Accept Insurance for Reimbursement: Should I or Shouldn�t I?

By Vivian Madison-Mahoney, LMT
May 29, 2009

Accept Insurance for Reimbursement: Should I or Shouldn�t I?

By Vivian Madison-Mahoney, LMT
May 29, 2009

We often have a tendency to look at only the surface of things. We jump to conclusions and immediately affirm that we don't want to deal with or get involved in whatever the problem is, before we really take the time to analyze the situation.

An example of this is when clients or others ask a therapist if they accept insurance for payment. Therapists immediately answer, "I'm not interested." Then often add either, "I know it won't work," or "I have heard others say it's not worth the hassle." Other statements include, "because there's too much time consumed in phone calls, paperwork, waiting for money, possible losses, preparation time, etc."

Let me ask you three questions:

  1. What would those of you who have insurance do if your doctor or hospital said they did not accept your insurance for those very same reasons?
  2. Did becoming a massage therapist come with any guarantees? No, you received your license and/or certification and then had to find your way forward. And each step forward in your training may have been a bit difficult, because you had not crossed that path yet. Working with insurance is just a process and one more extension of your massage business.
  3. If someone were to tell you there's a good deal of money buried in your yard and all you had to do to get it is to shovel the dirt until you discovered it, would you just leave it there? Or would you do what you had to in order to access the money?

Sounds silly, doesn't it? Not really, the money is there to collect from insurance cases. However, there are necessary steps to take in order to make it happen.

Insurance Acceptance is an Avenue

Insurance acceptance is not about taking insurance or medical cases. Accepting insurance for payment is an avenue to help more people, to increase your income, to open new doors for yourself and your patients, for doctors to refer, and for our profession as a whole. Insurance and medical referrals can be considered a business within your massage therapy business. Accepting insurance cases is not a means to an end. It's just another door to walk through to increase your clientele and income.

I hear those who say that accepting insurance will be the end for us, that we will have to accept insurance fees, if lower. They say we will end up having to do what insurance companies tell us to do. We are now independent and need to always fight for our right to remain independent, as well as working with individuals with or without injury or illness, and of course, to accept or not to accept insurance for reimbursement, if that is what we wish to do. Working with insurance-related patients, we need a physician's prescription, rightfully so in that we are not allowed to diagnose a medical condition. No one will force you to accept insurance for reimbursement - it is a choice you make.

When you decided to become a massage therapist, you did not have all the answers on how to do it, did you? You had to invest your time, you had to invest your dollars, then you had to be willing to learn the ropes, take the proper courses and tests to even get the first sense of direction. There were no guarantees. The same goes for the business end of accepting medical cases and insurance for payment, there are no guarantees, just open-door opportunities when and while they exist.

Accepting Medical Referrals and Insurance Is a Nine-Step Process

Before we go into the nine steps, let me ask you:

  1. Are you tired of working for others?
  2. Do you have any goals?
  3. How much do you want or need to earn?
  4. Are you willing and ready to change things in your practice?
  5. Do you object to others working for you so you could have some free time?
  6. If you or a family member, God forbid, were injured or ill, wouldn't it be nice if you still were able to have an income, whether or not you actually were there to perform the therapy?
  7. Do you want to own your own business and would you like to do what you want, when you want and how you want?
  8. Do you want to be able to work on a patient for the time necessary to make positive changes rather than someone limiting you to a few minutes?
  9. Do you want to help change the industry for our profession?

If you have answered yes to even a few of these questions with the exception of number 5, you might just be ready to learn how to take on a few medically referred patients and to accept insurance for payment from those whose insurance companies will reimburse you directly.

Remember, to bill insurance, you should know the ropes by receiving proper training. Know, too, that medical cases are legal cases and must be prescribed by attending physicians, documented properly and billed accurately; using only codes within your scope of practice. Also, you must charge fees that are ethical, customary and payable.

Know that not all kinds of insurance will reimburse you, not all patients have insurance and not all patient conditions are covered. We still are in the baby stages, taking one step at a time. We still are trying to be accepted and recognized in the insurance industry. To bombard the insurance companies with threatening or disrespectful behavior and brazenly overcharging and over-coding is not how we got this far.

Here are the nine steps to accepting insurance for reimbursement:

  1. Know the types of cases you can and cannot accept.
  2. Be prepared for advanced preparation (forms, files, etc.).
  3. Make sure you are welcoming patients, conducting an intake interview, doing all the necessary paperwork and getting the proper signatures.
  4. Be sure to obtain authorization or verification of coverage.
  5. Be sure to evaluate patients prior to and during treatment.
  6. Document treatment and understand documentation rules.
  7. Prepare and submit all claims and any accompanying documentation.
  8. Record claim submissions, payments and balances due.
  9. Collect how-to's if and when necessary.

Good luck and let me know how the process works for you!