Whiplash Injuries: Massage Therapy & Insurance Billing?

1/17/12

Massage Therapy & Insurance Billing?

Massage Therapy & Insurance Billing?
That's a really loaded question that there is no definitive answer to and I have been looking for one for 20 years as a massage therapist.

From what I have learned it is illegal to bill insurance companies more than your cash clients. You can only charge them a small fee that would cover the amount you would pay someone to do your billing. People will argue differently till they are blue in the face and try to say that they have to wait longer to get paid, they do different techniques, it takes time to chart and bill but no matter how you want to try and rationalize it it is illegal. They will say that doctors do it all the time. The way these two lawyers explained it for AMTA-WA is that saying others do it won't hold up in a court of law.

But do people do it? Yes all the time. I personally do not do anything different as far as treatment of a cash or insurance billing client. You will also run into trouble when a cash client becomes an ins. client and a ins. client becomes a cash client.

You have to set your fees for cash and insurance clients based on what you need to make to make a living and be a profitable business.
The extra time and expenses related to billing should be factored into the fee. People who pay cash will have to pay higher cash rates because of insurance really.

You will probably get 100 different answers from 100 different massage therapists.
Is it appropriate / legal / ethical to bill insurance companies more than cash paying clients?

If you are a massage therapist and bill insurance:
* what do you charge to a cash paying client?
* what do you charge to an insurance company?

How did you determine this? Was it by a percentage? Or just by 'X' dollar amount?

Thanx