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Massage Today
October, 2007, Vol. 07, Issue 10

Tips for Working With Insurance Cases

By Vivian Madison-Mahoney, LMT

Insurance issues continue to confound many massage therapists across the country. I hope this article will help shed some light on the sometimes difficult road traveled when dealing with insurance companies and their endless forms and procedures.

I hope the following nine steps to accepting insurance will be helpful to you.

Nine Simple Steps to Accepting Insurance

  1. Advanced preparation (Have your "tools of the trade" ready).
  2. Patient interview (Be prepared up front for the interview).
  3. Paperwork/signatures (Have files ready, be sure to get signatures).
  4. Authorization/verification of coverage (Contact insurance adjuster).
  5. Treating the patient (Be aware of conditions and statements to document).
  6. Documenting the treatment (Document only what coincides with DX).
  7. Submitting the claims (Certified, return receipt, personal and confidential).
  8. Recording payments and balances due (Contact patient for balance).
  9. Collections, if necessary (Collections should be minimal if done correctly).

If it is not an auto, workers' comp or slip and fall case, then ask the pa-tient to see their policy. If they expect you to accept their insurance for payment, they should comply with your request.

You should always look for exclusions (what does the policy exclude?), inclusions (what does the policy include?), limitations (what does the policy limit?) and loopholes (how can you make it work?).

You should always submit the following with your first claim: 1500 Claim Form; Prescription/Letter of Referral Form; Release of Records (all in one form); Payment Agreement (all in one form); Assignment of Benefits Form (all in one form); Initial Evaluation/History Intake Form; Auto Accident Information Form (if it is auto accident related); Workers' Compensation Information Form (if it's work related); Muscles Involved in Treatment Form (use for first visit and re-evaluation); Disclosure Form for PIP Case if in Florida (must send with first visit).

With additional claims, you should always submit a prescription copy, documentation for each day's visit and the 1500 claim form.

The Importance of Proper Training

With all of this said, I couldn't stress enough the importance of having all of the information, directions, correct forms, correct codes and instructions from A-Z at your fingertips prior to beginning. Even those who have accepted insurance for years are finding they have lost money because they didn't have all of their i's dotted and t's crossed.

It is imperative to have your training if you expect to succeed. Just as you had your training prior to being able to earn a living as a massage therapist, you must have proper training before expecting to earn a living working with medically-oriented cases and accepting insurance for reimbursement.

Unfortunately, we cannot accept all types of cases and expect to be paid at this time. But, if we go about it haphazardly and do not show the insurance companies and medical field that we are proficient in billing just as we need to be with hands-on skills, we will not create the open doors we need to move forward to be accepted in the future for continued billing.

Click here for previous articles by Vivian Madison-Mahoney, LMT.


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