Benefits Of An Alliance

A massage therapist who elects to be a provider for an insurance company, or several companies, can benefit in the following ways:

• Insurance companies provide massage therapists with a base of thousands of clients, at no cost.
• Insurance companies do all the marketing, and are constantly introducing new products and increasing their base of clients that massage therapists have access to, at no cost.
• Insurance companies promote massage therapy through their newsletters and list of all massage providers, their location and telephone numbers in their provider booklet and on their Web site. Again, at no cost. Also, this means that no matter where the client chooses to vacation, they will be able to find a massage therapist in that area.
• Massage therapists receive increased credibility because insurance companies are respected third-party payers. As one of their providers, you get the insurance company’s stamp of approval. Being affiliated with an insurance company publicly demonstrates that you are a credible professional, and ready to take your place among other health professionals. Isn’t this what we are looking for?

Competency And Responsibility

If we are to be accepted as a full partner in the health-care profession, we must be competent and responsible. These are the two qualities the insurance companies and other professions look for in their peers. If we are not competent and responsible, we will not be taken seriously in the health-care profession.

What Insurance Companies Require

When you apply to become a provider for an insurance company, it will want to credential you. The company is seeking information about you and your background that will justify its giving you its stamp of approval. Ultimately, a given firm will only recommend massage therapists who have met the minimum requirements acceptable in our profession.

Insurance companies will want to know what massage school you graduated from, how many hours you completed in the school’s program, if you are licensed, if you are nationally certified, if you have a criminal record, if you have liability insurance, and finally, the location and telephone number of your office. Overall, it is not a difficult process.

Your clients refer their friends because they know you, trust you and understand your background and quality of work. Credentialing is the process in which insurance companies get to know you and trust you. Based on the credentialing information, insurance companies refer their clients to you.

Alternative/Complementary Benefits

Over the past few years, based on subscriber pressure, the pressure of competition and pressure from the general public, most insurance companies have added alternative/complementary benefits to their offerings, massage therapy being just one.

In states where there are mandated benefits, there are generally limits to the frequency of the services used and fees. This is based on the premiums of the insurance policy. Like anything else, the higher the insurance premium, the more benefits you will receive.

There are no free benefits in life. When you receive reduced insurance rates, or increased benefits at no additional cost, someone else will be picking up part of your cost. Conversely, in similar circumstances, you will pick up part of someone else’s cost.

The cost of an insurance policy is based on the size of the group you are in, the age and general health of the people in that group and other actuary statistics. The days of insurance companies paying all charges submitted by providers disappeared decades ago. To look at it from another perspective, if insurance companies take in $100 in premiums, they can’t afford to pay out $110 in benefits. Therefore, they try to balance the group with some people who will most likely not use the benefits with people who will probably use their benefits frequently. They also try to balance one group against the other. The insurance company’s, or any company’s, bottom line is the same as yours: More money must be taken in than goes out.

A second approach that many insurance companies are taking is to offer alternative/complementary programs at no cost to the subscriber. In these cases, massage therapists are not required to keep or submit reports to the insurance company, there are no limits to the number of times the client can come for a massage and there are no additional fees. Insurance companies only ask that you give their subscribers a 10 to 20 percent discount, depending on the insurer.

If you stop to think about the value of your time, it would cost more to submit the paperwork each time to the insurer than the amount you have discounted your services.

A third approach that is beneficial to massage therapists has been taken by a national health-care company expressly focusing on complementary and alternative pathways to health. It has a long history of arranging for clinically supported complementary and alternative medicine (CAM) programs within the managed care environment.

What are the benefits of this type of structure?

• You credential once, and become a provider to many insurance companies simultaneously. No credentialing with every insurance company.
• You instantly are listed as a provider in all the affiliated companies’ publications and Web sites.
• Your potential clientele base is increased automatically each time. No marketing cost, just an increased client base.
• They do the statistical research on consumer demands, at no cost to you. This option also asks its providers to discount its services.

Professionalism

On the professional level, it is not responsible, nor is it acceptable, for therapists to build their argument by constantly bashing their opponent. Instead, that time would be more profitably spent investigating the benefits of an alliance with the insurance industry and then deciding, on an individual basis, whether it is profitable for you to join that particular insurance company as its provider. No one should feel pressured to enter the insurance arena, nor should those who desire to join be hindered or constantly demeaned for their views.

At one state meeting, a woman stood up and bashed the insurance industry on false information and what she thought insurance companies would require of massage therapists. She said, “The insurance companies will tell us what we can and cannot do, how we must run our business and how much they will pay us for our services. They should not tell us. We should tell them what we will do and what we expect to be paid.”

That statement is myopic. Massage therapists, along with other professions—doctors, chiropractors, physical therapists, etc.—will never be in a position to dictate to the insurance industry. With that type of arrogance, insurance companies just laugh at us.

If we are to be accepted as professionals, we can’t accept that type of argument, or any argument that is based on innuendo and false information. We must do our homework, research the issues, have an open and honest discussion of the issues and then make up our minds according to what is in our best interest.

My wife is a registered nurse with her bachelor’s degree in Health Care Administration. She has been a nurse for 37 years, and for the past 16 years has worked for several insurance companies. She has had to deal with massage therapists. She has talked to massage therapists and called for their complete medical records. She has come home and asked if these massage therapists are for real. They whine, twist the story, submit false statements, want doctors to fudge their records and come very close to, if not, crossing over the line into fraud. That is not the image massage therapists want to foster.

Insurance companies take fraud very seriously. All background information goes into a national database to which all insurance companies have access. When you apply for insurance, they will research the database to determine if there are any discrepancies or problems in the information you submit.

Statistical Report

According to the 1998 Landmark Report I survey on consumer demand for alternative care, 71 percent indicated a moderate to strong demand for alternative care. According to the 1999 Landmark Report II survey, 74 percent indicated a moderate to strong demand for alternative care. Zero percent believed there will be no demand.

That is good news for massage therapy, because the demand, in the consumer’s view, is increasing. The perceived benefits of massage will encourage more people to try massage therapy.

Your Decision

Massage therapy, on this issue, is at a crossroad. Are you going to continue to listen to those who prefer to whine and complain, or are you going to honestly look into being an insurance provider, do your homework and make an informed decision for yourself?

One thing you must remember is that there are no providers—doctors, chiropractors, physical therapists, massage therapists, etc.—who dictate to the insurance companies what they will pay. Do you dictate the fee and requirements for your massage license? No. What about your driver’s license or your national certification? Of course not. Therefore, you certainly can’t expect to dictate to insurance companies, either.

Beyond just the economic benefits, there are many other benefits to being an insurance provider. Be honest with yourself and look at the possibilities carefully. Take an honest and open look at both sides, and make up your own mind, without being pressured or demeaned into making a particular decision. In my opinion, that is when you begin to be a professional.

Summary

Whether we like it or not, the general public will eventually demand that their insurers cover massage therapy on some basis, and they will seek out those therapists who will take insurance reimbursement or give a reduction in their massage fees.

Research shows that this is what has happened to other health-care services. Massage therapy has yet to feel this pressure because it is still in its infancy. As time goes on, the general public is becoming more aware of the benefits of massage therapy, and are increasingly demanding this service from their health-care insurers. 

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David M. Munsey, B.Sc., M.Sc., M.Ed., is a licensed massage therapist with a practice in Simsbury, Connecticut. An AMTA member, he has worked successfully with insurance companies in recent years. He can be reached via E-mail at: his.covenant@juno.com.