate. The only benefit a massage therapist gets is "possible" referrals. I am a business owner and started my business 1 1/2 years ago. The business has grown and continues to grow. I advertise some, but most of my new clients come from referrals, from other clients (word-of-mouth). With some hard work and patience, the referrals come and I don't have to take a cut in pay.

As a business owner, I can decide at any time who to give a discount or coupon to, for whatever reason. I would never agree to giving too many discounts, because I have monthly business expenses (office rent, phone, laundry, supplies, self employment taxes, etc.). I also earn my living solely on the profit of the business, so I cannot afford to give to many discounts. I opened my own business because I wanted to be the decision maker and not dictated to about policy and procedure.

I am also worried about HMO payments with the set price of $45 per hour (because that's the set price that all participating MTs have agreed to). Massage therapists participating in this sort of arrangement will never be able to get raises as they desire.

I only charged $45 per hour during my first year, but have since raised the price to $50 per hour. I will always try to keep my prices affordable for my clients. I pay out-of-pocket for my chiropractic care and at times, massages. I think enough about my health that I don't mind paying out of pocket for alternative health services. I don't expect any more from my clients than I expect from myself.

I don't ever want to take insurance payments because that will come with all kinds of problems (treatment dictation, three-month wait for reimbursement, etc.). I work extremely hard at my business. It's more than just doing massages. It's cleaning the office; washing the sheets; client chart paperwork; self-employment and tax paperwork; designing and printing my own brochures; newsletters; advertising; mailing birthday cards and newsletters to clients; etc.

I realize that $50 per massage sounds like a lot of money, but after my expenses and the time that I actually invest, I'm lucky if I'm making $12 per hour. I work too hard to make any less.

So honestly, what is the reason that MTs would participate in the networking program? Why not go out and get your own referrals, and charge what you think is fair to your clients?

Susan Cumpian, CMT
King William, Virginia

Reward Wellness, Not Sickness

Dear Editor:

I read your article in Massage Today concerning "Massage and Medicine. I was very taken with the article. As a massage therapist, I have many clients ask me if I take insurance. My reply is always, "No!" for the simple fact that I do not want to be dictated to. I work for myself on purpose. This way I have control over my business in its entirety. I know that Blue Cross and Blue Shield are involved in the alternatives now. Many organizations have approached me about belonging to their group. The reason I say "No" is because they want to tell me how to run my business concerning their clients, as you so aptly stated in your article.

I am 52 years old and have been practicing for 5 1/2 years. My practice is doing very well and I am grateful to all of my clients. If they choose to submit their time with me to their insurance carrier, I will give them a receipt for that purpose. This is as far as I am willing to go. People need to be responsible for their own health. Insurance carriers should be reimbursing clients for their wellness, not the other way around. It is just a matter of time before insurance companies reward people for maintaining wellness instead of rewarding them for sickness.

Cory Thurston
Sugar Hill, New Hampshire


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