Vaccine Injury? The Autism Debate (Part 2)
As suggested in my first article on this topic [August 2018],1 my impression is that the vaccine authoritarians and radicals have not helped to mold a proper social / political environment for addressing the issue of vaccine injury.
An Update From the Acupuncture Now Foundation
Since launching the Acupuncture Now Foundation (ANF), our volunteer leadership has continued to work to achieve our vision of "Creating a World Where the Benefits of Acupuncture are Known and Available to All.
Depression & The Secondary Vessels
As an acupuncturist I see many people suffering from depression. I often think depression is the major imbalance of our culture. I have a patient I've been working with for several years. Her major challenge is chronic stubborn depression.
Multichannel Access: Software for a Better Customer Experience
It is no secret that today's consumer has high expectations when it comes to how and when they can contact a business. In fact, one of the reasons clinic management software has become so popular with acupuncture practitioners is they allows customers to book appointments and make payments online day or night.
UHC Up to Its Old Tricks With Latest Headache Policy
A decade ago, UnitedHealthcare announced changes to its chiropractic services policy that declared manipulative therapy for headache unproven and ineligible for reimbursement.
Time-Saving Tips for Your Practice & Life
Of all the finite resources we possess, perhaps the most valuable one is time. There never seems to be enough time to accomplish everything that must be done, and all too often we sacrifice things in our personal life to meet the demands of our practice.
Support Patients With Multi-Channel Customer Service
It's no secret that today's consumers have high expectations when it comes to how and when they can contact a business. In fact, one of the reasons clinic management software has become so popular is that they allow patients to book appointments and make payments online day or night.
The Origin of Blood
The Roman doctor, Galen, (2nd century AD) did pivotal work to prove that blood, which he thought was produced by the liver, and the cardio vascular system existed. He conceived that the arteries and veins were two separate networks.
The international standardization conference was held this year in Shanghai, China (June) - this was the ninth plenary session. Meetings for technical committees, or working groups also took place at the conference.
That's a Wrap: Compression Bands for Contemporary DCs
Over the past decade, compression bands have been increasingly utilized in trainer and manual therapy offices. I was first introduced to the compression band by Kelley Starrett, author of Becoming a Supple Leopard, and have since been using it as a teaching tool.
Food for Thought: An Examination of Diet & Digestion
Even an acute poison can become an excellent drug if it is properly administered. On the other hand even a drug, if not properly administered, becomes an acute poison. — Charaka Samhita
Bringing Acupuncture to Ohio
The jolt of seeing a woman conscious and talking during surgery left a lasting impression in 1971 when acupuncture was on the national news.
X-Ray: To Be or Not to Be - That Is the Question
For the past year, I have been asked by many practicing chiropractors, college presidents, faculty and others what my opinion is on the "Choosing Wisely" guidelines the American Chiropractic Association (ACA) recently adopted for its members.
The Benefits of Going Paperless
The benefits of going paperless in your practice are profound. If you haven't done it yet, here's why you should.
More Access to Chiropractic Instead of Opioids: H.R. 5722
With the opioid epidemic both an ongoing public health crisis and a hot topic extending well beyond the health care industry, Congress continues stepping up to the plate.
A Historic First for Chiropractic Assistants
The New Jersey State Board of Chiropractic Examiners will begin issuing licenses as early as Nov. 1, 2018 to chiropractic assistants who have undergone a 500-hour training course and passed a competency exam.
Lead Patients to the Fountain (and Foundation) of Youth
We're all seeking the fountain of youth and marketers are capitalizing on it. (Global demand for anti-aging products, treatments and services was valued at 140.3 billion in 2015, according to Zion Market Research.)
Neck Pain: Activation Exercises
In observing patients and studying rehab, I have learned that tight muscles are weak muscles and that stretching is sometimes less effective than muscular activation. There is a delicate balance between joints that move too little and joints that are hypermobile.
Working for Someone Else: Know the Rules of the Game
Many of us decide to become acupuncturists because we are healers at heart and want to focus on treating patients, not because we want to own and operate a business. So we work for someone else, which can have great advantages, especially as a new graduate.
"Don't Crack My Neck": What Do You Do Next?
It's Monday morning and your first new patient of the day, a 35-year-old female, presents with chronic headaches and neck pain. The patient was referred by her primary care provider for evaluation and management without the use of cervical manipulation.
Easy, Inexpensive Tools for a Successful Practice (I Promise)
Successful practitioners are the ones who know how to run a business, first and foremost. I became a licensed acupuncturist in 2006. After having worked in chiropractor's offices for nine years, I opened my own office in 2015: four treatment rooms, a back office and a waiting room.
A New NCCIH Director ... One That Backs Acupuncture
The third time is a charm—the National Center for Complementary and Integrative Health (NCCIH), a division of the National Institutes of Health (NIH), announced it's newest director, Dr. Helene Langevin.
The Science Behind the Efficacy of Cosmetic Acupuncture
The beauty industry continues to boom and grow constantly, from topical creams, lotions and potions all the way to cutting edge cosmetic surgeries.
Travel-to-Treat Coverage Finally Becoming a Reality?
Long-awaited legislation poised to hit the president's desk extends liability insurance coverage from one state to another for DCs and other state-licensed health care professionals who care for athletes / athletic teams that cross state lines.
Chiropractic Management of Patellofemoral Arthralgia
Patient reports with pain in the front part of her right knee, especially during and after her weekly Zumba class. She states there has been no injury of which she is aware. No outward sign of injury is observed.
The Importance of the Scapulohumeral Rhythm
The shoulder has the greatest range of motion of any joint in the body. What is often overlooked in shoulder mechanics is that motion in the shoulder is not purely at the glenohumeral joint.
Possession: Blocks to Healing
Before we can approach treatment of a patient's primary elemental imbalance (AKA "Causative Factor" or "CF"), a number of specific energetic blocks must be considered and, if present, removed in order for treatment to be effective. I cannot emphasize this enough.
It's Time to Reward Yourself
An interesting study recently published in the Journal of the American Heart Association (JAHA) confirms what we all learned when we were children – and serves as food for thought as to how you can improve your practice and your personal life.
Your First Impression Always Deserves a Second Chance
Doctor, have you ever had a patient you just couldn't "warm up to"? You know, the kind of patient who "irks" you, who has a hidden agenda to get something you haven't anticipated, perhaps causing you to want to hide in a closet when they come in for treatment.
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